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Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.
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Clinical data and genetic mutation characteristics of a patient with Coffin-Siris syndrome by 6q25.3 deletion were summarized. The child was a 7-year and 6-month old girl who had feeding difficulties, repeated infection, language and motor retardation, low intelligence, laryngeal cartilage dysplasia, thick eyebrows, sparse teeth, hairy back, hyperactivity and aggressive behavior, seizures and ataxia. There was no abnormality in chromosomal karyotype analysis by proband; genomic copy number variant sequencing (CNV-seq) indicated approximately 4.27 Mb heterozygous deletion in chromosome 6q25.3 region, with 17 genes including ARID1B gene, father maternal CNV-seq showing no abnormalities. Trio-whole-exome sequencing showed the proband missed all exons 1-20 of the ARID1B gene, with wild-type parents. The proband had severe clinical symptoms and haplodose insufficiency which was the genetic etiology.
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Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.
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Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.
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The authors took the management practice of " one hospital with multiple districts" in Children′s Hospital Affiliated of Zhengzhou University as the research object, analyzed the main problems and challenges faced by the multi-district hospital management under the new pattern of national regional medical center. Through coordinating the hospital′s strategic planning and the development of discipline layout, building an integrated management system, improving the level of homogeneous service and other key countermeasures, the hospital has significantly improved its management efficiency and operation efficiency, and the medical service capacity of each district has developed in a balanced way. It could give full play to the pilot value for the construction of national regional medical center, hoping to provide reference for hospital administrators.
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Objective:To describe the treatment strategies in children with septic shock in China.Methods:A questionnaire was prepared and 368 pediatric intensivists from the Pediatric Critical Care Physician Branch of Chinese Medical Doctor Association were surveyed about the treatment of pediatric septic shock from April to June 2017.Results:Surveys were received from 87.2%(68/78) institutions and 368 questionnaires (response-rate 45.1%) were included.59.2% and 77.7% of the respondents chose debridement surgery and fluid drainage as source control intervention.Antibiotics were used within 1 hour of shock in 90.8% of respondents.98.4% of respondents chose normal saline, 72.3% of respondents chosen albumin, and 53.8% of respondents chosen plasma for fluid resuscitation.When no venous access was available during shock resuscitation, 57.1% of respondents preferred intraosseous access.79.3% and 83.2% of the respondents used the adjuvant therapy such as glucocorticoids and intravenous immunoglobulin.96.7%, 85.3% and 22.0% of respondents were likely to provide oxygen and mechanical ventilation, continuous renal replacement, and extracorporeal membrane oxygenation as organ support, respectively.Additionally, 322 (88.7%), 188 (51.1%), and 85 (23.1%) respondents chose the "best advice" options to simulated clinical cases of fluid resuscitation, inotropic agents, and vasoactive agents, respectively.In the simulated cases of vasoactive drugs and inotropic drugs, 69.3% and 24.2% of the respondents chose fluid resuscitation strategy, respectively.In cases of fluid resuscitation, 49.7% (183/368) of respondents reported performing fluid responsiveness and volume status assessment, and instruments used in the assessment included bedside echocardiography[39.4% (145/368)], bioreactance[10.3% (38/368)], transpulmonary thermodilution devices[6.3% (23/368)]. Pediatricians who received advanced life support courses for children ( P=0.006) and intensive care specialist training center training ( P=0.002) were more likely to choose the " best recommendation" option than those who did not attend the training. Conclusion:The current status of pediatric septic shock treatment strategies in China are active source control intervention, antibiotic use and organs support, and increased awareness of non-invasive hemodynamic monitoring.However, there may be excessive fluid infusion and inappropriate use of plasma, glucocorticoids and intravenous immunoglobulin.Different training and continuing education may improve rational treatment strategies.
