Caffeine has been applied in clinic more than 30years,nowadays,which is one of the safe and effective drugs for the treatment of neonatal disease.It has been proved that caffeine can significantly re-duce the major acute neonatal morbidities include apnea of prematurity,bronchopulmonary dysplasia,severe retinopathy,patent ductus arteriosus with surgical ligation.Moreover,recent research also shown that caffeine can improve babies neurological outcome and lung function.This review summarized the latest progression in the pharmacological characteristics,clinical applications and untoward effect of caffeine.

Objective To analyze the relationship between Tourette syndrome and mycoplasma pneumoniae.Methods Seventy Tourette syndrome children were selected as TS group, and seventy healthy children as control group, then throat swabs MP-DNA and plasma MP-IgM, MP-IgG were detected.TS group were divided into MP-DNA positive group (n =21) and MP-DNA negative group (n =21) according to result of throat swabs MP-DNA.TS group were given haloperidol orally, we noted down daily dose of haloperidol at weekend.On the basis of the haloperidol therapy, MP-DNA positive group were treated with azithromycin.Before and 1, 2, 4, 6, 8 weeks after treatnent, we assessed YGTSS of MP-DNA positive group and MP-DNA negative group.Results (1) MP-DNA positive rate of TS group and control group were 30％ and 0％ respectively, and the differences were significant (x2 =24.706, P =0.000);MP-IgM positive rate of TS group and control group were 27％ and 17％ respectively, and there was no significant difference between two groups (x2 =2.030, P =0.154);MP-IgG positive rate of TS group and control group were 80％ and 64％ respectively, and the differences were significant (x2 =4.301, P=0.038).(2) Before and after 1, 2 weeks of treatment, the score of YGTSS was 30.65 ±5.41, 12.14 ±5.93, 28.07 ±8.69, 29.63 ±2.99, 11.68 ±5.99, 25.80 ± 9.42 respectively in MP-DNA positive group and MP-DNA negative group, and there was no significant difference between two groups (P ＞ 0.05);After 4, 6 and 8 weeks of treatment, the score of YGTSS was 60.87 ±23.75, 71.93 ±13.08, 80.19±12.91, 46.94±18.76, 60.53 ±17.42, 71.08 ±14.22 respectively in MP-DNA positive group and MP-DNA negative group, and the differences were significant (P＜0.05);3.After 1, 2, 4 and 6 weeks of treatment, the daily dose of haloperidol was 0.43 ±0.12, 0.86±0.23, 1.71 ±0.46, 2.37 ±0.67, 0.44 ±0.11, 0.88 ±0.22, 1.76 ±0.44, 2.54 ±0.54 mg respectively in MP-DNA positive group and MP-DNA negative group, and there was no significant difference between two groups (P ＞ 0.05);After 8 weeks of treatment, the daily dose of haloperidol was 2.45 ± 0.75, 3.00±0.93mg, and the differences were significant (t=2.104, P=0.042).Conclusion Mycoplasma pneumoniae may play a role in the pathogenesis of Tourette syndrome, the pathogensis of Tourette syndrome been involed in immune reaction.

Objective To study the clinical application value of humidified high flow nasal cannula(HHFNC) on bronchitis in children.Methods Total 85 cases of bronchitis that needed oxygen therapy in our department from Oct 2015 to Feb 2016 were randomly divided into three groups,HHFNC group,NCPAP group and nasal cannula oxygen group(control group).According to the blood gas results,FiO2 was adjusted to maintain PaO2 in 50~70mmHg(1mmHg=0.133kPa),TcSO2 90% to 95%.The main symptoms and signs(wheezing,shortness of breath,three depression sign,wheezing rale) disappeared time,length of oxygen inhalation and stay,the change of PaO2,PaCO2,respiratory rate were compared among the three groups.Results Compared with control group,the clinical symptoms and signs disappeared time and length of oxygen inhalation and stay were significantly shorter in HHFNC group(P<0.05).The recovery of blood gas and respiratory rate in HHFNC group were better than those in control group(P<0.05).No statistically significant differences existed between HHFNC group and NCPAP group(P>0.05).Conclusion HHFNC can significantly improve the clinical symptoms,signs and blood gas results in children with bronchitis,reduce the length of oxygen inhalation and stay.HHFNC is an effective and well-tolerated treatment for bronchitis in children.

Objective To analyze the clicinal feature and therapy of the children with severe pancreatitis.Methods The clinical data of 12 children with severe pancreatitis were collected and analyzed retrospectively.Results All the cases had acute onset,10 cases had abdominal pain and fever,6 cases had abnormal blood glucose,2cases had gastrointestinal bleeding.All these cases had abdominal distention,hypoactive bowel sounds,ascites,intestinal obstruction.All these cases had a higher level of blood and urine amylase than normal,and abnormal liver function.9 cases had elevated WBC,3 cases had descendant blood calcium,edematous and inflammatory thymus were presented in 12 cases,2 of whom were associated with expancreatical damage,such as liver,intestinal,and biliary tract stones.Conclusion The early stage of severe pancreatitis is not obvious in symptoms and signs,and is prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.

