Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.

Objective:To summary the mixed infection as well as clinical characteristics and analyze the risk factors for mixed infection of severe adenovirus pneumonia(SAP) in children.Methods:The clinical data of 114 children with SAP were retrospectively analyzed.Multivariate Logistic regression analysis was performed to assess the risk factors for mixed infection.Results:The incidence age was from 6 months to 2 years(62.5%). High fever(94.7%), cough(98.2%), dyspnea(86.8%) and lethargy(95.6%) were the main symptoms.Laboratory examination showed that children with SAP were prone to increased white blood cell count, C-reactive protein, procalcitonin, aspartate aminotransferase, alanine aminotransferase and CK-MB, as well as decreased proportion of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + and NK cells.The main complications intrapulmonary organ were respiratory failure(80.7%). The main complications extrapulmonary organ were circulatory complications (55.3%). SAP was easily combined with other pathogenic infections.Streptococcus pneumoniae(22.9%)was the most common bacterial pathogen.Respiratory syncytial virus(10.0%)were the most common virus, in addition, mycoplasma pneumoniae(17.1%) was also common.Multivariable Logistic regression analysis showed that the decreasing ratio of CD4 + /CD8 + and NK cells, congenital heart disease and congenital airway dysplasia were the independent risk factors for mixed infection of SAP in children( P<0.05). Conclusion:The SAP patients could easily suffer from mixed infection and high fatality rate.Immune dysregulation is the important risk factors for mixed infection of SAP in children.So immunoregulatory treatment is very important.

Objective:To discuss the role of continuous blood purification (CBP) therapy in children with severe adenovirus pneumonia.Methods:A total of 114 children with severe adenovirus pneumonia admitted to the Department of PICU at Children′s Hospital of Hunan Province from June 2018 to July 2019 were selected as the research objects.According to whether treated with CBP, they were divided into CBP group and control group.The following indicators during the process of treatment were compared between two groups, including respiratory mechanics indicators[respiratory index(PaO 2/FiO 2), dynamic lung compliance(Cdyn)]; hemodynamic indicators(heart rate and mean arterial pressure); changes in levels of inflammatory factors interleukin(IL)-6, IL-10, tumor necrosis factor(TNF)-α and the prognosis 28 days after admission. Results:The respiratory mechanics index, serum IL-6 and TNF-α levels of two groups after treatment were significantly lower than those before treatment, and the serum IL-10 level was significantly higher than that of this group before treatment.There were statistical differences in the CBP group before and after treatment, while there was no statistical difference in control group.In the CBP group, the serum IL-6 and TNF-α levels after treatment were significantly lower than those of the control group( P<0.05), and the serum IL-10 level was significantly higher than that of the control group( P<0.05). The 28-day mortality rate of patients in CBP group was 8.6%(3/35), which was significantly lower than 13.9%(11/79) of control group ( P<0.05). Conclusion:CBP could improve the main respiratory mechanical indexes of adenovirus pneumonia and decrease the level of inflammatory cytokines.

Objective:To retrospectively analyze the clinical application of extracorporeal membrane oxygenation (ECMO) in severe adenovirus pneumonia, and to evaluate the application value of ECMO in children with severe adenovirus pneumonia.Methods:Children diagnosed with severe adenovirus pneumonia and intervened with ECMO in the Hunan Children′s Hospital from January 1, 2018 to December 31, 2019 were recruited in this study for analyzing.The gender, age, clinical manifestations, mechanical ventilation duration, ECMO duration, the length of hospital stay, complications and prognosis were collected and analyzed.Results:A total of 4 children were included in the study, involving 2 cases were successfully evacuated from ECMO.Finally, 3 children died, and 1 case survived.Three death cases had a longer than 18 days of duration from the onset to the start with ECMO.Their ventilator assist time before star-ting ECMO was 3-5 days, and ECMO intervention time was longer, with the maximum of 27.5 days.The survived case had an 11-day duration from the onset to the start with ECMO, and the ventilator assisted time and ECMO intervention time were 5 days, and less than 10 days, respectively.Conclusions:ECMO treatment for children with severe adenovirus pneumonia has a low success rate, but it is still the most important way to save children.Early application of ECMO can improve the prognosis of children with severe adenovirus pneumonia.