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Rapid diagnosis is an important link in the prevention and control of infectious diseases.Point-of-care testing(POCT)is portable, fast, easy to operate, intelligent and sensitive, which has been widely used in the detection of pathogenic microorganisms of infectious diseases, host biomarkers, microbial drug sensitivity in recent years.It is of great significance for the monitoring and management of disease epidemiology and rational use of antibiotics.This review summarized the application of POCT in the diagnosis and treatment of pediatric infectious diseases.
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Sleep disruption is prevalent in patients of pediatric intensive care unit(PICU). A variety of factors can cause sleep disruption in critical children, which may have an impact on disease recovery and long-term prognosis.Currently, there is still no systematic study on sleep disruption in critical children, and the available evaluation tools on sleep in PICU are limited.The diversified sleep management programs may be effective in promoting sleep.
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Objective:To investigate the clinical manifestation, genetic characteristics, treatment and prognosis of Crouzon-like syndrome.Methods:Clinical data of one case of Crouzon-like syndrome diagnosed in Children′s Hospital Affiliated to Zhengzhou University in May 2019 were collected, including clinical test, treatment plan, follow-up outcomes. The clinical characteristics and the mutation characteristics of IL11RA-related Crouzon-like syndrome were analyzed combined with the literature.Results:The male proband, five years and four months old, was admitted with the main clinical manifestations including headache, vomiting, exophthalmos, ocular hypertelorism, nasal root flat and scaphocephaly. CT showed that the cerebellar tonsil moved down slightly, the occipital magnum was full, the bilateral cranial plates were locally thinner, the bilateral cranial diameters were increased, and the cranial seams were closed. Magnetic resonance imaging showed ChiariⅠmalformation. The mutation c.40_63del and splice site mutation c.811-2A>G of the patient′s IL11RA gene were screened by whole exome sequencing. Sanger sequencing showed that the mutations are compound heterozygous and both are first reported. The mutation c.811-2A>G was derived from the patient′s mother, and the other one is de novo.Conclusions:The main clinical manifestations of Crouzon-like syndrome are craniosynostosis and midface hypoplasia and ocular deformity. The study identified two novel mutations in the Crouzon-like syndrome related IL11RA gene. Genetic sequencing is helpful for accurate diagnosis and timely surgical treatment.
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Intracranial hypertension crisis is a critical condition of intracranial hypertension in children.It often occurs in acute intracranial hypertension and is a precursor to cerebral hernia.It needs to be identified and treated urgently.The treatment and prognosis of acute intracranial hypertension and intracranial hypertension crisis are important to the long-term development of children.In this review, we reviewed the etiology, pathogenesis, early identification, monitoring and intervention of acute intracranial hypertension/intracranial hypertension crisis, hoping to be helpful to clinicians.
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Sleep disruption is prevalent in patients of pediatric intensive care unit(PICU). A variety of factors can cause sleep disruption in critical children, which may have an impact on disease recovery and long-term prognosis.Currently, there is still no systematic study on sleep disruption in critical children, and the available evaluation tools on sleep in PICU are limited.The diversified sleep management programs may be effective in promoting sleep.
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A case with mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency(HMGCSD)was related and foreign and domestic reported cases were reviewed.The female proband was 7 months and 16 days old, and admitted to the hospital due to acute onset of " fever for 4 days, wheezing for 3 hours, dyspnea and moaning for 2 hours" . She was mainly manifested as encephalopathy, hepatomegaly, liver function damage, low ketone hypoglycemia, and hyperlipidemia.She died of respiratory and circulatory failure on the third day of hospitalization.Two compound he-terozygous variants in HMGCS2 gene were found by total exome sequencing, namely, c.1061+ 1 G> C and c. 476 G> T. HMGCSD could be diagnosed by gene detection in combination with clinical features of the patient. Thirteen literatures related to HMGCSD were collected, including 26 patients in total, with the age of onset ranging from 3 months to 6 years. The main cause of the disease was insufficient intake, mainly manifested as hypoglycemia accompanied by low ketone, hepatomegaly, liver damage, etc. A high level of urinary 4- hydroxy-6- methyl-2- pyrone might be a strong indicator of HMGCSD. Three died during the acute attack. Up to now, there were 32 mutations in HMGCS2 reported in 26 patients, and the main type was missense mutation. In this article, the second case of HMGCSD in China was identified, and 2 novel variants of HMGCS2 were found, which extended the clinical phenotype and mutation spectrum of HMGCSD.
