Neonatal jaundice is one of the common diseases in preterm neonates. But there are still some problems to be determined,for example,the clinical diagnosis criteria for neonatal jaundice,the prediction,diagnosis and therapies for hyperbilirubinemia,and diagnosis for bilirubin encephalopathy in early-stage and prevention from bilirubin encephalopathy sequelae.

Naphazoline,Diphenoxylate, Over-the-counter (OTC) cough and cold medications, widely used for the symptomatic relief of nasal obstruction, diarrhea or common cold symptoms. But these medicines might cause poisoning even if utilized in recommended doses for treatment. The side effects of these medicines were neglected when they were used much more commonly. The clinical manifestation of these medicine poisoning were delitescence and children' s parents couldn't provide the whole history, so these medicine poisoning were often misdiagnosis, even lead to treatment failure. We explore the toxicities of these medicines ,discuss their mechanisms and clinical manifestation, and suggest why physicians should be more vigilant in specifically inquiring about them when evaluating an ill child.

The adenovirus pneumonia is one of the severe pneumonia in infants and young children.Adenovirus serotype 3 and 7 can cause severe clinical presentation,a wide range of clinical syndrome,difficult treatment,high mortality and serious pulmonary sequelae.The epidemiology,pathogenesis,clinical manifestation,treatment and prognosis of severe adenovirus pneumonia in children are reviewed in the paper.

Adenovirus,respiratory syncytial virus,influenza virus type A and B,cytomegalovirus and EB virus are the mainly etiology of severe pneumonia in children.New type of virus,such as influenza-H1N1 virus,avian influenza virus(H5N1 or H7N9) can also be epidemic in pediatric population.Ribavirin is effective drugs in the treatment of respiratory syncytial virus and adenovirus pneumonia.Acyclovir or ganciclovir is used for EB virus or immune deficiency and irnmunosuppressive patients with CMV pneumonia.Current opinin strongly recommend treatment with oral oseltamivir as soon as possible in influenza and seasonal influenza.Oseltamivir reduces the severity,duration of the symptoms of influenza,and reduces the frequency of secondary illnesses and exacerbation of underlying conditions.Zanamivir and peramivir may be effective in patients infected with influenza virus,including oseltamivir-resistant virus.Some Chinese medicine such as maxingshigan-yinqiaosan can obtain similar effect of oseltamivir in treatment of influenza virus infection.

Objective To investigate the clinical and laboratory characters of infantile organic acidemia(OA) accompanied with acute metabolic crisis.Methods We analyzed retrospectively datum of infants with OA diagnosed in our unit from April 2006 to October 2014.Results Fity-three cases(37 male and 16 female,aged under 1 year old) were enrolled in this study,in which,28 cases were methylmalonic acidemia,11 cases were propionic acidemia,3 cases were biotinidase deficiency,3 cases were glutaric acidemia type Ⅱ,2 cases were glutaric acidemia type Ⅰ,2 cases were isovaleric acidemia,1 case was variety of coenzyme A carboxylase deficiency,1 case was glycerol kinase deficiency,1 case was 3-methylcrotonyl-CoA carboxylase deficiency and 1 case was holocarboxylase synthetase defect.Tweny-five of the 53 cases(47.2％)developed metabolic crisis within 7 days after onset,main manifestations included feeding difficulties,frequent seizures dyspnea,et al.The most common abnormal laboratory findings manifested severe hypoglycemia,intractable metabolic acidosis,hyperammonemia,et al.Twenty cases had family history.All patients were given symptomatic relief and supportive treatment,including colleting hypoglycemia,reducing hyperammonemia,keeping water,electrolyte and acid base balance,maintaining function of vital organs,suppling metabolic cofactor and special fomula,et al.After treatment,32 cases (60.4％) improved markedly while death occurred in 15 cases(28.3％).Conclusion OA confirmed under 1 year old is especially vulnerable to acute metabolic crisis,which characterized by sudden onset,rapid progress and is difficult to treat.Feeding difficulties,frequent seizures and dyspnea were the very common presentations.Early diagnosis and timely treatment are critical for improving the prognosis.Clinicians should be aware of it,and an early metabolic disorders screening should be intervened in patients with hypoglycemia of unknown etiology or refractory metabolic acidosis.

Pneumonia is the primary cause of death in children under five-years old.About 2 million children younger than 5 years die of pneumonia each year worldwide,accounting for 19％ of the total number of deaths.According to the survey in 2008,7％ to 13％ of the children with pneumonia were severe pneumonia.Currently,the early diagnosis and treatment of severe pneumonia is often difficult.In order to improve the early diagnosis an prognosis cognition level of severe pneumonia,here is to make a review on the recent literatures on the biomarkers like brain natriuretic peptide,D-Dimer,C-reactive protein,lactate,zinc,procalcitoin,prealbumin,platelet count,endothelin-1 and high mobility group box 1 in children with severe pneumonia.

