In the review,we analyzed the status of triage in pediatric emergency both at home and abroad,stated the importance of the correct implementation of emergency triage in the emergency medical services,and maked recommendations for pediatric emergency triage.

The current situation of pediatric emergency medicine and the pediatric emergency medical service systems were analyzed.The equipment configuration,personnel allocation and the requirement of professional knowledge and technology in pediatric emergency setting,the triage system,the process of medical services for patients with acute illness or trauma,and the optimizing process of diagnosis and treatment for emergency cases and critical cases were discussed.The nationwide development model of pediatric emergency service systems were reviewed.

Pediatric advanced life support (PALS) training program development has been more than 20 years.PALS program provides a systematic,organized approach for the evaluation and management of acutely ill or injured children.It plays an active role in guiding treatment of critically ill children.In this paper,we reviewed the PALS training purpose,importance and training content,and introduced the current situation and promotion of PALS training in China.

Objective To investigate the pathogen of 21 infective endocarditis (IE) cases treated with operation in Shanghai Children's Medical Center from 2007 to 2010.Methods Blood culture,vegetation culture and vegetation PCR assay(target gene to the conserved region V3 in 16SrRNA gene) were detected in 21 IE patients; multiplex PCR amplification of staphylococci for methicillin-resistant staphylococcus was performed.Results Of 21 IE cases,20 cases were detected positive by vegetation PCR with the detection rate of 95.2％,12 IE cases were detected positive by blood culture with the detection rate of 57.1％,2 IE cases were detected positive by vegetation culture with the detection rate of 9.5％.The difference of the positive rates of the three methods was statistically significant (P ＜ 0.0001).The vegetation PCR of one case was actinobacillus actinomycetemcomitans,while the blood culture was haemolysis pasteurell which was inconsistent with the vegetation PCR result.Howerver,the PCR result of colony obtained by blood culture was consistent with vegetation PCR that was confirmed as actinobacillus actinomycetemcomitans.The endocardium PCR results of 11 IE cases were consistent with the results of blood culture.MecA gene was detected by multiplex PCR,which could identify methicillin-resistant staphylococcus quickly,sensitively and accurately and could also effectively identify methicillin resistant staphylococcus aureus,when coupled with femA gene detection,thus glycopeptides antibiotic could be prescribed promptly.All the 21 patients recovered and discharged without infection recurrence in the follow-up.Conclusion Universal primer V3 coupled with multiplex PCR can improve vegetation pathogen detection rate of IE patients and is minimally influenced by antibiotic therapy.Multiplex PCR can be applied for etiological diagnosis of IE patients with indication of surgery and negative blood culture or difficult diagnosis,contributing to post-surgery antibiotics selection and improvement of recovery rate of IE patients.

Objective To investigate the status and demands of prenatal education among pregnant women,and to provide reference for better prenatal education. Methods A total of 750 pregnant women were recruited from 20 hospitals in Chengdu and were investigated with a serf-designed questionnaire. Results 74.42% of the pregnant women had participated the prenatal education,25.58% of them didn't take even one prenatal class. The most preferred knowledge was newborn care. They most preferred to take prenatal classes at weekends in small group. The women's educational level,family income, delivery experience and times of prenatal check-up were the key factors to affect the participation in the prenatal educa-tion. Conclusions It is suggested to innovate the contents and means of prenatal education in order to attract the pregnant women to participate prenatal education actively.

Objective To investigate the clinical manifestations of the febrile neutropenia cancer children,explore the relationship between the clinical data and sepsis.Methods A prospective observation study was employed,and 66 cancer children complicated with febrile and neutropenia after chemotherapy were enrolled.Sixty-six cases were divided into two groups:septic group ( n =26 ) and non-septic group ( n =40).Clinical and laboratory data were collected and compared.Results Body temperature,neutropenia duration,absolute neutrophic count ( ANC ),C-reactive protein ( CRP ),procalcitonin (PCT) and culture positive rate showed statistically differences between the septic and non-septic groups ( P ＜ 0.05 ).Body temperature ＞40 ℃,ANC ＜ 0.1 × 109/L,increases of serum CRP and PCT levels and positive culture were correlated with sepsis.Body temperature ＜ 39 ℃,neutropenia duration ＜ 5 ds,ANC ＞ 0.5 × 109/L were less correlated with sepsis.Conclusion High initial temperature,long duration of neutropenia,severely reduced ANC,increases of CRP and PCT,and culture-positive are correlated with sepsis in cancer children.