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Objective:To understand the early clinical characteristics and drug sensitivity results of children died of invasive pneumococcal disease (IPD) in Pediatric Intensive Care Unit (PICU) so as to guide the early clinical identification and treatment.Methods:The early clinical data and drug sensitivity result of children died of IPD in PICU of the Children′s Hospital, Zhengzhou University and Beijing Children′s Hospital, Capital Medical University from May 2015 to May 2019 were retrospectively analyzed.Results:A total of 18 children meeting the criteria were enrolled, including 6 males and 12 females.The median age was 1 year and 9 months (ranged from 2 months and 20 days to 6 years and 7 months), there were 2 cases(11.1%) > 5 years old, and 16 cases(88.9%)≤ 5 years old.There were 17(94.4%) children related to community acquired infection.Among 18 cases, the first symptom was intracranial infection in 10 cases (55.6%), bloodstream infection in 4 cases (22.2%), and pulmonary infection in 3 cases (16.7%). There were 5 cases complicated with virus infection at the same time.Auxiliary examination: all of the 18 cases had anemia and hypoalbuminemia, and 15 cases(93.8%) had HCO 3- reduction.White blood cells(WBC), platelets(PLT) and natural killer (NK) cell decreased in 7 cases (7/18 cases), 12 cases (12/18 cases) and 6 cases (5/16 cases), respectively, but C-reactive protein(CRP), procalcitonin (PCT), lactic acid concentration(LAC), D-dimer (D-Di), international normalized ratio (INR) and B-type natriuretic peptide (BNP) were increased in 12 cases (12/18 cases), 14 cases (14/18 cases), 7 cases (7/17 cases), 14 cases (14/17 cases) and 9 cases (9/9 cases), respectively.Six children(33.3%) did not receive the treatment of sensitive antibiotics before admission.According to the drug sensitivity results: all the 18 strains had multiple-drug resistance(MDR), and the resistance rates of Penicillin, Erythromycin, Tetracycline, Clindamycin and Sulfamethoxazole were 22.2%, 100.0%, 100.0%, 100.0% and 94.4%, respectively, all the strains were sensitive to Vancomycin, Linezolid and Levofloxacin. Conclusions:Most of the children died of IPD in PICU are of community-acquired infection and less than 5 years old.Anemia and hypoalbuminemia are common in the dead children.The decreased in HCO 3- and increased PCT, LAC and D-Di in the early stage might be related to poor prognosis of patients.Most of the children died of IPD are infected with MDR strains.