Objective To explore the experience of emergency operation for patent ductus arteriosus (PDA) in neonates and to assess the therapeutic effect.Methods The clinical data of 31 PDA neonates(15 male,16 female) treated in our department from July 2012 to February 2015 were reviewed retrospectively.Of these cases,28 were preterm infants and 3 were full term infants.Mean gestational age was 30+4 weeks ranging from 26+2 to 39 +3 weeks.Mean birth weight and weight at operation was(1 159.0 ± 729.2) g and (1 522.0 ± 644.5) g,respectively.We operated with left transaxillary straight incision in 6 cases and posterolateral minimal incision in 25 cases,and the pleural cavity was entered via the 4th intercostal space.All the neonates were divided into ＜ 1 500 g group(n =24) and ＞ 1 500 g group(n =7) by weight,the clinical prognosis were analysized.Results All 31 operations were finished successfully.No deaths occurred as a result of surgery.Average time of operation was (62.7 ± 29.9) min.Mean time of mchanical ventilation after the operation among survivors was (5.5 ± 4.7) d.The time of mechanical ventilation between ＜ 1 500 g group and ＞ 1 500 g group were (7.2 ± 2.3) d and (4.9 ± 2.4) d respectively,and there was significant difference between two groups(P ＜ 0.001).The time of hospital stay were (45.3 ± 11.0) d and (20.4 ± 14.5) d respectively between two groups (P ＞ 0.05).Twenty-eight cases recovered and released from the hospital successfully.Two cases quited the treatment themselves and 1 succumbed to death because of heart failure,hyperkalemia and arrhythmia.ConclusionEmergency surgical closure is a safe and effective method for the treatment of neonatal large PDA,especially with congestive heart failure,a variety of complications,long time ventilator dependence,medical treatment failure,which should be ligatured timely as it can have severe influence on the cardiopulmonary function.After ligation the abnormal shunt will disappear and the cardiopulmonary function will be better.It is helpful to extubate ventilators and improve the survival rates.

Objective To summarize the effectiveness and security of endoscopic removal of foreign bodies of battery in the gastrointestinal tract in children.Methods We analyzed retrospectively the clinical data of 13 patients who swallowed foreign bodies including button cell and cylindrical battery.The 13 patients were treated in our hospital between July 2011 and April 2015,aged 19 months to 12 years.Results A total of 9 cases of foreign bodies in esophagus,including embedded in the first the esophageal stenosis in 4 cases,the second the esophageal stenosis in 3 cases,cardia in 1 case,and 4 cases of foreign body in stomach.We successfully removed 16 foreign bodies of the battery in endoscopy.No serious complications such as perforation,hemorrhaging happened during and after operation.Conclusion It is one relatively safe and effective method of diagnosis and treatment of endoscopic removal of foreign bodies of battery in gastrointestinal tract in children.

Objective To identify uropathogens responsible for urinary tract infection in children less than 5 years of age and determine the antibiograms.Methods The data of 523 children(2 months to 5 years old) admitted at the Shengjing Hospital of China Medical University from January 2008 to December 2013 were studied retrospectively.Results Out of 523 children suffering from urinary tract infection,54 (10.3％) were complicated urinary tract infection,including 24 vesicoureteral reflux,8 ureter-pelvic junction stenosis,5 hydronephrosis,4 double kidneys,2 renal dysplasia,2 bladder diverticula,2 bladder ear,2 neurogenic bladder,1 urethral vaginal fistula,1 congenital megaureter,1 horseshoe kidney,and 1 Ureteral cyst and stone.A total of 487 cases underwent urine culture,207 (42.5 ％) had positive bacterial growth,the gramnegative bacteria accounted for 94.69％,gram-positive bacteria 5.31％.E coli was the most common uropathogens in gram-negative bacteria (79.23 ％),the second was Klebsiella (5.31％),the third was Proteus mirabilis(2.90％).Gram-positive bacteria was almost Enterococcus (4.35％).Twenty one strains were extended-spectrum beta-lactamase enzyme positive(ESBLs +),and they were sensitive to imipenem,amikacin and piperacillin/tazobactam.Conclusion The clinical features were atypical in children with urinary tract infection,we should investigate the underlying causes such as urinary anomalies or stones.E coli was still the most common uropathogens in children with urinary tract infection,the empirical therapy should according to the patient's conditions while awaiting the culture and sensitivity results.

Objective To analyze the clinical characteristics and risk factors of prognosis in children with brain trauma.Methods We retrospectively analyzed the clinical data of 125 cases diagnosed as brain trauma in PICU of Shengjing Hospital affiliated to China Medical University from January 2009 to December 2014.The risk factors influencing prognosis were analyzed by using single factor analysis and multiple factors Logistic regression methods.The risk factors included Glasgow coma score (GCS) on admission,blood glucose,lactic acid,prothrombin time,international normalized ratio (INR),serum sodium,serum potassiumin,pulse within 24 hours after admission,gender,age,time for therapy,shock,respiratory failure,cerebral hermia and surgery.Results Eighty-four cases survived and 41 cases died.The fatality rate was 32.8％.T test and chi-square test of risk factors showed that GCS score,blood glucose,blood lactic acid,INR,respiratory failure,shock had a significant influence on the prognosis of brain trauma in children (P ＜ 0.05).Multviariable Logistic regression analysis showed that GCS score,blood glucose,blood lactic acid,respiratory failure were independent risk factors affecting the prognosis of brain trauma (OR =7.434,0.473,0.615,0.000,P ＜ 0.05).Conclusion Pediatric brain trauma has a rapid progress and poor prognosis with high mortality and disability rate.GCS score,blood sugar,blood lactic acid,respiratory failure are independent risk factors for prognosis of brain trauma in children.