Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit / 中华儿科杂志

Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.

Iron status and effect of early iron supplementation on sub-clinical iron deficiency in rural school-age children from mountainous areas of Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand iron nutritional status in school-age children, incidence of the sub-clinical iron deficiency (SID) and effect of iron supplementation on SID in the rural school-age children from mountainous areas of Beijing.</p><p><b>METHODS</b>The dietary survey and food frequency questionnaire survey were conducted in 1,012 school children aged 7 - 13 at rural mountainous areas of Fangshan District, Beijing, and their blood samples were collected for analyzing biochemical indicators for iron nutrition. Two hundred and sixty-seven children with IDs (iron deficiency store) and IDE (iron deficiency erythropoiesis), based on screening criteria for iron-deficiency anemia, received an iron supplementation (NaFeEDTA) capsule (containing 60 mg iron element) weekly, and those with IDA (iron deficiency anemia) received NaFeEDTA capsule thrice weekly for nine weeks. Blood biochemical indicators for iron nutrition were determined repeatedly and compared with those before and after the intervention.</p><p><b>RESULTS</b>The daily average intakes of energy, protein, iron and vitamin C in school children of all age groups reached the daily recommended criteria (> 85% of the RNIs), but the proportion of heme in dietary iron constitution was lower. The average blood biochemical indicators for iron nutrition were as follows: serum ferritin (SF) (50.83 +/- 33.09) micro g/L, free erythrocyte protoporphyrin (FEP) (489.44 +/- 219.61) micro g/L, hemoglobin (Hb) (130.57 +/- 10.82) g/L, and the ratio of FEP/Hb (3.83 +/- 1.96), respectively. Incidence of total iron deficiency in rural children was 26.5%, with proportions of iron deficiency (IDs), iron deficiency erythropoiesis (IDE), and iron deficiency anemia (IDA) of 15.5%, 7.1%, and 3.9% respectively. SID accounted for 85.4% of the total iron deficiency, which was 5.8 times as much as IDA. With iron supplementation for 9 weeks, the hematdogical index of iron increased significantly and returned to the normal level.</p><p><b>CONCLUSIONS</b>The incidence of subclinical iron deficiency in the rural school-age children was insidious and should be attached more importance, which was helpful to its early recognition and intervention. Iron supplementation is important for children with SID to prevent and decrease the occurrence of IDA.</p>