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Objective:To investigate the clinical characteristics and prognosis of children with septic shock caused by invasive pneumococcal diseases (IPDs) in pediatric intensive care unit (PICU).Methods:The clinical data of children diagnosed as septic shock caused by IPDs and hospitalized in the intensive care unit (ICU) of Beijing Children′s Hospital, Capital Medical University and the PICU of Henan Children′s Hospital from January 2013 to August 2019 were retrospectively collected, and the clinical characteristics and prognosis of these patients were analyzed.Results:Twenty-one children were included, with a median age of 1.2 (0.75, 3.90) years old.The pediatric index of mortality 2 (PIM-2) at admitting was (23.3±29.6)%, and 6 cases had underlying diseases.Main sites of infection included blood flow (20 cases) and suppurative meningitis (15 cases). The drug sensitivity test was performed on 18 children, among who 9 cases were sensitive to Penicillin, 10 cases to Cefepime, 11 cases to Cefotaxime and 10 cases to Meropenem.All 18 patients were sensitive to Vancomycin and Linezolid.Seven cases and 13 cases were treated with sensitive antibiotics at the disease onset and before septic shock, respectively.In 21 cases whose lactic acid level was (6.1±4.6) mmol/L, the shock redress time of 10 cases was (10.9±10.1)h, and 13 cases (61.9%) died (14.6±12.2) hours after septic shock, among who 10 died of transforamed magna herniation.The PIM-2 score at admitting into PICU and the rate of intracranial hypertension crisis in the death group were significantly higher than those in the survival group [(37.1±30.3)% vs.(0.9±1.3)%, 69.9% (9/13 cases) vs.25.0% (2/8 cases)](all P<0.05). There was no significant difference in age and the utilization rate of effective antibiotics before septic shock between the two groups (all P<0.05). Four of the surviving 8 children had severe cerebral functional disability. Conclusions:Septic shock caused by IPD is more common in children under 5 years old, and the most common sites are blood flow and intracranial infection.It has high resistance rate against Cephalosporins and Carbopenem.Patients with purulent meningitis are easy to develop intracranial hypertension crisis, which has an extremely high mortality and morbidity, so it needs to be identified and treated early.
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Sepsis-associated encephalopathy (SAE) is a common complication of sepsis.Not only the cognitive impairment which may develop in the future can reduce the quality of life, but also there is a high mortality in patients with this complication.There is no clear pathogenesis characterized and no specific therapy developed up to date.The synthetic treatment for sepsis is the most commonly used therapy.However, the treatment for encephalopathy is still under research.Therapy that can reduce inflammation caused by SAE, protect the blood-brain barrier, inhibit neurotransmitter abnormality, and restrain other key pathophysiology injuries should be developed in the future to prevent the permanent brain functional damage caused by SAE in patients.
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We present a case of severe COVID-19 in a male newborn. A 22-day infant was transferred to Children's Hospital Affiliated to Zhengzhou University due to "intermittent fever for 18 days". The parents of the infant had been living in Wuhan and returned to Xinyang 9 days before delivery. Suspecting COVID-19 infection, a cesarean section was performed at 38 gestational weeks. The diagnosis of COVID-19 in the mother was confirmed at 2 days postpartum, as well as the father and the grandparents-in-law within 5 days postpartum. The baby developed fever and cough 5 days after birth, and a positive result for the new coronavirus nucleic acid test in the pharyngeal swab was shown 6 days after birth. The fever continued intermittently for 18 days, whilst nasal catheter oxygen inhalation treatment was administered. The percutaneous oxygen saturation decreased to 79% after cessation of oxygen, and the baby was transferred to the hospital for further treatment. After admission, the infant presented with cough, occasional choke, shortness of breath despite nasal catheter oxygen inhalation, increased heart rate, low urine volume, and an enlarged liver 2 cm below the right costal margin. The baby was diagnosed with severe COVID-19 accompanied by anemia, hyperkalemia, pneumonia, and atrial septal defect seen on the echocardiogram. After isolation in an incubator, oxygen inhalation, cardiotonic intervention, blood transfusion and antiviral treatment, the patient made a good recovery, with good breastfeeding, significant resorption of the lung inflammation and no fever or respiratory symptoms. The baby was discharged 14 days after hospitalization, with negative results for nucleic acid test of pharyngeal swab for 2 consecutive times.
