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Effect of postural drainage assisting trachea suction on meconium aspiration syndrome

Jinqiong SU ; Xiaoyu ZHU ; Chuanzhong YANG ; Shixin YUAN

Chinese Pediatric Emergency Medicine.2010;17(5):421-423. doi:10.3760/cma.j.issn.1673-4912.2010.05.016

Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.

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Comparison of Hamm and Zhoushousheng's formulae for expected compensation in acid-base imbalance

Guoqiang WEI ; Juan CHEN ; Yinguo WANG ; Xiaochun LUO ; Xinfeng YAO

Chinese Pediatric Emergency Medicine.2010;17(5):413-415. doi:10.3760/cma.j.issn.1673-4912.2010.05.013

Objective To compare the difference and rationalities between Harmm and Zhou' s formulae for expected acid-base compensation in acid-base imbalance. Methods 745 cases of arterial blood gas analysis results of acid-base disorder were evaluated respectively by Hamm and Zhou' s formulae, and the concordance was judged. Results For metabolic acidosis ( 108 cases), the concordance rate was 70. 4% between Hamm and Zhou's( Kappa value =0. 41 ,P ＜0. 01 ) ;for metabolic alkalosis ( 132 cases) ,the concordance rate was 59. 1% ( Kappa value =0. 18 ,P ＜0. 05) ;for acute respiratory acidosis(81 cases) ,the concordance rate was 65.43% ( Kappa value = 0. 31, P ＜ 0. 01 ) ;for acute respiratory alkalosis ( 168 cases), the concordance rate was 54. 8% ( Kappa value = 0. 24%, P ＜ 0. 01 ); for chronic respiratory acidosis ( 119 cases ), the concordance rate was 67.2% ( Kappa value = 0. 41, P ＜ 0. 01 ) ;for chronic respiratory alkalosis( 137 cases), the concordance rate was 66. 6% ( Kappa value = 0. 43, P ＜ 0. 01 ). Conclusion The difference between Hamm and Zhou' s formulae for expected acid-base compensation in acid-base imbalance was obvious. The Zhou' s expected max compensation coefficient were slightly higher than the primary adopted compensation coefficient.

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Early biomarkers for acute kidney injury

Ling HOU

Chinese Pediatric Emergency Medicine.2010;17(5):454-456. doi:10.3760/cma.j.issn.1673-4912.2010.05.031

Acute kidney injury (AKI) represents a common and devastating problem in clinical medicine. The lack of early biomarkers for AKI has led to a delay in initiating potentially effective therapies.Identification of novel biomarkers for AKI has progressed to the clinical phase of the biomarker discovery process. The most promising AKI biomarkers include neutrophil gelatinase-associated lipocalin, IL-18, kidney injury molecule-1 and liver-type fatty acid binding protein. In this article, we review the study of neutrophil gelatinase-associated lipocalin,IL-18, kidney injury molecule-1 and liver-type fatty acid binding protein in recent years,in order to provide the theory basis for the clinical application of the early biomarkers for AKI.

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Short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy

Bin YI ; Donghai LIU

Chinese Pediatric Emergency Medicine.2010;17(5):424-426. doi:10.3760/cma.j.issn.1673-4912.2010.05.017

Objective To assess short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy induced by perinatal asphyxia. Methods Twenty-three infants of moderate/severe hypoxic ischemic encephalopathy (HIE) were divided into treatment group ( 14 cases) and control group (9 cases). The head hypothermia in the treatment group [rectal temperature ( 34. 0 ～ 35.0) ℃, nasopharyngeal temperature (34. 0 ± 0. 5 ) ℃]was induced by circulating water cooling cap for up to 72 h. Control group were treated routinely. All newborns were monitored and analyzed for blood pressure, heart rate, neurological function. Neonatal behavioral neurological assessment (NBNA) was conducted for assessment of neurobehavioral development on day 28 after birth. Results Treatment group showed slower hear rate as nasopharyngeal temperature decreased and there was significant difference as compared with the control group ( P ＜ 0.05 ). Apnea and arrhythmia were not found in either group. As compared with the control group, treatment group showed better results in seizure incidence, recovery of neonatal reflex( embracing reflection, sucking reflex and grasp reflex), and improvement of limb muscle tension. The NBNA score on day 28 was much higher in hypothermia group(35.00 ± 1.41 ) than that of control group(30. 67 ± 1.58) and there was significant difference (P ＜ 0.05). Conclusion Selective head cooling is safe for newborns with moderate/severe HIE if the nasopharyngeal temperature maintains at (34 :± 0. 5 ) ℃, rectal temperature at 34 ～ 35 ℃. Selective head cooling can effectively improve the short-term nervous symptoms and the neurobehavioral score,but the long-term efficacy remains to be further studied.

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Nasal intermittent mandatory ventilation combined with pulmonary surfactant for the treatment of neonatal hyaline membrane disease

Yongmian SU ; Yinjin ZHANG ; Runzhong HUANG

Chinese Pediatric Emergency Medicine.2010;17(5):427-429. doi:10.3760/cma.j.issn.1673-4912.2010.05.018

