All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.
Bronchoscopy/*statistics & numerical data ; Hospitals, Pediatric/*statistics & numerical data ; Malaysia ; Respiratory Tract Diseases/*pathology ; Respiratory Tract Diseases/*surgery

OBJECTIVEAcute intracranial hypertension/cerebral edema (ICH/CE) is an increase in brain volume caused by an absolute increase in cerebral tissue water content. Severe ICH/CE is often associated with a higher mortality and higher neurological consequence rate in intensive care unit. However, little relevant information is available on critical condition of central nervous system in children. The aim of this survey was to study the causes, clinical epidemiology and risk factors of critical illness with ICH/CE in pediatric intensive care unit (PICU).

METHODSCase records of critically ill patients with ICH/CE admitted to PICU in Children's Hospital Affiliated to Shanghai Jiaotong University during the period from January, 1999 to December, 2003 were reviewed for causes, case fatality rate, prognosis and relationship with multiple organ dysfunction syndrome (MODS). Univariate analyses were performed to identify risk factors associated with ICH/CE.

RESULTSDuring the 5 years, 1446 cases with critical illnesses were admitted and ICH/CE developed in 216 patients. The leading causes of ICH/CE were central nervous system infection (27.8%), accidental injuries (22.4%), and sepsis (10.2%). The overall mortality of the patients with ICH/CE was 29.2%. The mortality showed no significant change during the years from 1999 to 2003 (chi(2) = 0.371, P = 0.985). There was no significant difference in mortality of patients with ICH/CE between those with and without neurological diseases (chi(2) = 0.546, P = 0.460). Univariate analyses involving 12 factors indicated the following risk factors: younger age, number of failed organ, lower pediatric critical illness score, underlying diseases, abnormal respiration and change in size of pupil (P < 0.05 or < 0.001). The following factors were not associated with higher risk of death from ICH/CE: sex, organ of primary disease, Glasgow coma score ( 7) on admission, elevated blood pressure and anterior fontanelle change (P > 0.05).

CONCLUSIONSThe mortality of ICH/CE remains high since 1999. Central nervous system infection, accidental injuries, and sepsis were leading causes of ICH/CE in PICU of the hospital. Children who had ICH/CE due to younger age, lower pediatric critical illness score, and complicated with MODS had a higher mortality rate.

Acute Disease ; Brain Edema ; mortality ; Child ; China ; epidemiology ; Critical Illness ; Hospitals, University ; Humans ; Intensive Care Units, Pediatric ; statistics & numerical data ; Intracranial Hypertension ; mortality ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVETo summarize the spectrum of disease and common diseases that cause death in children admitted to the Pediatric Intensive Care Unit (PICU), Shengjing Hospital of China Medical University between 2005 and 2012.

METHODSA retrospective analysis was carried out on the clinical data of 4484 children admitted to the PICU of Shengjing Hospital between 2005 and 2012.

RESULTSAcute bronchopneumonia, which was found in 1099 (24.51%) of the 4484 cases, was the most common disease in the PICU between 2005 and 2012. The incidence of intracranial infection, sepsis, hand-foot-mouth disease and trauma showed an increasing trend from 2005 to 2012, but that of non-traumatic intracranial hemorrhage, epilepsy and congenital heart disease showed a decreasing trend. The mortality decreased from 11.5% in 2005 to 3.1% in 2012, and the overall mortality was significantly higher in 2005-2008 than in 2009-2012 (11.98% vs 4.41%; P<0.01). The main causes of death included severe acute bronchial pneumonia, severe sepsis, complex congenital heart disease, severe cerebral trauma, respiratory failure, severe hand-foot-mouth disease, acute poisoning and circulatory failure.

CONCLUSIONSAcute bronchopneumonia was the most common disease in the PICU of Shengjing Hospital between 2005 and 2012, but the spectrum of disease changed over time. The mortality showed a decreasing trend among the children in the PICU between 2005 and 2012, and the main causes of death included severe acute bronchial pneumonia and severe sepsis.

Adolescent ; Cause of Death ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Hospital Mortality ; Hospitals, University ; Humans ; Infant ; Intensive Care Units, Pediatric ; statistics & numerical data ; Male ; Retrospective Studies ; Time Factors

OBJECTIVETo systematically review and assess the relationship between particulate matter (PM(10) and PM(2.5)) and children's hospital admissions for asthma, using both time-series and case-crossover analyses.