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Objective@#To investigate the value of abnormal expression of HLA-DR on peripheral blood monocytes in evaluating the immune function status, clinical prognosis and severity of patients with hand, foot and mouth disease (HFMD).@*Methods@#From June 2017 to October 2018, 100 cases of mild HFMD, 80 cases of severe HFMD, 32 cases of critical HFMD and 40 healthy children (control group) were recruited in this study. The patients were divided into two groups, lower DR group (DR-L, HLA-DR expression<30%) and normal DR group (DR-N, HLA-DR expression>30%) according to the HLA-DR expression on monocytes. Flow cytometry was used to detect the CD14+ monocytes expressing HLA-DR and the absolute count of lymphocyte subsets. Immunoturbidimetry was used to detect the levels of IgG, IgM and IgA in plasma samples. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IFN-γ and IL-10 in plasma samples. Pediatric critical illness score (PCIS) and the pediatric risk of mortality Ⅲ (PRISM Ⅲ) were used to estimate the severity of HFMD.@*Results@#① There were significant differences in HLA-DR expression on monocytes among children with mild, severe and critical HFMD (F=47.102, P<0.05). Patients with critical HFMD had the lowest HLA-DR expression (P<0.05). ② The numbers of CD14+ monocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells and NK cells in peripheral blood of the DR-L group were significantly lower than those of the DR-N group and the normal group, especially in patients with severe or critical HFMD (P<0.05). ③ There was no significant difference in the level of IgG, IgA or IgM among the DR-L, DR-N and control groups (P>0.05). ④ Compared with the DR-N group, the DR-L group showed decreased IFN-γ level and increased IL-10 level in plasma (P<0.05). The ratio of IFN-γ/IL-10 of the DR-L group was lower than that of the DR-N group and control group (P<0.05). HLA-DR expression was negatively correlated with the concentration of IL-10 in plasma (r=-0.704, P<0.05), and positively correlated with the IFN-γ/IL-10 ratio (r=0.773, P<0.05). ⑤ Compared with the DR-N group, the DR-L group showed lower PCIS and higher PRISM Ⅲ. HLA-DR expression was positively correlated with PCIS (r=0.715, P=0.00) and negatively correlated with PRISM Ⅲ (r=-0.610, P=0.00). ⑥ The incidence of pulmonary edema, pulmonary hemorrhage and cardiopulmonary failure and the mortality of HFMD patients in the DR-L group were significantly higher than those in the DR-N group (P<0.05).@*Conclusions@#Patients with severe or critical HFMD had cellular immune dysfunction and abnormal HLA-DR expression on CD14+ monocytes. Assessing the expression of HLA-DR on monocytes could be used to evaluate the cellular immunity of patients with severe or critical HFMD. Lower expression of HLA-DR on CD14+ monocytes might be associated with severe HFMD and poor prognosis.
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Objective To investigate the value of abnormal expression of HLA-DR on peripheral blood monocytes in evaluating the immune function status, clinical prognosis and severity of patients with hand, foot and mouth disease (HFMD). Methods From June 2017 to October 2018, 100 cases of mild HFMD, 80 cases of severe HFMD, 32 cases of critical HFMD and 40 healthy children (control group) were recruited in this study. The patients were divided into two groups, lower DR group (DR-L, HLA-DR expres-sion<30％ ) and normal DR group (DR-N,HLA-DR expression>30％ ) according to the HLA-DR expression on monocytes. Flow cytometry was used to detect the CD14+ monocytes expressing HLA-DR and the absolute count of lymphocyte subsets. Immunoturbidimetry was used to detect the levels of IgG, IgM and IgA in plas-ma samples. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IFN-γ and IL-10 in plasma samples. Pediatric critical illness score ( PCIS) and the pediatric risk of mortality Ⅲ(PRISM Ⅲ) were used to estimate the severity of HFMD. Results ① There were significant differences in HLA-DR expression on monocytes among children with mild, severe and critical HFMD (F = 47. 102, P<0. 05). Patients with critical HFMD had the lowest HLA-DR expression (P<0. 05). ② The numbers of CD14+ monocytes, CD3+T cells, CD4+T cells, CD8+T cells, B cells and NK cells in peripheral blood of the DR-L group were significantly lower than those of the DR-N group and the normal group, especially in pa-tients with severe or critical HFMD (P<0. 05). ③ There was no significant difference in the level of IgG, IgA or IgM among the DR-L, DR-N and control groups (P>0. 05). ④ Compared with the DR-N group, the DR-L group showed decreased IFN-γ level and increased IL-10 level in plasma (P<0. 05). The ratio of IFN-γ/ IL-10 of the DR-L group was lower than that of the DR-N group and control group (P<0. 