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06 September 2016, Volume 31 Issue 9 Previous Issue    Next Issue

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Focusing on standardized application of parenteral nutrition in critically ill children JIA Xin-lei，QIAN Su-yun 2016, 31(9): 641-644.  DOI: 10.7504/ek2016090601 Abstract ( )   Parenteral nutrition has become a mainstay in the treatment of critically ill children with intestinal or conditions that preclude enteral feeding. Accurate assessment of nutritional status and energy requirements in critically ill children will help to better implement the strategy of parenteral nutrition. The timing of the optimal parenteral nutrition has not been determined，and at present the supplementary parenteral nutrition tends to be started at a later stage. “All in one” is recommended for parenteral nutrition. Pharmacological nutrients have been recommended in critically ill adult patients with different levels，but more extensive research is still needed in critically ill children.

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Paying attention to the transport of children in emergent and severe condition ZHU Yi-min 2016, 31(9): 645-648.  DOI: 10.7504/ek2016090602 Abstract ( )   The importance of transport of critically ill children is being increasingly recognized. To assure the children receive the most efficient way of transport and best level of nursing，it is nessesary to make sure the safe and standardized transport. This article reviews the development of domestic and international transport of children，put forward the principle of inter-hospital transport，focused on the optimum composition of the best transport system，which requires the appropriate specialty team，the best way and program. Finally，this article introduces the referral to evaluation and judgment the children，suggest it crucial to avoid adverse events.

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Timing of parenteral nutrition in critically ill children REN Xiao-xu 2016, 31(9): 649-652.  DOI: 10.7504/ek2016090603 Abstract ( )   The total parenteral nutrition（TPN） or supplemental PN（SPN） are necessary and safe for patients with contraindications of enteral nutrition（EN） or patients with EN failing to reach caloric targets. But the PN start time is  controversial and  the related research findings  are conflicting. In terms of current research，in low-risk patients PN can be delayed for 7 days. In high-risk patients the PN starting 3 days after admissicn is reasonable. At the same time，daily nutritional assessment and metabolic status monitoring are important.

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Access of parenteral nutrition and management in critically ill children TANG Qing-ya，WU Qing-qing 2016, 31(9): 652-655.  DOI: 10.7504/ek2016090604 Abstract ( )   The incidence of malnutrition in critically ill children is always high，and parenteral nutrition（PN） support is one of the important way to improve infants’nutrition status. The proper venous access and management is the fundamental assurance to infusion of PN. Properly venous access should be selected according to the concentration，osmotic pressure，pH and duration of parenteral nutrition. Venous accesses consist of peripheral venous access and central venous accesses，and central venous accesses consist of percutaneously inserted central catheter access， peripherally inserted central catheter access and port. It will reduce complications effectively to choose suitable venous access，handle and manage inserted catheter well.

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Mornitoring of parenteral nutrition and management of complication WANG Li-jie，LIU Chun-feng 2016, 31(9): 655-661.  DOI: 10.7504/ek2016090605 Abstract ( )   Parenteral nutrition (PN) is an essential and often life-saving treatment for infants and children who cannot be adequately fed orally or enterally, to prevent or correct malnutrition, and to sustain appropriate growth. PN is more costly and can induce severe complications than oral nutrition or EN. The complications is reduced by a meticulous mornitoring, establishment of a multidisciplinary nutrition support team, avoidance of unbalanced or excessive substrate supplies, strict hygiene measures to reduce catheter infections, and forceful enhancement of enteral feeding where possible to limit the amount and duration of PN.

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Relationship between the sufficiency of calories and protein supply and the prognosis in critically ill children ZHANG Chen-mei，YE Sheng 2016, 31(9): 661-664.  DOI: 10.7504/ek2016090606 Abstract ( )   The critically ill children often present nutritional and metabolic disorders，and have severe illness，which often leads to further deterioration of children’s nutritional status， affecting the prognosis of the disease. The critically ill children have different nutritional status and have less muscle fat reserves，so they need to be given adequate calories and protein.But recent studies have found that the energy required for critically ill children under stress is not large，so how to choose the right calories and protein supply is our current concern which is worth exploring.

