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06 November 2015, Volume 30 Issue 11 Previous Issue    Next Issue

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Anti-pathogency treatment for severe encephalitis in children LI Hai-bo 2015, 30(11): 801-803.  DOI: 10.7504/ek2015110601 Abstract ( )   Pediatric severe encephalitis is very common critical disease，and is one of important causes of death in PICU. It is a key link to reduce mortality and disability rate to understand the etiology，clinical features，early identification， diagnosis，and timely treatment of the disease. In this paper，the pathogenic characteristics of children with severe encephalitis and the anti-pathogeny treatment for the disease are briefly described.

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Treatment for convulsive status epilepticus in severe encephalitis HU Jia-sheng，LIU Zhi-sheng 2015, 30(11): 803-807.  DOI: 10.7504/ek2015110602 Abstract ( )   Convulsive status epilepticus （CSE） in severe encephalitis is one of the most common medical emergencies in children. Recently， there has been some understanding on the management of convulsive status epilepticus. Not only have the definition and time frame of a seizure changed but many new drugs have been introduced. The aim of this review is to present the current definition of CSE and treatment options it

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Occurrence and management of secondary brain injury in children with severe encephalitis XU Wei，LIU Chun-feng 2015, 30(11): 807-813.  DOI: 10.7504/ek2015110603 Abstract ( )   Severe encephalitis is one of the most common critical diseases in children. Severe inflammatory damage to cerebral cells can lead to children’s death or disability. Low blood pressure，hypoxemia，increased intracranial pressure， hyperglycemia，hypoglycemia，high body temperature，anemia，electrolytic disorders and convulsions probably happen during encephalitis，which might lead to secondary brain injury，deterioration of patients’ situation，which increases mortality and morbidity. It’s very important to identify these factors and prevent secondary brain damage.

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Respiratory and circulatory support therapy for severe viral encephalitis in children REN Xiao-xu 2015, 30(11): 813-816.  DOI: 10.7504/ek2015110604 Abstract ( )   The respiratory and circulatory support treatments are essential to critically ill viral encephalitis and postinfectious encephalitis patients in PICU. This support treatments ensure other therapy measures to give full play and can reduce braindamage and win time for recovery. Respiratory and circulatory dysfunction is common in severe encephalitis patients. Early and proper respiratory and circulatory support treatments can help to bring down the mortality and improve its prognosis.

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Fluid therapy for pediatric critical encephalitis YANG Yi-yu, HAN Ying, LIANG Yu-feng 2015, 30(11): 816-819.  DOI: 10.7504/ek2015110605 Abstract ( )   The fluid therapy for pediatric critical encephalitis is the elementary management related to protection of brain, treatment for brain injury and recovery. The fluid therapy includes the balance of water, sodium and crystalloid, colloid, circulation and so on. The objective is to follow traditional experience, depend on pathology and patho-physiology, and emphasize individualization for pediatric critical encephalitis. This paper reviewed the evidence of patho-physiology of severe encephalitis and principle for management and treatment, and discussed how to avoid secandary brain injury due to iatrogenic disorder from water and electrolyte and circulative fluctuation.

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How to maintain the intracranial pressure and cerebral perfusion pressure of critical encephalitis in children HE Yan-xia 2015, 30(11): 819-825.  DOI: 10.7504/ek2015110606 Abstract ( )   There is paucity of data evaluating and managing ICP in sever encephalitis in children. In this article, we refer to the data extrapolated from results of studies done on brain trauma, meningitis, and so on， combine with basic theory and influence factors of ICP， CPP and CBF， to introduce the methods of evaluating ICP and CPP， prophylaxis and management of raised ICP，and maintaining of CPP in severe encephalitis patients.

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Application of transcranial Doppler ultrasonography to the non-invasive monitoring of intracranial pressure SUN Shi-xin，HE Yan-xia 2015, 30(11): 826-830.  DOI: 10.7504/ek2015110607 Abstract ( )

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Timely vaccine immunization to prevent pneumonia in children LIU Ying，YAO Kai-hu 2015, 30(11): 831-835.  DOI: 10.7504/ek2015110608 Abstract ( )   Pneumonia is still the leading cause of death in children younger than 5 years old worldwide. The infection caused by the virus and / or bacteria which cause pneumonia frequently can be prevented by vaccine immunization. Such pathogens include influenza virus, measles virus, Bordetella pertussis, Haemophilus influenza and Streptococcus pneumoniae. It has been well demonstrated that immunizing children with these vaccines can prevent pneumonia and decrease the following death.