Objective To compare the clinical efficacy of different blood purification methods in children with acute liver failure,and to explore the clinical application mode,time and prognosis of blood pur-ification in children with acute liver failure. Methods The clinical data of 85 children with acute liver failure admitted to PICU of Hunan Children′s Hospital from January 2010 to October 2016 were retrospectively ana-lyzed. Sixteen patients were treated with general integrated medical treatment(conservative group). Twenty-seven patients were treated with continuous venovenous hemodiafiltration ( CVVHDF) model non-biological artificial liver on the basis of general integrated medical treatment(CBP group). Sixteen cases were treated with plasma exchange ( PE group). Twenty-six cases were treated with plasma exchange combined with CVVHDF mode (combination group). The main biochemical indexes,coagulation function,model for end-stage liver disease(MELD) score and delta MELD before and after treatment among groups were compared. Results Compared with those before treatment,the improvement of liver function and prognosis in the con- servative was not significant after treatment. There were significant differences in the improvement of liver function and prognosis among the other three groups treated with non-biological artificial liver. Comparing the biochemical indexes and prognosis of three groups of children treated with different modes of non-biological artificial liver,there was no significant difference in the total effective rate between PE group and CBP group [56. 3% (9/16) vs 55. 6% (15/27),P>0. 05]. The total effective rate of combined group[84. 6% (22/26)] was significantly higher than those of PE group and CBP group. There was no significant difference in the improvement of liver function between PE group and CBP group (all P>0. 05),but the indexes of liver function in combined group were significantly lower than those in PE group and CBP group ( P<0. 05). It significantly increased prothrombin activity,albumin and alpha-fetoprotein levels(all P<0. 05). At the same time,procalcitonin, sequential organ failure assessment scores, pediatric end-stage liver disease scores and MELD scores in the death group were significantly higher than those in the survival group,and there were significant differences between the two groups. However,the effect of non-biological artificial liver was not good in the subgroups of MELD<25 and MELD>40. Conclusion PE and CBP have a good effect on chil-dren with acute liver failure,and if combined with the two methods can improve the therapeutic effect. At the same time,MELD score should be monitored in children with acute liver failure,and non-biological artificial liver therapy should not be recommended for children with MELD<25 and MELD>40.

Objective To explore the application value of the FilmArray detection system in the diagnosis and treatment of severe pneumonia in children,and to understand the pathogenic characteristics of severe pneumonia in children.Methods A tolal of 158 nasopharyngeal swab specimens were collected from children with severe pneumonia in Hunan Children's Hospital from May 2017 to March 2018.FilmArray were used to detect respiratory pathogen.Blood routine,C-reactive protein (CRP),procalcitonin (PCT) and seven kinds of respiratory virus antigen were also performed on all the samples.The pathogenic characteristics of 158 cases of severe pneumonia were analyzed,and the positive rate of seven kinds of respiratory virus antigen test method and FilmArray were statistically analyzed.Results Among 158 patients with severe pneumonia,114(72.15％) were positive and 91 (57.59％) single pathogen infection were detected by FilmArray,with the highest detection rate of rhinoviruses/enteroviruses (16.46％).23(14.56％) mixed infection were detected by FilmArray,respiratory syncytial virus combined with adenovirus infection had the highest positive rate (2.53％).The detection of respiratory pathogens in different age groups was analyzed.The highest positivity rates of children aged ＜ 1 years were human rhinovirus/enterovirus and respiratory syncytial virus (25％),＞ 1-3 years was human rhinovirus/enterovirus (25％),3-5 years were influenza virus A and adenovirus (27.27％),＞ 5 years was human rhinovirus/enterovirus (26.08％).Among 158 patients,53(33.54％) had bacterial infection,and the most common bacterial infection was Streptococcus pneumoniae (7.59％).In seven respiratory virus antigen test negetive children,PCT in Film Array negative group was higher than that in Film Array positive group (P =0.03).The positive rate of FilmArray was higher than that of the seven respiratory virus antigen test method (72.15％ vs 19.62％,P ＜0.01).The level of white blood cell and cough days in pertussis group were higher than that in non-pertussis group,which was significantly different (P ＜ 0.01).The PCT level in non-pertussis group was higher than that in pertussis group,with significant difference (P ＜ 0.01).Conclusions FilmArray detection can detect 20 kinds of respiratory tract pathogens rapidly and accurately.The positive rate of detection is high,and the diagnosis rate of virus is improved.The combination of infection indicators and sputum culture results by clinicians can better guide the clinical diagnosis and treatment.