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Characteristics and clinical application of lipid emulsion LI Yu-mei，ZHANG Zhen 2016, 31(9): 664-666.  DOI: 10.7504/ek2016090607 Abstract ( )   Lipid emulsion is an important part of parenteral nutrition support，which is considered as a source of calories and essential fatty acids. Lipid emulsion can keep cell structure and function and affect immunity function. Lipid emulsion plays an important role in the nutritional support of the critically ill children. During almost fifty years of progress since its creation，lipid emulsion has formed a series of preparations of different prescription. Different metabolic characteristics of the lipid emulsion metabolism are the basis of different uses of various lipid emulsions in clinical application.

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Improving neonatal transfer KONG Xiang-yong，FENG Zhi-chun 2016, 31(9): 667-669.  DOI: 10.7504/ek2016090608 Abstract ( )   Services for neonatal transfer in China have evolved in a largely unplanned and unstandard fashion. Neonatal intensive care units of different sizes provide various amounts of intensive care，and，with a few exceptions，there is little formal regional neonatal transport network system. To be successful and adverse incidents to be minimised，to improve and optimise neonatal transfer arrangements in many regions in China will be required. Regionalisation of neonatal intensive care presents a major opportunity to establish safe, efficient transfer networks.

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Regional transport network and its role in critically ill children FU Dan，HE Yan-xia 2016, 31(9): 669-673.  DOI: 10.7504/ek2016090609 Abstract ( )   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.

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Intra-hospital  transport  of  critically  ill  children HUANG Li，JIN Rong 2016, 31(9): 673-677.  DOI: 10.7504/ek2016090610 Abstract ( )   Intra-hospital transport（IHT） is an inevitable and important part of intensive care unit（ICU） treatment. IHT is frequently required in order to perform diagnostic or therapeutic procedures for critically ill children. The incidence of adverse events（AEs）during IHT of critically ill children is very high. The decision to transport a critically ill child is based on an assessment of the potential benefits and risks. Specialized training， perfect clinical evaluation，appropriate equipment，use of checklist and monitoring during transport may decrease adverse events and increase safety in IHT.

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Rescue strategy and transfer of pediatric public health events MIAO Hui-jie，ZHANG Yu-cai 2016, 31(9): 677-680.  DOI: 10.7504/ek2016090611 Abstract ( )   The management of pediatric public health events should include whole-decision，organization，transport critically ill associated event，and resolving emergency events. The most important strategy is rescue therapy on site of accident and transfer the severe cases to specialized hospital. It’s also a comprehensive emergency ability test for doctors and nurses. In recent years，the transport ability of pediatric public health events is developed well，and the pediatric intensive care unit commonly established，critically ill children can be rescue timely and effectively. In order to deal with public health events occurred in children. Medical personnel training and policy specification is needed.

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Application of findings of lung ultrasonography examinations in Pediatric Intensive Care Unit CHEN Shui-wen，XU Xuan，LIU Jing 2016, 31(9): 681-685.  DOI: 10.7504/ek2016090612 Abstract ( )   Objective    To study the features of lung ultrasonography（LUS） in lung diseases and evaluate the value of LUS in pediatric intensive care unit（PICU）. Methods    Totally 137 children hospitalized from May 1，2015 to August 31，2015，in pediatric intensive care unit of Bayi Children’s Hospital， General Hospital of Beijing Military Command， were included in this study. All the children were examined by LUS and diagnosed by medical history， clinical manifestation， laboratory examination， signs of X-ray or chest CT. The results of LUS were compared with them. Results    There were 89 cases（66.7%） who were lung diseases and 48 cases（33.3%） without lung diseases. The cases with lung diseases were as follows： 76 cases（85.4%） with pneumonia， 8 cases（9.0%） with  capillary bronchitis and 5 cases（5.6%） with acute respiratory distress syndrome（ARDS）. The main characteristics of children with lung diseases on LUS were as follows： A-lines disappearance， pleural line abnormalities， lung consolidation， interstitial syndrome， lung pulse and pulmonary edema. The signs of pleural line， A-lines， lung consolidation， interstitial syndrome， pulmonary edema and lung pulse could be used to monitor the conditions of children with lung diseases. Futhermore， compared with by X-ray， it was much easier to find the lesions of patients by LUS who failed to be withdrawn ventilator. The features of LUS in children with no lung diseases included pleural line and A-lines，but did not include abonormal signs of B-lines， interstitial syndrome and lung consolidation. Conclusion    The diagnosis of LUS is precise in lung diseases. LUS has more practical value， especially for patients with condition waving， and those with withdrawing of mechanical ventilation. Moreover， LUS has more advantages， including no radiation and monitoring the diseases on bed without interfering the treatment. Therefore， it is necessary that LUS should be routinely used in PICU.