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Sleep pressure score in the evaluation of cognitive function impairment in children with mild obstructive sleep apnea syndrome ZHANG Jing，ZHANG Qing-qing，SUN Ting，JIANG Fan，YIN Yong，CHEN Jie 2015, 30(11): 836-841.  DOI: 10.7504/ek2015110609 Abstract ( )   Objective    To investigate the effect of mild obstructive sleep apnea syndrome（OSAS） on the neurocognitive function of the children and evaluate the potential value of sleep pressure score（SPS） in the diagnosis of the neurocognitive deficits in these children. Methods    Consecutive OSAS children（aged 5～7 years） were recruited from Shanghai Children’s Medical Center as the case group， and non-snoring healthy children as the control group. Both of the 2 groups underwent the overnight polysomnography（PSG） and a comprehensive neuropsychological battery including attention and memory test. The case group was divided into 2 subgroups according to the apnea hypopnea index（AHI）：mild OSAS（AHI 1～5 times per hour） and moderate to severe OSAS （AHI≥5 times per hour）. The sleep architectures and sleep arousal parameters were analyzed and the neurocognitive tests were performed in the three groups. Analyze the SPS as a diagnosis tool of neurocognitive impairment in mild OSAS in children by ROC curve. Results    There were 30 cases recruited into the control group. Mild OSAS group included 33 cases and moderate to severe group 28 cases. In the 3 groups， there was no difference with regard to the age， gender， BMI z score or parents’ education level （P＞0.05）. There was significant difference in AHI， obstructive apnea index （OAI）， nadir SpO2 and respiratory arousal index （RAI）， spontaneous arousal index （SAI）， sleep pressure score （SPS） in the 3 groups. The AHI， OAI， nadir SpO2， RAI and SPS of mild and moderate to severe OSAS group were significantly higher than those in control group. There was no significant difference in retention and the percentage of recall of the immediate memory （P＞0.05）. There was significant difference in cognition-attention index in the 3 groups even in the mild OSAS group， and the moderate to severe OSAS group was the worst. In the ROC analysis， the area under the curve was 0.88 ［95 % confidence interval （CI） = 0.82 to 0.94］ for SPS. The cutoff point of 0.11 for SPS was optimal for diagnosing cognitive-attention deficit in mild OSAS group （sensitivity 71.4%， specificity 74%）. Conclusion    Mild OSAS may be associated with the deficit of attention and SPS could be an effective index to evaluate it in mild OSAS children.

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Nebulized hypertonic saline treatment for bronchiolitis in infants：a Meta-analysis of randomized controlled trials ZHOU Hua，JI Shan-bao，JIANG Yuan-yuan，CHE Da-tian 2015, 30(11): 842-847.  DOI: 10.7504/ek2015110610 Abstract ( )   Objective    To assess the effects of nebulised hypertonic （≥ 3%） saline solution （NHS） in infants with acute viral bronchiolitis. Methods    The PubMed，EMbase，Cochrane Library （Issue 5， 2015）， EMbase， CBM， CNKI， VIP and Wan Fang Data were searched up to January， 2015 to collect randomized controlled trials （RCTs） about the efficacy of NHS in treatment of acute bronchiolitis in infants. Two reviewers independently screened literature according to the inclusion and exclusion criteria， extracted data， and assessed methodological quality of included studies. Meta-analysis was then conducted using Metafor software. Results    A total of 17 RCTs， including 14 relatively high qualities RCT， were finally included. The results of Meta-analysis showed that： compared with control group， NHS group had better outcomes in duration （day） of hospitalization ［MD＝-0.58， 95%CI：-1.14 to -0.02， P＝0.0428］ and the clinical severity score （MD in day 1＝-0.66， 95%CI： -1 to -0.31，P＜0.0001）；  MD in day 2＝-0.8， 95%CI：-1.18 to -0.41， P＜0.0001； MD in day 3＝-0.93， 95%CI：-1.54 to -0.32， P＝0.0002）， all with significant differences. In comparison with control group in the department of emergent setting， NHS group showed the trend of reducing the admission of hospital （RR＝0.75）， but no statistical difference was observed. Conclusion    Nebulized HS treatment can significantly shorten the duration of hospitalization and improve the severity score. Due to the efficacy and cost-effectiveness， HS should be considered for the treatment of acute bronchiolitis in infants during hospitalization.

