Recurrent respiratory tract infections (RRIs) is a common clinical presentation in paediatrics and represent a huge burden of children health,family life and socioeconomic costs.Nowadays,the definition of pediatric RRIs has not been reached a consensus in the international field.Diagnosis and treatment of pediatric RRIs present a muddled picture clinically.This review introduces the definition and judgement,pathogeny and risk factors,classification,principle of management and prevention of pediatric RRIs in order to provide a reference for clinical practice of pediatrician.

Lower respiratory tract infection (LRTI), particularly pneumonia, is a leading killer of children. Bacteria are the main pathogen of LRTI in children of developing countries. Streptococcus pneumoniae is the most important pathogen causing LRTI. An increase in the incidence of invasive pneumococcal disease (IPD) caused by non-vaccine serotypes (NVTs) (serotype replacement) has been observed since the introduction of the seven-valent pneumococeal conjugate vaccine (PCV7), and the increasing antibiotic resistance to NVTs is of particular concerns. Genetic and microbiological studies have revealed that community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) is associated with a novel genetic profile and phenotype that distinguish it from hospital-acquired (HA) MRSA. There are obviously different antibiotic resistance between CA-MRSA and HA-MRSA. Gram-negative bacilli are still the chief pathogens in HA-LRTI. The common pathogens between CA-LRTI and HA-LRTI are different, but have overlaps. To understand the distribution and current status of antibiotic resistance to the common bacteria of LRTI in children is very important to guide clinical rational drug use.

Bronchial asthma (also called asthma) is the most common chronic respiratory inflammatory disease in childhood.With the increased incidence of asthma in recent years,the guidelines for diagnosis and treatment of asthma have been also updated quickly at both domestic and overseas.Acute exacerbations of asthma will result in unscheduled medical attendances in emergency department or hospitalizations,and the severe one may be life-threatening,which brings a heavy burden to the families and society.Several guidelines,Meta analysis,and studies in treatment of childhood asthma exacerbations are reviewed in this article,so as to provide recommendations in the treatment of childhood asthma exacerbations for physicians.

Objective To evaluatethefunctions of an emergency pediatric observation unit(OU).Method The OU located in the Second Affdiated Hospital ＆Yuying Children'Hospital of Wenzhou Medical CoHege.a pediatric tertiary care teaching hospital.The records of all patients admitted to OU and the discharge diagnoses of all patients ofinpatient unit(IU)from January to December 2006 were retrospectively analyzed.[)d(Is ratios(OR) witll 95%C1 was used to show the advantages ofOU in SOme pedian4c diSOrders.Results There were45 beds in the OU,and 348 beds in tlle IU.111e number ofthe patients in OU per year WaS 42.5%compared to IU f5471 Vs.12 881).The average number of patients in OU per bed in one year WaS 122.which was 3 times as much as the average number of patients in IU admission per bed(122 vs.37).Totally 3879(70.9%)patients in OU were discharged and 1592(29.1%)were transferred.For the olmervation patie.ts,the IIIeaIl age Was 7 years old.with 65.6%under or equal to 2 years old.The 111ean le,ch of stay(IDS)in OU was95.7 hours.Respiratory disorders(2204/5471,40.3%)and gastrointestinal problems(960/5471,17.5%)were the most common disease in OU.Of the total admission(IU and ou),diagnoses with high OU utilization were croup(73/75,97.3%),poiflonin(277/,97.2%),flsthma(128/133,96.2%),fleiZl.1lwith high fever(274/365,75.1%),enteritis/dehydration(618/726,85.1%),seizure with 110 fever(274/365,75.1%)and acute respiratory infection(486/624.77.9%).The likelihood of an OU admifor these illness vells IU addlission(adjusted for subsequent need for IU admission)was poisonings OR 43.21(26.1,71.6),P<0.001;croup 15.7(8.3,29.7),P<0.001:asthma 0R 10.5(7.0,15.8),P<0.001;seizure with high fever OR 8.5(6.5,11.1),P<0.001;seizure with no fever2.6(2.2,3.1),P<0.001;acute respiratory infection 0R 1.0(0.9,1.1),P=O.591;enteritis/dehydration 1.0(0.9 1.1),P=0.919.Conclusions The emergency OU,characterized by large ac.commodation,fast circulation and high utilization rate of bed,plays an important role in observation,treatment and hospital admission of children,esoeeially infants and young children for common pediatric diseases.The emergency observation unit is also an alternative disposition for certain pediatric diseases.The extending construefion of OU in a childrenS hospital with big population of out-/in-patients is an effective way to the hospital resources.