Objective To evaluate the effect of nasal intermittent mandatory ventilation (NIMV)combined with pulmonary surfactant for the treatment of hyaline membrane disease in premature children and to compare the clinical efficacy with conventional mechanical ventilation and continuous positive airway pressure (CPAP). Methods Seventy-four babies with severe respiratory syndrome were given curosurf[100 mg/(kg·dose)],25 of them were given to NIMV, another 25 were given conventional intermittent mandatory ventilation (IMV), the last 24 patients were given conventional CPAP. Blood gas analysis parameters and incidences of respiratory complications including respiratory tract infection and chronic lung disease,frequent apnea and carbon dioxide retention, were compared among the three groups. Results After treatment of 1 h, symptoms and signs of the patients markedly improved. All the three groups showed an increase in arterial oxygen partial pressure, but arterial pressure of carbon dioxide and oxygen index decreased significantly by the time of 6,12,24 h after treatment and there were not significantly difference among the three groups. The rates of respiratory infection and chronic lung disease in NIMV group were less than that of conventional IMV group[(8% vs 36% ) ,(20% vs 72% )],the rates of frequent apnea and carbon dioxide retention in NIMV group were less than that of CPAP group[(8% vs 36% ), (20% vs 72% )]. Conclusion NIMV combined with pulmonary surfactant is a potentially efficient therapy for hyaline membrane disease in premature infants. NIMV treatment of hyaline membrane disease in premature infants can reduce or avoid ventilation-associated pneumonia,chronic lung disease and other complications,but also efficiently reduce the incidence of frequent apnea and carbon dioxide retention.

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Low-dose heparin micro-pump continuous regular infusion in the treatment of primary nephrotic syndrome

Jiandong HONG ; Qingliu FU ; Tianwen ZHENG ; Zhiqiang SU ; Zhanrong XI

Chinese Pediatric Emergency Medicine.2010;17(5):404-406. doi:10.3760/cma.j.issn.1673-4912.2010.05.010

Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.

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Application of blood purification of critical disease with non-renal indications in PICU

Xuan XU ; Xiu YIN ; Xiannan CHEN ; Zhichun FENG

Chinese Pediatric Emergency Medicine.2010;17(5):400-403. doi:10.3760/cma.j.issn.1673-4912.2010.05.008

Objective To investigate the application of blood purification for critical disease with non-renal indications in PICU. Methods We retrospectively analyzed the clinical data of 10 critical disease cases with non-renal indications in PICU admitted from Jan to Dec 2009. Five cases were with acute liver failure,2 with autoimmune disease (1 with Guillaln-Barre syndrome, 1 with systemic juvenile rheumatoid arthritis with macrophage activation syndrome) ,2 with severe sepsis,one with metabolic diseases. Results Four cases were treated with plasma exchange combined with continuous veno-venous hemmofiltration. Three cases were treated with continuous veno-venous hemmofiltration. Three cases were treated with plasma exchange.Conclusion CBP is an effective and safe method in the treatment of critical diseases with non-renal indications in PICU.

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Epidemiology and clinical research of newly discovered respiratory viruses

Enmei LIU ; Caijing PENG

Chinese Pediatric Emergency Medicine.2010;17(5):390-391. doi:10.3760/cma.j.issn.1673-4912.2010.05.003

Respiratory tract infection is very common in children. Viruses play a critical role in childhood respiratory infection. Recently, there are several newly discovered viruses which have been investigated widely.Here we tried to introduce the epidemiology and clinical research of human metapneumovirus,SARS-coronavirus,coronavirus-NL63,coronavirus-HKU1 ,human Boca virus,KI-polyomavirus and WU-polyomavirus.

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Recent approach of adrenal dysfunction in critical illness

Yiping ZHOU

Chinese Pediatric Emergency Medicine.2010;17(5):458-460. doi:10.3760/cma.j.issn.1673-4912.2010.05.033

There is high incidence of relative adrenal insufficiency (RAI) in critical children. The causes of adrenal insufficiency in patients with severe sepsis and septic shock are the mechanical injury of the hypothalamic-pituitary-adrenal axis, cytokines and other mediators of inflammatory or hormone resistance. There are many symptoms associated with adrenal insufficiency. Diagnosis is often suspected when these patients have hypotension refractory to fluid therapy and to vasoactive drugs. The corticotropin stimulation test is widely used as a method to identify adrenocortical hyporesponsiveness, but controversy exists as to the corticotropin dose to be used. The 250 μg dose is the standard dose. Low doses of corticotropin (1 μg) have recenfly been proposed,suggesting that they may have higher sensitivity and the characteristics of safe and effective.

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Damage of vascular endothelium and the changes of coagulation in children with Henoch-Schonlein purpura

Weiyan CAI ; Guangyu ZHOU ; Xuemei LIU ; Aimin LI ; Chunxiang LI ; Hongbo LIU

Chinese Pediatric Emergency Medicine.2010;17(5):410-412. doi:10.3760/cma.j.issn.1673-4912.2010.05.012

Objective To investigate the changes and the role of plasma thrombomodulin(TM),von willebrand factor (vWF) ,and coagulation status indicators in children with Henoch-Schonlein purpura(HSP).Methods The plasma concentrations of TM,vWF were measured by ELISA method and the levels of D-dimer,PT,APTT,palatelet count were measured in 56 acute SHP patients,50 recovery patients and 40 healthy controls. Results The plasma levels of TM、vWF、D-dimer、palatelet count in acute group were significantly higher than those in healthy controls group and those of recovery group ( P = 0. 000). The plasma levels of PT、APTT showed no significant difference among three groups( P ＞ 0. 05 ). The plasma levels of TM、vWF in recovery group were significantly higher than those in healthy controls group ( P ＜ 0. 05, P ＜ 0. 01 ), while the levels of D-dimer、palatelet count reduced to nomal levels(P ＞0. 05). As compared to non-renal damage group, The plasma levels of TM、vWF、 D-dimer were higher in renal damage group ( P ＜ 0. 05, P ＜ 0. 01 ), the levels of PT 、APTT、palatelet count showed no significant difference ( P ＞ 0. 05 ). Conclusion The damage of vascular endothelium and hypercoagulability play an important role in the pathogenesis of HSP. Changes of plasma TM、 vWF、palatelet count can be used as an indicator of the early lesion of renal function.

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