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Study of single infections and mixed infections by respiratory syncytial virus in children with acute lower respiratory tract disease LIU Jun，LIU Chun-yan，XIE Zheng-de，REN Li-li，XU Bao-ping，WANG Jian-wei，SHEN Kun-ling 2015, 30(11): 848-851.  DOI: 10.7504/ek2015110611 Abstract ( )   Objective    To investigate the clinical relevance of multiple viral infections in children with acute lower respiratory disease. Methods    A total of 1722 children with clinical diagnosis of lower respiratory tract infection （ALRTI） during the period of October 2007 to September 2011 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. （RT） PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus （RSV） ， rhinovirus （RV） ， influenza virus type A and B， parainfluenza virus （PIV） type 1-4， adenovirus ，enterovirus， human coronavirus， human metapneumonia virus and human bocavirus. Results    Totally 206 children had single RSV infection， 124 children had dual infections （RSV co-infected with an additional virus） and 40 children had multiple infections along with a RSV infection. Out of the 124 patients， 68（54.8%） were co-infected with RV， 24 with PIV. There was a statistically significant difference between the dual viral infections group and the RSV-infected group in hospital stay（P＜0.001）. Compared to patients in the single RSV infected group， patients in the multiple viral infection group had significantly more frequency in fever （P＝0.017）， duration of fever longer（P＝0.015）， hospital stay also longer（P＜0.001），and they received more intravenous steroid therapy during hospitalization（P＝0.005）. There was no significant difference in oxygen therapy， respiratory support and use of bronchodilators. Conclusion    Multiple viral infections are linked to more frequency in fever， longer fever days， longer hospital stay， and more frequent use of intravenous steroid therapy during hospitalization. Mixed respiratory virus infection may affect the patient's disease severity and prognosis.

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Monitoring and analysis of influenza in Shanghai Children’s Hospital from 2011 to 2013 BI Wen-jun，FANG Ming-jun，GE Wei 2015, 30(11): 852-854.  DOI: 10.7504/ek2015110612 Abstract ( )   Objective    To strengthen the cognition about the epidemiological characteristics of influenza in children and to provide reference for its prevention and control. Methods    Analyze the data of influenza-like cases in Shanghai Children’s Hospital from 2011 to 2013. Results    A total of 29 524 influenza-like cases were surveyed. The patients who were less than 5 years old occupied the largest proportion （74.40%）. A total of 3168 pharyngeal swabs were collected and 559 influenza viruses were checked out （17.65%）. Totally 232 （41.5%） of these influenza viruses were identified as influenza A （H3N2） virus， 229 （40.97%） as influenza B virus and 98 （17.53%） as novel influenza A （H1N1） virus. The differences of the virus types were statistically significant each year（P＜0.01）. The higher positive detection rates occurred from January to April in 2011 （20.51%~45.89%）， from December 2011 to April 2012 （28.77%~57.65%）， from July to August in 2012 （44.74%～35.14%） and in December 2013（52.29%）. Conclusion    The children with influenza surveyed in 2011—2013 are infected by influenza A （H3N2） virus， influenza B virus and novel influenza A （H1N1） virus. The epidemic strains change every year. The types of influenza viruses are popular alternatively. The influenza is with  high incidence in winter-spring commonly， but can also be popular in summer. Children less than 5 years old are more susceptible to influenza.