Objective To investigate the changes of plasma activated protein C(APC)in the pediatric leukemia patients with acute lung injury(ALI),and the relationship with the outcome.Methods During the study period(from Jan to Dec 2009),17 pediatric leukemia patients with ALI were selected.They were divided into neutropenic(n =10)and non-neutropenic(n =7)group.We collected the basic data including the age,gender,stage of chemotherapy,pediatric critical illness score,mechanical ventilation time,ICU time.The blood gas and plasma APC levels were detected on day 1 and day 4 of ALI onset.Results Compared with the non-neutropenic group,the neutropenic group had a significantly longer mechanical ventilation time [(16.60 ± 1 0.83)d vs(3.79 ± 4.08)d,P =0.009 6],lower PaO2 level on day l[(54.90 ± 17.05)mm Hg vs (92.70 ± 27.53)mm Hg,P =0.009 7],and lower APC level on day 4[(193.06 ± 63.19)pg/mlvs(286.28 ±25.12)pg/ml,P =0.007 7].Conclusion The APC generation is severely impaired in the neutropenic group,especially in those who died.The lower APC level is,the longer is the mechanical ventilation time,the worse is oxygenation,the poorer is the prognosis.APC replacement therapy may be promising in these patients.

ObjectiveTo assess the relationship between serum macrophage migration inhibitory factor (MIF) and sepsis in children with hematologic malignancy.Methods( 1 ) An observational study was performed in a university pediatric intensive care unit.Forty-one children were enrolled in our study,and were divided into two groups:sepsis group (27 cases) and non sepsis group ( 14 cases).(2) Serum samples were taken in the both two groups in 24 h after they were admitted in hospital.Clinical and laboratory parameters,including the levels of serum MIF,cortisol,corticotropin releasing hormone ( CRH),and ferritin were measured and compared between the two groups.Multiple linear regression analysis was used to assess the relationship between MIF and CRH,cortisol and pediatric critical illness score (PCIS).ResultsThe level of MIF was significantly elevated in the sepsis group[ (5 022.71 ± 3 915.82) pg/ml] than that of non sepsis group[ ( 1 722.81 ± 1 738.53) pg/ml] (P =0.001 ).Multiple linear regression analysis showed that CRH as well as PCIS were the correlative factors of MIF( t =- 2.830,P =0.009; t =2.852,P =0.009 ).The higher CRH concentration,the lower PCIS score,and the higher MIF was.ConclusionThe level of serum MIF could reflect the severity of children with hematologic malignancy complicated with sepsis.The higher MIF concentration,the lower PCIS score,then the disease is more serious.To some extent,serum MIF is related with the adrenocortical function of sepsis children.

Objective To investigate the levels of Th1 and Th2 cell in the peripheral and the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium at different time in the porcine model with multiple organ dysfunction syndrome(MODS) after continuous blood purification(CBP). Methods Twenty-four young porcines were given intravenous infusion of endotoxin to induce MODS, then were randomly divided into 2 groups:CBP group(n = 12) and MODS group without CBP(n = 12). Continuous venovenous hemodiafiltration (CVVHDF) was the main mode for CBP. At baseline, onset of MODS, and 2 h,4 h,6 h after treatment of CVVHDF,we picked the blood respectively to separate the T helper cell using the beads,detected the Th1 and Th2 cell by FACS and detected the cytokines (IFN-γ,TNF-α,IL-12,IL-10,IL-4) in the culture medium by ELISA. Results The MODS group showed a obvious rise in TNF-α,the drop tendency in IL-12,IFN-γ,IL-10,Th1/Th2 ratio, and no significant change in IL-4. After the treatment, the CBP group showed the drop in TNF-α and IL-4;and increase in IL-12,IFN-γ,IL-10 and Th1/Th2 ratio. Conclusion CBP helps to dear immune function,and restore the balance of Th1/Th2 in porcine MODS model.

Objective To analyze the clinical characteristics of PICU infant with sepsis,severe sepsis,and to explore the impact of prognostic factors.Methods We conducted a retrospective study of 141 cases (from January 2006 to December 2011) who were diagnosed as sepsis and severe sepsis to identify the clinical characteristics.There were 14 variables of the PICU admission day which concluded gender,age,underlying diseases,sepsis severity,organ involvement,critical score,blood biochemistry (lactate,albumin,glucose),blood gas (base excess,bicarbonate,pH),shock,culture-positive.The death or discharge as the outcome factor.The data were analyzed with the Logistic regression model.Results One hundred and forty-one cases aged from 1 to 12 months,of which 72 cases were sepsis and 69 cases were severe sepsis,29 cases died with the mortality of 20.6％.In 29 death children,13 cases had underlying diseases.In children with sepsis and severe sepsis,the most common infection site was lung,accounting for 47.2％ (34/72) and 47.8％ (33/69) ;blood cultures were positive for 34 cases,accounting for 47.2％ (34/72) and 49.3％ (34/69).Variables in the univariate analysis those were significantly associated with death from sepsis were gender,underlying diseases,age,sepsis severity,shock,organ involvement,the number of critical illness score,blood lactate,base excess,bicarbonate and pH.In the Logistic regression model,the variables significantly associated with death were the severity of sepsis (OR =22.5,95 ％ CI =5.089,99.475),and the number of organ involvement (OR=3.305,95％CI=2.152,5.075).Conclusion The heavier sepsis severity and the more number of organ involvement are,the greater the risk of death will be.