Objective To study the expression and signiifcance of phospholipid transfer protein (PLTP) and macrophage migration inhibitory factor (MIF) in mice with bronchopulmonary dysplasia (BPD). Methods Ninety-six 4-day-old mice were randomly divided into oxygen group and air group. Mice in oxygen group were exposed to a FiO2 of 65%, and mice in air group were exposed to air. On day 7, 14, 21 and 28, blood and lung tissue samples from 12 randomly selected mice in each group were obtained. The serum levels of MIF and PLTP were measured by ELISA assay. The morphological changes of lung tissue were ob-served with HE staining. Results The mice in oxygen group showed thickened lung parenchyma and obvious pulmonary ifbrosis. The radioactive alveolar count was signiifcantly lower in oxygen group than that in air group (P<0.01). PLTP level in air group was increased gradually from day 7 to day 21, and began to decrease on day 28. PLTP level in oxygen group was increased from day 7 to day 14, and decreased on day 21 and day 28. MIF level in air group did not change during the experiment. MIF level in oxygen group was signiifcantly increased from day 7 to day 21, and began to decrease on day 28. Conclusions MIF and PLTP may be good biomarkers for the diagnosis of BPD.

Objective To evaluate the efficacy and safety of aripiprazole treatment for co-morbid attention defi?ciency hyperactivity disorder (ADHD) in children with Tourette syndrome (TS). Methods Forty four TS children with co-morbid ADHD were randomly divided into aripiprazole group and haloperidol group. The aripiprazole group and halo?peridol group received aripiprazole and haloperidol treatment for 12 weeks, respectively. Yale global tic severity scale (YGTSS) and Conners parent symptom questionnaire (PSQ) were used to assess the tic and ADHD symptoms before, 2, 4, 8 and 12 weeks after treatment. Side effects were recorded weekly. Results Repeated measure ANOVA indicated that the main effects of groups was not significant to the YGTSS scores (P>0.05), but significant to the PSQ scores (P<0.05). After 12-week treatment, the YGTSS scores between two groups were not significantly different (P>0.05). The PSQ scores of aripiprazole group were significantly lower than that of haloperidol group. The adverse reactions of aripiprazole group were milder compared with the haloperidol group (P<0.05). Conclusions The present study demonstrates that aripipra?zole has the same efficacy in the treatment of tics as haloperidol, improves co-morbid ADHD symptoms, and its adverse reactions are much less compared with haloperidol.

Objective To study the clinical efficacy of caffeine in premature infants receiving mechanical ventilation and related complications .Method From January 2014 to September 2016, preterm infants (28w≤GA<33w) treated with nasal continuous positive airway pressure (NCPAP) or conventional mechanical ventilation ( CMV ) in neonatal intensive care unit were studied .They were randomly assigned into the caffeine group and the control group .The caffeine group received caffeine when NCPAP ventilation was applied or adjusting to synchronized intermittent mandatory ventilation ( SIMV) mode.The control group was injected with 5%glucose without caffeine .The t test andχ2 test were used to analyze the clinical efficacy and related complications .Result A total of 96 patients receiving NCPAP ventilation were collected ( birth weight between 1300~2100 g), including 51 cases in caffeine group and 45 cases in the control group. 84 cases received CMV ventilation (birth weight between 1000~1499 g), with 43 cases in the caffeine group and 41 cases the control group.Among the NCPAP infants, the incidence of failure to withdraw ventilator (0% vs.13.3%) and the incidence of bronchopulmonary dysplasia (3.9% vs.17.8%) were lower in the caffeine group than the control group .The duration of assisted ventilation and hospital stay in the caffeine group were shorter than the control group [(6.2 ±3.1) d vs.(8.2 ±3.2) d, (16.3 ±8.7) d vs. (19.5 ±9.2) d], the differences were statistically significant (P<0.05).Among the CMV infants, the incidence of failure of A/C to SIMV mode transition and bronchopulmonary dysplasia were lower in the caffeine group than the control group and the duration of assisted ventilation and hospital stay were shorter . The differences were statistically significant ( P <0.05 ) . No differences were found in the related complications in each group ( P>0.05) . Conclusion Caffeine can help reduce the incidences of withdrawal failure, bronchopulmonary dysplasia , ventilation duration and hospital stay when using NCPAP and CMV ventilation.

Objective:To explore the application value of humidifying high-flow nasal cannula oxygen therapy (HHFNC) in children with pediatric intensive care unit (PICU) after weaning.Methods:From January 2018 to October 2021, 42 children with endotracheal intubation admitted to PICU of Tai′an city Central Hospital were prospectively selected and randomly divided into HHFNC group and nasal continuous positive airway pressure (NCPAP) group, with 21 patients in each group. The blood gas analysis [arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide in artery (PaCO 2), PaO 2/oxygen concentration (FiO 2)], blood oxygen saturation (SaO 2), comfort, non-invasive ventilation time, and total hospital stay of the two groups of children 1 hour after using HHFNC and NCPAP were compared, and the rate of reintubation of trachea within 48 hours, gastroesophageal reflux, nasal injury, facial skin indentation, abdominal distension, and pulmonary air leakage were recorded. Results:There was no significant difference between the two groups in terms of blood gas analysis (PaO 2, PaCO 2, PaO 2/FiO 2), SaO 2, pulmonary air leakage, non-invasive ventilation time, hospital stay, and reintubation rate within 48 h after weaning (all P>0.05). Compared with NCPAP group, HHFNC group had higher comfort, lower incidence of facial skin indentation, gastroesophageal reflux, nasal injury and abdominal distension, and the difference was statistically significant (all P<0.05). Conclusions:HHFNC and NCPAP can both be used as the transitional respiratory support mode after weaning, and the clinical treatment effect are similar. The HHFNC group has higher comfort, which is more conducive to improving the tolerance of children, reducing adverse reactions, and has higher safety.

Objective: To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis. Methods: This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed. Results: During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO₂, PaCO₂, and PaO₂/FiO₂; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05). Conclusion Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.