METHODThe PubMed, Ebsco, Ovid and four Chinese periodical databases were screened for studies related to short-term effects of particulate matter on pediatric asthma hospital admissions published from 1 January 1990 to 31 December 2013.Sixteen studies on PM(10) and 10 studies on PM(2.5) were selected finally for meta-analysis. Relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CI) of asthma hospital admissions per 10 µg/m³ increase of daily particulate matter were obtained from each study. RevMan 5.2.11 was used to test the heterogeneity of the results among the different studies and amalgamat the effect size by fixed or random effect model.

RESULTAs the concentration of PM(10) increased per 10 µg/m³, the children's hospital admissions for asthma increased by 1.75%; for PM(2.5), a 3.45% increase for asthma hospital admissions as the concentration increased per 10 µg/m³. By subgroup analysis based on study design, the effect size on both PM(10) and PM(2.5) of case-crossover study's results were higher than time-series analysis.

CONCLUSIONThe short-term increase of the concentration of PM(10) and PM(2.5) may led to the increase of Children's hospital admissions for asthma, and PM(2.5) will present a higher risk contribution.

Air Pollutants ; adverse effects ; Asthma ; epidemiology ; Child ; China ; epidemiology ; Cross-Over Studies ; Hospitalization ; statistics & numerical data ; Hospitals, Pediatric ; Humans ; Odds Ratio ; Particulate Matter

OBJECTIVETo learn application status of continuous blood purification (CBP) in pediatric intensive care unit (PICU), to provide reference to promote the development of CBP technology.

METHODThe survey of CBP application was conducted using questionnaire in 40 hospitals providing intensive care, which included children's hospitals and the pediatric sections of general hospitals from 28 provinces/municipalities/autonomous regions in China during March to July of 2012.

RESULTTotally 38 hospital replied, 25 hospitals carried out CBP technology, first carried out in 1997, the median year was 2008, 21 hospitals' PICU could independently carry out CBP device, 18 hospitals had the nurses who could professionally operate, routinely maintain the device. Continuous veno-venous hemodiafiltration was the largest implementation mode of CBP, accounting for 51.9%. Twenty-three hospitals used ordinary heparin, and 2 hospitals used low molecular weight heparin; 21 hospitals chose activated partial thromboplastin time as the coagulation testing, due to lack of equipment, only four hospitals chose activated clotting time as coagulation testing. Only 3 hospitals could apply before and after dilution joint technology. Kidney failure is still the disease accounting for the highest proportion of diseases requiring CBP application, accounting for 38.1%, followed by sepsis, 19.1%, drug poisoning 16.7%.

CONCLUSIONCBP started 10 years ago, and got attention and promotion nearly five years ago in China, but the associated personnel, equipment were inadequate, anticoagulation, before and after dilution and other technical applications were not complete enough, high volume hemofiltration mode was seldom used.

Anticoagulants ; administration & dosage ; Child ; China ; epidemiology ; Hemofiltration ; methods ; statistics & numerical data ; Heparin ; administration & dosage ; Hospitals, Pediatric ; Humans ; Infant ; Intensive Care Units, Pediatric ; Partial Thromboplastin Time ; Renal Dialysis ; methods ; Renal Insufficiency ; therapy ; Sepsis ; therapy ; Surveys and Questionnaires

OBJECTIVETo study the epidemiological status on rotavirus diarrhea in Kunming to improve the rotavirus vaccine immunization program.

METHODSA hospital-based sentinel surveillance program for rotavirus was set up among children less than 5 years old with acute diarrhea in Kunming Children's Hospital. Clinical information and fecal specimens were collected and rotavirus were detected by polyacrylamide gel electrophoresis (PAGE) and/or enzyme linked immunosorbent assay (ELISA). Positive specimens were further serotyped or genotyped by ELISA and/or RT-PCR.