05). HLA-DR expression was negatively correlated with the concentration of IL-10 in plasma (r= -0. 704, P<0. 05), and positively correlated with the IFN-γ/ IL-10 ratio (r = 0. 773, P<0. 05). ⑤ Compared with the DR-N group, the DR-L group showed lower PCIS and higher PRISM Ⅲ. HLA-DR expression was positively corre-lated with PCIS (r=0. 715, P=0. 00) and negatively correlated with PRISM Ⅲ (r = -0. 610, P = 0. 00).⑥ The incidence of pulmonary edema, pulmonary hemorrhage and cardiopulmonary failure and the mortality of HFMD patients in the DR-L group were significantly higher than those in the DR-N group (P<0. 05).Conclusions Patients with severe or critical HFMD had cellular immune dysfunction and abnormal HLA-DR expression on CD14+ monocytes. Assessing the expression of HLA-DR on monocytes could be used to evaluate the cellular immunity of patients with severe or critical HFMD. Lower expression of HLA-DR on CD14+ monocytes might be associated with severe HFMD and poor prognosis.
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Objective To explore the protective effect of magnesium sulfate on the nerve injury in severe hand, foot and mouth disease ( HFMD) caused by enterovirus A71 ( EV-A71) and to investigate its clinical and prognostic effects.Methods A total of 240 cases of severe HFMD with EV-A71 infection and nerve injury were enrolled.According to the random number table method, the patients were randomly divided into conventional treatment group (control group) and magnesium sulfate treatment group ( treatment group), with 120 cases in each group.The control group was given the routine treatment, and the treatment group was given the magnesium sulfate adjuvant treatment on the basis of routine treatment.The neurological symptoms and signs, clinical efficacy and prognosis were observed before and after treatment in the two groups.The blood and cerebrospinal fluid neuron-specific enolase ( NSE), S100-βprotein and neuropeptide Y ( NPY) were analyzed before and after treatment.The amplitude integrated electroencephalogram (aEEG) was used to monitor the abnormal recovery of EEG.The t-test was applied to analyze quantitative data, and the chi-square test was used for qualitative data comparison.Results Among children with severe HFMD, there were 83 cured cases, 29 improved cases and 8 ineffective cases in control group, with the total effective rate of 93.3%; while in the treatment group, 101 cases were cured, 18 cases were improved and 1 case was ineffective, the total effective rate was 99.2%.The therapeutic effects (Z＝2.918, P＝0.004) and the total effective rate ( χ2 ＝4.156, P＝0.041) were statistically significantly different between the two groups.Three days after treatment, the average levels of serum NSE, S100-βprotein and NPY in magnesium sulfate treatment group were significantly lower than those in control group (t＝-7.239,-10.020 and -11.053, respectively, all P＜0.01).Five days after treatment, the average levels of cerebrospinal fluid NSE, S100-β protein and NPY in magnesium sulfate treatment group were significantly lower than those in control group ( t＝-6.546,-13.308 and -10.258, respectively , all P＜0.01).After treatment, the neurological function score in treatment group was significantly lower than that in control group and that before treatment , and the differences were statistically significant ( t ＝-9.473 and 12.162, respectively, both P ＜0.01 ).The recovery time of the main symptoms and signs in treatment group was ( 2.33 ±0.76 ) d, which was significantly shorter than that of control group ([3.21 ±0.82] d), the difference was statistically significant (t＝-12.52, P＜0.05).The average length of hospital stay in treatment group was (5.79 ±1.42) d, which was shorter than that in control group ([ 6.71 ±1.46 ] d ), and the difference was statistically significant ( t＝-4.932, P＜0.05).Of the 240 children with severe HFMD, 194 (80.8%) patients had abnormal aEEG.Before treatment, the aEEG abnormal rates in control group and the magnesium sulfate treatment group were 79.2%(95 cases) and 82.5%(99 cases), respectively, there was no significant difference ( χ2 ＝0.430, P＞0.05); while after treatment for 3 days, 76 cases in treatment group returned to normal, and the recovery rate of aEEG was 76.8%, which was higher than that in control group (52.6%). The difference was statistically significant ( χ2 ＝12.406, P ＜0.05 ).Conclusions Magnesium sulfate adjuvant therapy can reduce the abnormal levels of NSE, S100-βand NPY in blood and cerebrospinal fluid, relieve clinical symptoms, shorten the course of disease and average length of hospital stay, improve the neurological function score, and promote the recovery of abnormal aEEG.Thus, it has neuroprotective effect on severe HFMD with nervous system lesion.