Objective To evaluate the role of an emergency observation unit(OU) in pediatric care.Methods A retrospective study was conducted to evaluate the medical service of the OU for 12 months.Results During 12 months,5?471 children were admitted to the OU,which was 0.78% of all visits to the outpatient department(OD) and emergency department(ED).Of OU patients,70.9% children were discharged home and 34.6% children were discharged under 48 hours.Of OU patients,65.6% children were under 2 years old.Median length of stay was 95.7 hours.The average admission rate was 15 children per day.The patient volume per month of OU was in positive relation with the visits volume per month of OD and ED (r=0.835,P=0.001).The commonest causes for children admitted to the observation unit were pneumonia(22.2%),enteritis(13.3%) and acute upper airway infection(11.4%).Conclusion The emergency pediatric OU should be set to assess and treat young children with a variety of conditions.It is effective in relieving the problems of limited inpatient hospital bed spaces and high-volume patient visits,and helpful for limiting inappropriate hospitalization.

Children′s infected pleural effusion refers to any of the pleural effusions caused by infection, the common pathogens include bacterium,mycoplasma and bacillus tuberculosis. The treatments of pleural effu-sion are general treatment,anti-infection drugs ( including antibiotics or antituberculosis drugs) ,thoracic puncture drainage,or combination of plasminogen-activator, electronic thoracoscopy ( video-assisted thoracic surgery, VATS) and thoracic surgery (pleural decortication,modified thoracoplasty surgery,pleural pneumonectomy). This article reviews recent progress in each method of treatments about the indications,effects and prognosis of the disease.

OBJECTIVE To determine the pathogenic distribution and antimicrobial resistance of community acquired bacteremia in 105 children patients.METHODS Clinical profile,results of blood culture and antibiotic susceptibility test of 105 patients with community-acquired bacteremia treated from Jan 2003 to Dec 2006 were studied retrospectively.RESULTS The Gram-positive bacteria were from 58 cases which accounted for 55.2%.Most of them were Staphylococcus epidermidis,S.haemolyticus and S.hominis.The positive rate was 19.0%,15.5% and 10.3%,respectively.The Gram-negative bacilli were seen from 47 cases which accounted for 44.8%.Escherichia coli,Stenotrophomonas maltophilia and Klebsiella pneumoniae were the main microrganism in Gram-negative bacilli,the positive rate was 19.1%,14.9% and 10.6%,respectively.The resistant rate of Staphylococcus to penicillin was 100%.Their resistant rate to erythromycin was 94.7%.100% Gram-positive bacteria were susceptible to vancomycin,most of them were susceptible to ciprofloxacin,rifampicin and nitrofurantoin.The resistant rate of Gram-negative bacilli to ampicillin was 91.7%.Most of Gram-negative bacilli were susceptible to the third generation cephlosporin plus enzyme inhibitor,ciprofloxacin and imipenem.Resistance of the isolated pathogens to several commonly used antibiotics in pediatrics was observed.CONCLUSIONS We must focus on children aged under 3 years who are at risk of developing bacteremia.Empirical treatment with antibiotics is recommended only in life-threatening sepsis cases in pediatric emergency department.