Objective To evaluate the efficacy and safety of nasal continuous positive airway pres-sure (NCPAP) in treatment of severe pneumonia in children. Methods A series of 150 children with severe pneumonia were prospectively included from January 2016 to June 2017. The 150 children all still had short-ness of breath after 1 hours of nasal oxygen delivery,and then switched to NCPAP. We collected related clini-cal parameters (the basic vital signs,blood gas analysis index,shortness of breath,wheezing,groaning,nasal incitement,three depressions sign and NCPAP parameters) at three time points,including 0 h,1 h,4 h after using NCPAP. We compared the clinical parameters among the three time points before and after NCPAP with the purpose to assess the efficacy and safety of NCPAP. Results The proportion of shortness of breath (χ2=272. 218,P=0. 01),fast heart rate(χ2=31. 625,P=0. 01),wheezing(χ2=7. 624,P=0. 02),moaning (χ2=7. 203,P=0. 025),nasal flaring(χ2=74. 032,P＜0. 01),three depressions sign(χ2=117. 030,P＜0. 01) gradually decreased with statistically different among 0 h,1 h and 4 h after using NCPAP. PaO2/FiO2 (F=7. 32,P＜0. 01) gradually increased with statistically different among 0 h,1 h and 4 h after using NCPAP. Twenty-seven patients required intubations. PaO2and PaO2/FiO2in patiens received intubations were lower than those in patients only received NCPAP before treatment. Conclusion NCPAP is an effective and safe way for severe pneumonia children who remained abnormal breathing after conventional oxygen inhalation.

Objective To investigate the clinical efficacy and safety of continuous blood purification (CBP) in the treatment of severe sepsis in infants. Methods A retrospective analysis of 40 infants with severe sepsis treated with CBP was performed at PICU of Hunan Children's Hospital from January 2014 to July 2017,and 50 infants with severe sepsis who were not treated with CBP at the same period were enrolled as control group. The indicators included blood gas analysis,lactic acid (Lac),blood glucose,electrolytes, blood routine,C-reaction protein ( CRP) and procalcitonin ( PCT),alanine aminotransferase ( ALT) and aspartate aminotransferase (AST),total bilirubin(TB),urea nitrogen (BUN),serum creatinine (Scr) and creatine kinase isoenzyme MB (CK-MB),pediatric critical illness score (PCIS). Results (1) After 3 days of treatment,the recovery of body temperature,heart rate,respiratory rate and blood pressure in CBP group were better than those in the control group,and the differences between two groups were statistically signifi-cant(P < 0. 05). (2) After treatment,the levels of base excess(BE),Lac,white blood cell (WBC),PCT, CRP,ALT,AST,TB and BUN of CBP group recovered better than those of the control group,the differences were statistically significant (P < 0. 05). (3) The ΔPCIS (D3-D1) of CBP group was higher than that of the control group,and the difference between two groups was statistically significant (P < 0. 05). (4) The fatali-ty rate of CBP group was lower than that of the control group,and there was no significant difference between two groups (P > 0. 05). (5) Two cases of thrombocytopenia,2 cases of femoral vein thrombosis,2 cases of hypovolemic shock,and 1 case of blood coagulation in filter happened in CBP gruop,all cases had no punc-ture site infection. Conclusion CBP can improve the vital signs,internal environment,inflammatory reaction and organ function of infants with severe sepsis,and the effect is better than that of traditional methods. The complications of CBP in infants with severe sepsis are relatively large,so we should strictly master the indica-tions of CBP in the treatment of severe sepsis in children.

Objective To study the clinical data of patients treated with nasal continuous positive airway pressure (NCPAP) in PICU,and to explore the application time and range of NCPAP in critically ill children. Methods A prospective study was conducted to collect clinical data of 192 severe patients admitted to PICU from January 2016 to June 2017 who had shortness of breath after giving oxygen through nasal cath-eter for 1 hour and then switched to NCPAP. According to using NCPAP oxygen partial pressure,children were divided into three groups:group A[ shortness of breath ( PaO2≥70 mmHg,1 mmHg＝0. 133 kPa) ], group B[shortness of breath combined,reduced oxygen partial pressure(50mmHg

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.