RESULTSDuring the three years of surveillance, 466 specimens were collected. Rotavirus were detected on 246 (52.8%) specimens. 97% of the rotavirus diarrhea cases occurred among children less than 2 years old. There was a peak of admissions for rotavirus diarrhea cases between October and December which accounted for 48% of all the rotavirus hospitalizations each year. Among 204 specimens with G serotyping, the predominant strain was serotype G1 (47.5%) followed by G2 (17.6%), G3 (15.7%), G9 (4.9%) and G4 (1.0%). Mixed infection (2.5%) were rare and 22 specimens (10.8%) remained non-typeable. P genotyping showed P[4], P[8] and P[6] were the most common strains, accounting for 29.3%, 27.6% and 13.8% respectively. P[4]G2 was the most common strain which accounted for 34.1% (14/41) followed by P[8]G1 (29.3%) and P[6]G9 (12.2%). Another 7 uncommon P-G combinations were also identified.

CONCLUSIONRotavirus was the major cause of acute diarrhea in Kunming. An effective rotavirus vaccine for prevention and control of rotavirus diarrhea should be developed.

Child, Preschool ; China ; epidemiology ; Diarrhea ; virology ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Female ; Genotype ; Hospitals, Pediatric ; statistics & numerical data ; Humans ; Infant ; Male ; Reverse Transcriptase Polymerase Chain Reaction ; Rotavirus ; classification ; genetics ; isolation & purification ; Rotavirus Infections ; epidemiology ; Sentinel Surveillance ; Serotyping

OBJECTIVETo summarize the clinical characteristics of whooping cough in children and analyze the risk factors for severe whooping cough.

METHODA retrospective analysis was made on the clinical data of 247 children with whooping cough in Children's Hospital of Chongqing Medical University between Jan 2013 and Dec 2014. Of these patients, 126 were male, 121 were female, the median age was 3.1 months (23 days-4 years and eight months old). The patients were divided into two groups, group 1 had infants less than 3 months of age (n=120) and group 2 had infants and young children older than 3 months (n=127) according to their age. On the other hand, the patients were also divided into two groups according to vaccination status: vaccinated group (received diphtheria toxoid, tetanus toxoid, and acellular pertussis, DTP) (n=31) and unvaccinated group (n=188). Pure Bordetella pertussis infection was seen in 106 cases, and 141 cases had mixed infection. Severe disease was seen in 13 cases, and the other 234 cases had the modest disease. Clinical data were retrospectively analyzed and compared.

RESULT(1) Bordetella pertussis was identified in 57/680 cases (8.4%) in 2013, and 190/1 856 cases (10.2%) in 2014. The disease could be seen throughout the year, but 182 cases (73.7%) occurred in summer or autumn; 202 cases (81.8%) were less than 6 months. (2) Paroxysmal cough was seen in 238 cases (96.4%) , 61 cases (24.7%) had inspiratory whoop. Infants in group 1 often had episodes of cyanosis, apnea and suffocation (χ² = 19.999, 12.081, 6.508, P<0.05), persistent cough was often seen in group 2 (χ² = 9.885, P<0.05). Complications such as severe pneumonia, pulmonary consolidation and encephalopathy were more common in the group 1 than in group 2 (χ² = 17.340, 6.080, 11.030, 23.545, P<0.05). (3) The length of stay of group 1, and of unvaccinated group was significantly longer than that of group 2 and of vaccinated group (t=19.331, 26.741, P<0.05). (4) Leukocytosis was found in 224 cases (90.7%), 182 cases (73.7%) had predominant lymphocytosis. White blood cell in group 1, unvaccinated group and severe disease group was higher than the corresponding group (t=11.075,13.739,3.469, P<0.05). (5) Patients who had a history of exposure, fever, leukocytosis and pulmonary consolidation or atelectasis on chest imaging were prone to develop into severe pertussis (OR=4.521, 4.900, 1.085, 4.792, 50.400; P<0.05). A total of 244 cases (98.8%) recovered, 3 cases (1.2%) died, they were less than 3 months old and unvaccinated.

CONCLUSIONThe number of cases with whooping cough in Chongqing area tends to be rising. The disease occurred mostly in summer and fall. Infants less than 3 months old, unvaccinated with DTP had high susceptibility to pertussis, often had a severe clinical presentation and severe complications, had a high mortality rate.

Bordetella pertussis ; Brain Diseases ; Child, Preschool ; China ; epidemiology ; Cough ; Cyanosis ; Female ; Fever ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Leukocytes ; Lymphocytosis ; Male ; Pulmonary Atelectasis ; Retrospective Studies ; Risk Factors ; Seasons ; Vaccination ; statistics & numerical data ; Whooping Cough ; epidemiology

INTRODUCTIONThis study aimed to determine the usefulness and validity of the triaging scale used in our emergency department (ED) by analysing its association with surrogate clinical outcome measures of severity consisting of hospitalisation rate, intensive care unit (ICU) admission, length of ED stay, predictive value for admission and length of hospitalisation.

