Sepsis and septic shock are common critical diseases in the ICU, which have high mortality and seriously affect the patients′ quality of life.The Surviving Sepsis Campaign group pushed forward the " Hour-1 Bundle" concept which includes measuring lactate level, obtaining blood cultures prior to administration of antibiotics, administering broad-spectrum antibiotics, rapid fluid resuscitation, and applying vasopressors.The 2018 Surviving Sepsis Campaign bundle combined with the characteristics of children were reviewed, aiming at providing references for early goal oriented and cluster treatment, which in return to improve pediatric survival rate.

Sepsis-associated encephalopathy(SAE), as a relatively common complication of sepsis, is associated with mortality and poor prognosis.Its main symptoms are disturbed cognitive functions and consciousness, including decreased attention, delirium, lethargy, coma, mood changes.At present, the pathogenesis of SAE has not been clearly explained, and the diagnosis and treatment are still controversial.Many of the survivors suffer from long-term cognitive impairment, which imposes heavy burdens on patients, families and society.Therefore, SAE needs to attract the attention of clinicians.

Disseminated intravascular coagulation(DIC) remains a challenging syndrome for intensivists, as the markers enabling its identification are lacking, and the treatment is patient dependent.The process underlying DIC is a complex interlinked framework of proteases of both the coagulation and inflammatory cascades, thus explaining the difficulty in DIC management.Identification can be accomplished with scoring systems such as the DIC score, and treatment begins with identification and treatment of the underlying infectious cause.Supportive care and correction of coagulopathies should be provided simultaneously to prevent irreversible end-organ injury and DIC progression.

Sepsis is frequently complicated by multiple organ dysfunctional syndrome, and particularly by acute kidney injury.Sepsis-associated acute kidney injury(SAKI)is associated with high risk of hospital mortality and worse disability.The pathophysiological mechanisms for SAKI are still not fully defined.More importance is now increasingly attributed to immunologic and inflammatory mechanisms, along with the activation of the coagulation cascade, triggering adaptive responses of apoptotic cell death and sublethal injury of tubular epithelial cells (TECs)that amplify and potentiate microvascular and endothelial damage.Continuous renal replacement therapy(CRRT)can remove toxins and inflammatory factors, maintain hemodynamics, moderate fluid imbalance.The mode include continuous veno-venous hemofiltration, high volume hemofiltration, continuous veno-venous hemodiafiltration, and etc.But the CRRT timing and dosage need further inquiry.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.Proper endocrine adjustment is required for self-protection of the body during stress conditions; however, decompensation is harmful.It has been proved that violent stress response caused by sepsis can lead to endocrine decompensation and is harmful to children during clinical course and prognosis.

Septic shock is the most serious type of sepsis.Despite detailed treatment recommendations at domestic and abroad guidelines, some patients with septic shock have no response to treatment, and progress rapidly and develop into multiple organ failure leading to death.The recent guidelines and consensus of septic shock recommended extracorporeal membrane oxygenation(ECMO)as the last resort rescue for children with septic shock.However, worldwide consensus for ECMO application in children with septic shock is not available at the present time.Clinical conditions that ECMO should be initiated, ECMO catheterization method and prognosis of children received ECMO support are still controversial.The aim of this article was to review ECMO application in children with septic shock.

Considering that the pathological changes are inconsistent with severe organ dysfunction of sepsis.It is urgent to explore the other pathogenetic mechanisms besides inflammation and immunity.A extraordinary explanation for multiple organ dysfunction is associated with mitochondrial dysfunction during sepsis.Although the exact relationship between them is not proved, and therapeutic strategy is suggested to promote the organs function by improving mitochondrial metabolism for sepsis.This article focused on mitochondrial biology, mitochondrial dysfunction, metabolic disorder and mitochondrial resuscitation in sepsis.