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Objective To analyze the clinical characteristics in children with digestive tract poison-ing in emergency department and discuss the measures of prevention and treatment. Methods Four hundred and seventy-three cases with digestive tract poisoning who visited the emergency department of Zhengzhou Children′s Hospital were retrospectively analyzed from January 2015 to December 2017. The ages,toxic poi-soning causes,types,clinical features, laboratory examinations, hospitalization expenses and outcomes were analyzed. They were divided into drug poisoning and non-drug poisoning group to compare. Results There were 317 (67. 0%) cases aged 6 days to 3 years old,133 (28. 1%) cases aged 3 to 6 years old,23 cases (4. 9%) >6 years old. The incidence rate was similar in each season but slightly lower in winter. There were 462 (97. 7%) cases of accidental poisoning,of which 377 (79. 7%) cases were mistreated and 85 (18. 0%) cases were mistakenly fed by parents,other 11 (2. 3%) cases were non-accidental poisoning. Three hundreds and thirty-six (71. 0%) cases were drug poisoning,and 137 (29. 0%) cases were non-drug poisoning. Drug poisonings were higher in urban children than in rural children, the difference was statistically significant (χ2 ＝7. 037,P＝0. 008). The percentage of digestive symptoms and blood system symptoms in non-drug poi-soning group were higher than those in drug poisoning group,and the differences were statistically significant (54. 0% vs. 8. 3%,χ2 ＝120. 067,P<0. 001;7. 3% vs. 3. 0%,χ2 ＝4. 491,P ＝0. 034). The percentage of cardiovascular system symptoms and respiratory symptoms in the non-drug poisoning group were lower than that in the drug poisoning group,and the differences were statistically significant (1. 5% vs. 14. 9%, χ2 ＝17. 915,P<0. 001;2. 9% vs. 11. 0%,χ2 ＝8. 050,P＝0. 005). Except for liver function and myocardial en-zyme,the percentage of abnormal laboratory indicators(white blood cells,platelets,blood glucose,lactic acid, electrolyte,coagulation) in non-drug poisoning group were higher than those in the drug poisoning group,and the differences were all statistically significant(all P<0. 05). The hospitalization cost of the non-drug poison-ing group was greater than that of the drug poisoning group,and the difference was statistically significant (Z＝ －12. 444,P<0. 001). Both in the drug-poisoning group and non-drug poisoning group,the cure or im-provement rate of the <6 h treating group were higher than that of the >6h treating group,and the difference was all statistically significant(all P<0. 05). Conclusion Children with acute gastrointestinal poisoning are mostly infants and preschoolers,mainly accidental poisoning,and often taken by mistake. Drug poisonings are mostly found in cities and non-drug poisonings in rural areas. Non-drug poisoning children have more serious damages and higher hospitalization costs than drug poisoning children. Early treatment after poisoning is an important factor to improve cure rate.