METHODSA retrospective observational study was conducted of the performance markers of the Singapore Paediatric Triage Scale (SPTS) to identify children who needed immediate and greater care. All children triaged and attended to at the paediatric ED at KK Women's and Children's Hospital, Singapore, from 1 January 2014 to 31 December 2014 were included. Data was retrieved from the Online Paediatric Emergency Care system, which is used for patients' care from initial triaging to final disposition.

RESULTSAmong 172,933 ED attendances, acuity levels 1, 2 plus, 2 and 3 were seen in 2.3%, 26.4%, 13.5% and 57.8% of patients, respectively. For admissions, triage acuity level 1 had a strong positive predictive value (79.5%), while triage acuity level 3 had a strong negative predictive value (93.7%). Fewer patients with triage acuity level 3 (6.3%) were admitted as compared to those with triage acuity level 1 (79.5%) (p < 0.001). There was a correlation between triage level and length of ED stay.

CONCLUSIONThe SPTS is a valid tool for use in the paediatric emergency setting. This was supported by strong performance in important patient outcomes, such as admission to hospital, ICU admissions and length of ED stay.

Child ; Child, Preschool ; Critical Care ; statistics & numerical data ; Emergency Service, Hospital ; Female ; Hospitalization ; Hospitals, Pediatric ; Humans ; Infant ; Intensive Care Units ; Length of Stay ; Male ; Patient Admission ; Pediatrics ; methods ; Predictive Value of Tests ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome ; Triage ; methods

Administration, Oral ; Analysis of Variance ; Anti-Bacterial Agents ; therapeutic use ; Cohort Studies ; Databases, Factual ; Disease Progression ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Follow-Up Studies ; Hospitalization ; statistics & numerical data ; Hospitals, Pediatric ; Humans ; Incidence ; Infusions, Intravenous ; Logistic Models ; Male ; Multivariate Analysis ; Orbital Cellulitis ; diagnosis ; drug therapy ; epidemiology ; microbiology ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore ; Treatment Outcome

OBJECTIVETo establish baseline patterns of rotavirus diarrhea and to describe its epidemiologic features in Changchun city, prior to rotavirus vaccine immunization.

METHODSHospital-based surveillance was conducted among children under 5 years old with acute diarrhea in Changchun Children's Hospital. Fecal samples were determined to identify rotavirus by PAGE and/or ELISA. G serotypes of rotavirus were identified by ELISA and/or nested RT-PCR. P genotyping were carried out by RT-PCR. All data were computerized and analysed by "Generic Manual on Rotavirus Surveillance" set by CDC in the USA.

RESULTSIn total, 2 343 diarrhea cases were screened and 1 211 fecal samples were collected. Rotavirus was detected in 31.0% among outpatients and 52.9% in inpatients. During the peak of the season (November through March), 58.6% of diarrhea was caused by rotavirus among inpatients. 95.0% of rotavirus diarrhea cases occurred among children aged < 2 years. The predominant strain was serotype G1 (82.4%), followed by G2 (5.0%), G3 (3.3%), G4 (0.9%). P genotyping showed that P[8] and P[4] were the most common ones. Nine different P-G combinations were identified, four strains (P[8]G1, P[4]G2, P[8]G3, and P[8]G4) commonly seen worldwide accounted for 75.6% of the total. Taken together with uncommon strains, including the novel types P[4]G4 and P[8]G2, it highlights the extraordinary diversity of rotaviruses circulating in China.

CONCLUSIONRotavirus is the major cause of severe child diarrhea in Changchun. Developing a rotavirus vaccine for prevention of severe disease and reduction of treatment costs seemed to be necessary.

Child, Preschool ; China ; epidemiology ; Diarrhea ; etiology ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Feces ; virology ; Female ; Genotype ; Hospitals, Pediatric ; statistics & numerical data ; Humans ; Infant ; Male ; Reverse Transcriptase Polymerase Chain Reaction ; Rotavirus ; classification ; genetics ; isolation & purification ; Rotavirus Infections ; complications ; epidemiology ; virology ; Sentinel Surveillance ; Serotyping