Objective To provide the practical basis for clinical diagnosis and treatment of patients who were admitted by green channel because of vomiting and abdominal pain. Method 268 cases with vomiting andabdominal pain ( from January 2007 to December 2008 ) who were admitted into the emergency observation unit through green channel were retrospectively analyzed, and various risk factors were considered with logistic regression model. Result Among 268 cases, 34 kinds of different diseases were found,while gastrointestinal diseases were the greatest proportion [60. 1% (161/268)] and gastroenteritis was most common reason 77.6%( 125/161 ). Between different age groups ( ≤ 3-year-old group and>3-yearold group), the overall incidence of various diseases and the profile of disease was different (P<0.05).The incidence of diseases in the digestive tract, infectious diseases and surgical between two groups was statistically different (P<0.05). Between inpatient admission and non-inpatient admission patients, single logistic regression showed that there was significantly different between the nine events (age, fever, shock,duration of symptoms, blood routine test( BRT), liver function, blood Na+, blood / urine amylase, electrocardiogram) ( P <0.05). In the regression model, all showed significant difference except BRT. Conclusion Most of patients with vomiting and abdominal pain were digestive system diseases. Patients ≤ 3years old had a higher incidence of infectious and surgical diseases. The patients who accompanied by fever,shock and laboratory tests such asliver function, blood Na +, blood / urine amylase, electrocardiogram were abnormal would have higher hospitalize rate.

Objective To study the diagnostic significance of whole blood sample index in the severity of hand, foot and mouth disease, and to analyze its pathogenesis. Methods 194 cases of severe cases of hand, foot and mouth disease were selected as the case group,and 193 cases of mild hand, foot and mouth disease were selected as the control group. Blood samples were collected after admission to study the whole blood samples, including white blood cells, erythrocytes, platelets, medium cell ratio, lymphocyte ratio, mononuclear cell ratio, C-reactive protein test; The patient's immune system, the nervous system were also tested. Results Compared with patients with mild group, the white blood cell level of the patients in the severe group was higher and the albumin level was higher, the difference was statistically significant (P<0.05), the monocyte ratio, the T cell ratio was lower, the difference was statistically significant (P<0.05). Conclusion The white blood cell level and monocyte ratio of patients with severe hand, foot and mouth disease have changed. The whole blood sample has a certain sensitivity to the diagnosis of severe hand, foot and mouth disease.

Objective To investigate the efficacy of the clinical pathway introduced in children with bronchiolitis.Methods Based on a retrospective study,the duration of hospital stay,hospital expenses,antibiotics usage rates,curative rate and nosocomial infection rate were compared between 181 bronchiolitis patients (the clinical pathway group) managed according to clinical pathway and other 122 bronchiolitis patients (the control group).The variation of clinical pathway was analyzed in the clinical pathway group as well.Results The duration of hospital stay in clinical pathway group [4.96 (4.00,6.00) days] was significantly shorter than that in the control group [5.81 (4.82,7.00) days],and the difference was significant (Z =3.137,P ＜ 0.05).The hospital expenses [3 701.23 (3 124.50,4 396.19) yuan] in clinical pathway group were significantly lower than that in the control group [3 954.22 (3 325.07,4 679.66) yuan],and the difference was significant (Z =2.042,P ＜ 0.05).The antibiotics usage rate (20.44％)(37/181 cases) in clinical pathway group was significantly lower than that in the control group (40.16％) (49/122 cases),and the difference was significant (,x2 =13.945,P ＜ 0.05),and the curative rate (93.92％) (170/181 cases)in clinical pathway group was significantly higher than that in the control group (86.89 ％) (106/122 cases),and the difference was significant (x2 =4.447,P ＜ 0.05).The nosocomial infection rate (4.42％) (8/181 cases)was also lower than that in the control group (10.66％,13/122 cases),and the difference was significant (x2 =4.393,P ＜0.05).The variation rate of clinical pathway was 48.62％ (88/181 cases) in clinical pathway group.Conclusions The curative rate is improved and the duration of hospital can be shortened if the clinical pathway is introduced in bronchiolitis children,with less the hospital expense.Moreover,the antibiotics usage rates and the nosocomial infection rate are reduced in the implementation process of clinical pathway which is worthy to be put in use.However,there is a high variation rate in the clinical pathway.It should be interposed and administrated appropriately in dinical treatment for clinic.