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Relationship between gene polymorphism of CCL2-2518 and severity of enterovirus 71 infection JIA Wen-fang，LIU Pei-pei，HU Jing-fei，LI Fei，Lü Hua，ZHEN Yuan-yuan，SONG Long，CHEN Zong-bo 2016, 31(9): 686-689.  DOI: 10.7504/ek2016090613 Abstract ( )   Objective    To investigate the relationship between CCL2-2518A/G gene polymorphism and severity of enterovirus 71（EV71） infection. Methods    CCL2 gene polymorphism in 188 EV71-infected patients and 235 healthy controls were detected by the improved multiplex ligation detection reaction technique（iMLDR）. The level of CCL2 in two groups was determined by enzyme-linked immunosorbent assay（ELISA）. Results    No significant differences were found in the distribution of genotype CCL2-2518A/G between EV71-infected patients and the healthy control group（P＞0.05）. The G allele（genotypes AG or GG） in the CCL2-2518A/G（P＜0.001） was more frequent in patients with severe EV71 infection. The level of CCL2 in infected patients was higher than that of the heathy controls （P＜0.05）； the severe cases had higher level of CCL2 than that of the slight cases and healthy controls（P＜0.05）. The level of CCL2 in GG gene group was significantly higher than that in AG gene group and the level of CCL2 in AG gene group was significantly higher than that in AA gene group.The people with CCL2-2518G allele（GG+AG） had higher level of CCL2 than those only with CCL2-2518A allele（AA）（P＜0.05）. Conclusion    The G carrier of the CCL2-2518A/G is found to be associated with severity of EV71 infection，and could be susceptibility factors in the development of EV71 infection.

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Clinical observation on aerosol inhalation of recombinant human interferon alpha 2b in treatment of bronchiolitis ZHANG Xue-li，HUANG Ying，ZHAO Yan，HUANG Xia，WANG Jian，XU Xiao-Wen，HE Shan，LUO Rong 2016, 31(9): 690-693.  DOI: 10.7504/ek2016090614 Abstract ( )   Objective    To observe the efficacy of aerosol inhalation of recombinant human interferon alpha 2b in treatment of bronchiolitis and its effects on the pulmonary function restoration and recurrent wheezing. Methods    A total of 100 outpatient infants diagnosed with bronchiolitis between January 2015 and April 2015 （74 males，26 females）were divided into 2 groups，61 cases in group A and 39 cases in group B. In addition to  the conventional therapy，group A had aerosol inhalation of recombinant human interferon alpha 2b for 5-7 days. Group B，as the control group，only had the conventional therapy. Then the curative effect after 7 days of treatment，time for clinical symptoms and signs to disappear，the tidal breathing pulmonary function about 2 months later and the incidence of recurrent wheezing of both group 6 months later were compared. Results    The curative effect，time for clinical symptoms and signs to disappear and tidal breathing pulmonary function （TPTEF/TE，VPEF/VE） of group A were significantly improved when compared with group B （P＜0.05），but the incidence of recurrent wheezing between group A and B had no significant difference（P＞0.05）. Conclusion    Aerosol inhalation of recombinant human interferon alpha 2b in treatment of bronchiolitis has good curative effect. This treatment can help clinical symptoms and signs to disappear early，help the early restoration of small airway obstruction，and mildly reduce the rate of  recurrent wheezing.

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Analysis  of the relationship between plasma levels of D-dimer and the severity of mycoplasma pneumoniae pneumonia GU Hai-yan，WANG Quan，ZHAO De-yu 2016, 31(9): 694-697.  DOI: 10.7504/ek2016090615 Abstract ( )   Objective    To investigate the significance of D-dimer in the clinical evaluation of children with mycoplasma pneumoniae pneumonia（MPP）. Methods    Retrospective analysis of clinical data of 165 cases of MPP hospitalized children from January 2015 to June 2015 was made，and the relationship of plasma D-dimer level with clinical manifestation，imaging features and inflammatory markers in children with MPP was studied. Results    1.Among 165 cases of MPP children，95 cases were severe，while 70 cases were mild. The level of D-dimer in the severe cases was higher than that in the mild，the difference being statistically significant（P＜0.01）. 2.D-dimer levels of the cases who had the image feature of lung patchy shadow（95 cases），pleural effusion（68 cases），and atelectasis（35 cases） were obviously higher than those who had not （P＜0.01，respectively）. 3.The plasma D-dimer level in cases with extrapulmonary complications（27 cases） was higher than that in cases without extrapulmonary complications，and the difference was statistically significant（P＜0.01）. 4.Positive correlation was found between level of D-dimer and fever procedure，white blood counts（WBC），neutrophile granulecyte ratio（N%），C-reactive protein（CRP），as well as erythrocyte sedimentation rate（ESR） （all P＜0.01）. Conclusion    The level of D-dimer in MPP patients can reflect the severity of the disease. Detection of D-dimer levels is helpful to evaluate the condition of MPP，which has important clinical significance.