Objective: To demonstrate the relevance of heart-type fatty acid binding protein(H-FABP) and brain glycogen phosphorylase isoenzyme type(GPBB) with myocardial injury in sepsis.To explore the effect of H-FABP and GPBB on the severity of disease and clinical prognosis. Methods: A total of 40 cases of children with sepsis were selected in this study from January 1, 2017 to October 31, 2017.According to the illness severity, they were divided into sepsis group(n=15), severe sepsis group(n=13) and septic shock group(n=12), 19 cases of children with non-infectious diseases were selected as the control group for the same period.The levels of serum WBC, C-reactive protein, procalcitonin, cTnI, CK, CK-MB, CK-MB isoenzyme quality and NT-proBNP were collected within 24 hours of admission.The APECHEⅡ scores were calculated for each child.The peripheral blood of the patients within 24 hours after admission was used to determine the levels of serum H-FABP and GPBB by ELISA method.The differences of clinical indicators among the groups were analyzed.According to the survival of patients with sepsis, they were divided into 37 cases in the improved group and 3 cases in the death group.All patients with sepsis were divided into left ventricular ejection fraction(LVEF) normal group(n=26) and LVEF decreased group(n=14). According to whether the serum cTnI was elevated, all children with sepsis were divided into cTnI normal group (n=29) and cTnI increased group (n=11). The differences of H-FABP and GPBB levels were compared.According to the presence or absence of LVEF decline, the area under the ROC curve was used to evaluate the predictive power of each index for myocardial injury in sepsis.Based on the decrease of LVEF, the area under the ROC curve was used to evaluate the prediction of each index for myocardial injury in sepsis. Results: There were significant differences in H-FABP and GPBB levels among the control group, sepsis group, severe sepsis group and the septic shock group (H=42.241, P<0.05; H=32.486, P<0.05). Although there was no significant difference between the improved group and the death group(P>0.05), there was an elevated trend of H-FABP and GPBB in the death group.The levels of H-FABP (t=-3.770, P=0.001) and GPBB (Z=-2.113, P=0.033) were statistically significant in the LVEF normal group and the LVEF decreased group (LVEF≤60%). There were no significant differences in the levels of H-FABP and GPBB between the cTnI normal group and the cTnI increased group (P>0.05), but the cTnI increased group had an increasing trend.The area under the ROC curve in the diagnosis of myocardial injury in sepsis were H-FABP 0.821, NT-ProBNP 0.738, GPBB 0.661, CK 0.560, cTnI 0.512, in which the sensitivity(0.833) and specificity(0.786)of H-FABP were both higher. Conclusion The serum H-FABP and the GPBB levels can be used to monitor for myocardial damage, and it has a correlation with the severity of the disease and the prognosis.H-FABP has a significant advantage over traditional myocardial markers in sensitivity and specificity to determine the myocardial injury of sepsis.

Objective: To understand the present situation of the emergency ability of the pediatrics in township hospital of Hunan province, and to provide the basis for improving the treatment of critical diseases and strengthening the medical quality in basic hospital. Methods: Status survey, expert consultation, on-spot examination, and questionnaire were conducted.One representative of the 1 217 township hospitals participating in the appropriate health technologies for pediatric emergency was sent to a face-to-face survey by investigators. Results: In 1 217 township hospitals, only 965 pediatricians had been certified.Among them, 58 township hospitals did not purchase the first aid equipment in the scope of the survey, and 211 township hospitals were not equipped with first aid drug.Less than 30% of township hospitals had tracheotomy kits, cardiac defibrillator and first aid equipment such as neonatal incubator, newborn radiation table and infusion pump.Among the trained 1 095 general practitioners, only 305(27.85%) understood the basic first-aid knowledge of this training in pediatrics; 258(258/1 217, 21.20%) township hospitals could not carry out 7 pediatric emergency projects of this survey.The proportion of the capable of carrying out rescue treatment including acute respiratory failure (191/1 217, 15.69%), heart failure (201/1 217, 16.52%) and shock(227/1 217, 18.65%) in township hospitals were less than 30%. Conclusion The primary hospital is the basis for the treatment of critical diseases in pediatrics, but the level of diagnosis and treatment and basic equipment need to be further strengthened.The urgent task is to strengthen the training of medical and nursing staff in the treatment of critical diseases in pediatrics.

Objective: To analyze the clinical characteristics of children′s trematodiasis in order to enhance the level of clinical diagnosis and treatment. Methods: The medical history, clinical manifestations, results of laboratory examination, conditions of diagnosis and treatment of 15 confirmed different types of children with trematodiasis from 2002 to 2017 in Shanghai Children′s Medical Center were retrospectively analyzed. Results: Seven cases had eaten raw or undercooked freshwater crab, and 2 cases often drank raw stream or caught crabs.Five cases had polyserositis such as pleural effusion, ascites and pericardial effusion in different degrees.The eosinophil counts of 11 cases(73.3%) and IgE of 10 cases(76.9%) increased.Fifteen cases, trematodiasis serum antibody tests were positive, and 1 case′s fecal clonorchiasis was positive.Fifteen cases were improved by praziquantel. Conclusion The clinical characteristics of childhood trematodiasis are complex and atypical.Trematodiasis should be understood more deeply for clinician to avoid misdiagnosis.Praziquantel is a safe and effective drug for trematodiasis.