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Efficacy study of bronchoscopy lavage treatment for refractory Mycoplasma pneumoniae pneumonia WANG Fei，ZHANG Han，WANG Zhi-jia，DAI Bing，SHANG Yun-xiao 2015, 30(11): 855-858.  DOI: 10.7504/ek2015110613 Abstract ( )   Objective    To analyse the treatment effects of bronchoscopy lavage treatment for RMPP，and to study the proper time to do the operation. Methods    A total of 76 cases，from June to December 2013，were enrolled in the retrospective study. According to the the course of the disease，there were divided into three groups，≤2 weeks，＞2～3 weeks and ＞3 weeks. The febrile period，duration of hospital stay，WBC，N%，L%，CRP，the chest radiography and the bronchoscopic findings were compared with each other. Results    The febrile period：≤2 weeks group it was 13.9±3.8； in ＞2～3 weeks group，14.1±5.0； in ＞3 weeks group，14.1±5.0； they all had significant difference between each other. The chest radiographic changes were divided into complete absorption，partial absorption and no change. Compare the chest radiography at the 7th day after operation， the ratio was 14.3%，5.4% and 0；85.7%，75.8% and 76.0%；0，18.9% and 24.0%. At one month，the ratio was 41.4%，26.3% and 11.3%；42.4%，65.7% and 75.1%；0，7.9% and 13.6%. According to the bronchoscopic findings we analysed，the airway mucosal or bronchial wall’s lesions in RMPP mainly were white mucosa covered，mucosal erosions and roughness. Lumen stenosis，dilator，obliteration and mucosa plug were seen more in the third group. Conclusion    In the treatment of RMPP children，earlier bronchoscopy therapy can help shorten the fever course and promote chest radiography improvement. The mycoplasma infection of long time could cause lumen stenosis，dilator，obliteration and mucosa plug.

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Efficacy of therapeutic plasma exchange in pediatric hemolytic uremic syndrome：single centre experience ZHENG Yue，WU Yu-bin，ZHAO Cheng-guang，DU Yue 2015, 30(11): 859-863.  DOI: 10.7504/ek2015110614 Abstract ( )   Objective    To assess the efficacy of therapeutic plasma exchange（TPE） in pediatric hemolytic uremic syndrome （HUS）. Methods    A retrospective analysis was done in 20 HUS pediatric patients （2～10 years old） who were hospitalized in Pediatric Nephrology Department of Shengjing Hospital over a period of 13 years （2002～2014）.TPE procedures were done after the transfusion of red blood cell and gamma globulin and methylprednisolone pulse therapy，then they were treated with oral glucocorticoid or combined with immunosuppressive treatment sequentially.Pre-and post-procedual symptoms，laboratory profiles and follow-up studies were analyzed to assess the response to TPE therapy. Results    1. 1 TPE procedure was carried out once on eight pediatric patients，twice on eight patients，3 times on two patients and 4 times on two patients； five patients were also performed hemodialysis. All patients were complete responders to TPE procedures. 2.The level of hemoglobin，LDH，creatinine，urea nitrogen and bilirubin were improved significantly（P＜0.05） after treatment. 3.Out of 20 patients，1 was loss of follow-up， the other 19 all survived. During the follow-up of 0.5 to 13 years，17 patients were in normal condition；1 patient was with hypertension，but the renal function was normal； 1 patient had a relapse after 3 years， but got well under the conservative treatment and remained normal during the 10-year follow-up. Conclusion    Therapeutic plasma exchange is effective in the treatment of patients with HUS.

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Observation on the changes of pulmonary function in children with obesity and asthma DONG Wen-fang，ZHANG Lei，WU Yu-fen，LIN Jie，ZHANG Jing，YIN Yong，ZHANG Hao 2015, 30(11): 864-867.  DOI: 10.7504/ek2015110615 Abstract ( )

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Recognition of bronchodilator responses in children WANG Wan，CAO Ling 2015, 30(11): 868-872.  DOI: 10.7504/ek2015110616 Abstract ( )

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One case report on CLCNKB gene deletion mutation in Bartter syndrome HU Si-cui，SUN Qing，WANG Yi-bing，SUN Li-li，CUI Guang-mei 2015, 30(11): 873-875.  DOI: 10.7504/ek2015110617 Abstract ( )

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Report on three cases of bronchopulmonary infection with hypermastigotes in children YANG Qiao-zhi, CUI Ai-hua, FU Ai-xia，LV Xue-yun，ZHOU Kuo，LIANG Jun，WANG Wei，LIU Xi-cheng 2015, 30(11): 876-878.  DOI: 10.7504/ek2015110618 Abstract ( )

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Relapse of plastic bronchitis complicating severe influenza in one child ZHANG Jian-hui, KANG Xiao-lei, TAO Jian-ping 2015, 30(11): 879-880.  DOI: 10.7504/ek2015110619 Abstract ( )