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Expression and clinical significance of UBE2C in neuroblastoma MA Xiao*，YUAN Xiao-jun，WANG Li-feng，GU Long-jun 2016, 31(9): 698-701.  DOI: 10.7504/ek2016090616 Abstract ( )   Objective    To detect the expression of UBE2C in neuroblastoma（NB） tissue and analyze its association with the clinical features of NB patients. Methods    Paraffin-embedded surgical tissue specimens from 51 NB patients kept by the Department of Pathology， Xinhua Hospital，from January 2012 to January 2015，were collected. The expression of UBE2C protein was detected by immunohistochemistry，and the clinicopathological characteristics of these patients were analyzed retrospectively. The survival curve was established with Kaplan-Merier analysis. Results    Of 51 cases of NB， the male-to-female ratio was 1.8∶1. The median age at diagnosis was 36 months（ranging 3.3-156 months） and median duration of follow-up was 25.6 months（ranging 5.5-42.7 months）. The results of immunohistochemistry showed that the UBE2C protein positive expression rate in stage Ⅲ and Ⅳ group （90.0%） was significantly higher than that in stage Ⅰ，Ⅱ and Ⅳs group （47.6%）（P＜0.001） ； the UBE2C protein positive expression rate in recurrence group（91.3%） was also higher than that in the non-recurrence group（57.1%）（P＝0.001）. The survival curve based on Kaplan-Merier analysis revealed that patients with UBE2C positive expression had poor prognosis（P＝0.006）. Conclusion    The expression of UBE2C protein is closely related to the stage and the relapse of NB patients. Positive expression of UBE2C protein implies the poor prognosis for NB. UBE2C may play an important role in the invasion，metastasis and relapse of NB. It might become a new biomarker and potential drug target to NB.

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Analysis of the cerebral blood flow dynamics of vasovagal syncope by transcranial cerebral Doppler WANG Ming，ZHU Lin，DONG Xiang-yu，CHANG Yu-xiao，YANG Yi-nan，NI Qian 2016, 31(9): 702-705.  DOI: 10.7504/ek2016090617 Abstract ( )   Objective    To analyze the cerebral blood flow dynamics of vasovagal syncope（VVS） by transcranial cerebral Doppler（TCD） and explore the clinical value of TCD to VVS. Methods    A total of 38 children with vasovagal syncope and 20 healthy children received head-up tilt test（HUTT）. In the process of test，they were monitored by TCD. Results    Under basic condition，there were no obvious differences between patients and healthy children on the result of TCD. In the process of HUTT for healthy children，there were no obvious differences on the result of TCD. In the process of HUTT for vasovagal syncope children，compared with data of TCD under basic condition，the cerebral blood flow velocity（Vs，Vd，Vm） and pulse index（PI） had great improvement when syncope was induced by HUTT. Conclusion    Patients with vasovagal syncope have obstacles in terms of cerebral blood flow regulation. TCD can become a routine examination method in those children with vasovagal syncope.

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Electrocerebral function monitoring in acute and critically ill children LIAO Jian-xiang 2016, 31(9): 706-711.  DOI: 10.7504/ek2016090618 Abstract ( )

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Research progress in the clinical manifestations of pertussis XU Yong-sheng 2016, 31(9): 712-715.  DOI: 10.7504/ek2016090619 Abstract ( )

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Pulmonary infection as a manifestation of spinal cord type of pilocytic astrocytoma： A report of 1 case LU Lu，ZHU Liu-zhen，WANG Jin-ya，et al 2016, 31(9): 716-718.  DOI: 10.7504/ek2016090620 Abstract ( )

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Zika virus infection in children：A report of 1 case JI Yan-ni，LI Meng-rong，YANG Lian-fang，et al 2016, 31(9): 719-720.  DOI: 10.7504/ek2016090621 Abstract ( )