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Some clinical problems of first-aid medicines on severe cardiac arrhythemias in children

Chinese Pediatric Emergency Medicine.2013;20(5):447-451. doi:10.3760/cma.j.issn.1673-4912.2013.05.001

Severe cardiac arrhythmias is not rare in chilaren.Because they usually induce striking disturbance of the blood dynamics,heart failure,cardiogenic shock,Adams-stokes attack or sudden death can happen in sick child,therefore they belong to pediatric emergency.Though cardioversion-defibrillation and cardiac pacemaker implantation are widely applied to clinical practice recently,antiarrhythmic drugs are still the most common treatment method at present.In this article,dose and usage,harmful reactions,indications and contraindications of common fist-aid medicines would be introduced,and some important problems in clinical use also be discussed.

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Progress of angiotensin converting enzyme inhibitors in the treatment of heart failure in children

Fen LI ; Wanping ZHOU

Chinese Pediatric Emergency Medicine.2013;20(5):472-474. doi:10.3760/cma.j.issn.1673-4912.2013.05.008

Heart failure is one common critical cardiovascular disease in children.Angiotensin convening enzyme inhibitors plays an important role in the treatment of pediatric heart failure.In this paper,the pharmacological mechanism,pharmacokinetics,clinical studis and application of angiotensin converting enzyme inhibitors in the treatment of pediatric heart failure were concerned.

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The epidemic characteristics of interhospital transport of critically ill pediatric patients

Jun QIU ; Yimin ZHU

Chinese Pediatric Emergency Medicine.2013;20(5):475-478. doi:10.3760/cma.j.issn.1673-4912.2013.05.009

Objective The purpose of this study was to evaluate the importance of the interhospital transport of critically ill pediatric patients by analyzing the epidemic characteristics of pediatric patients transported from 2009 to 2012.Methods Nine thousand two hundred and thirty-one referral patients from January 2009 to June 2012 were evaluated by a cross-section study.Epidemiological data such as sex,age,seasons,and referral radius were collected.Results Among all the interhospital transport of critically ill pediatric patients,male to female ratio was nearly 2.24 to 1 and 87.39％ (8067/9231) patients were neonates and infants.Of all patients,66.32％ (6122/9231) patients were from department of pediatrics,neonatology or gynaecology and obstetrics in referring hospitals.The distribution of referring department among years was statistically significant in referring patients (x2 =227.53,P ＜ 0.000 1).Among the patients,56.88％ (5251/9231) were transported over 150km radius and only 12.18％ (1124/9231) patients in 50 km.52.89％(4882/9231) were transported in spring and winter.The seasonal distribution of interhospital transport of critically ill pediatric patients was statistically significant(x2 =1201.88,P ＜0.000 1).The majority of referral telephones were received between 9 AM to 12 AM.Conclusion With the limitation of equipment and technical measure in primary hospitals,critically ill pediatric patients should be transported to tertiary hospitals.According to the epidemiological characteristics of interhospital transport of critically ill pediatric patients,some measures should be adopted for the timely,safe and effective interhospital transportation.

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The relationship of recurrence rate and the age and body temperature of first febrile seizures in children

Shaoyang OU

Chinese Pediatric Emergency Medicine.2013;20(5):498-500. doi:10.3760/cma.j.issn.1673-4912.2013.05.015

Objective To explore the relationship of recurrence rate and the age and body temperature of fitrst febrile seizures (FS) in children.Methods One hundred and ninety-two cases of FS admitted to our hospital from Jan 2004 to Jun 2006,were divided into three groups according to the initial onset of body temperature with FS:＞40.0 ℃,～40.0 ℃,≤38.5 ℃ ;three groups according to the duration between fever initiation and seizure attack:≤6 h,～ 12 h,～24 h,＞24 h;four groups according to age:≤6 months,～ 18 months,～ 3 years,＞ 3 years.For each group of children with FS,the recurrence rate and follow-up were compared.Results All cases were followed up to 6 years old,22 cases were lost,and the follow-up rate was 88.5％ (170/192).Follow-up of 170 children with FS,the recurrence rate was 32.6％ (15/46),51.1％ (46/90) and 79.4 ％ (27/34) in each group of temperature ＞ 40.0 ℃,～ 40.0 ℃,and ≤ 38.5 ℃.There were statistically significant among three groups (x2 =17.18,P ＜ 0.05).Duration of fever before seizures ≤ 6 h group,～24 h group,＞ 24 h group,the recurrence rate were 70.7 ％ (29/41),51.6％ (49/95) and 29.4％ (10/34) respectively,the recurrence rate was significant difference among the three groups(x2 =12.71,P ＜0.05).The recurrence rate of different age groups in initial attack of FS were 84.6％ (22/26),63.4％ (45/71),39.5％ (15/38),17.I％ (6/35),the differences were statistically significant (x2 =34.17,P ＜ 0.05).Conclusion There was higher recurrence rate of febrile seizure in small children,lower body temperature and shorter duration between fever initiation and seizure attack.

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Clinical features and etiology of neonatal anemia

Li WANG ; Jingjun DIAO ; Jun ZHANG

Chinese Pediatric Emergency Medicine.2013;20(5):501-503. doi:10.3760/cma.j.issn.1673-4912.2013.05.017

Objective To investigate the clinical features,etiology and related clinical factors in neonatal anemia.Methods Two hundreds and sixty four infants admitted to the Neonatal Intensive Care Unit between January 2009 to March 2012 were retrospectively analysed with different levels,different age,different gestational age.Results Among 264 patients,the occupancy of blood loss anemia was 54.5 ％.Mild and medium neonatal anemia were more than severe anemia (172 vs 92).Fetomaternal hemorrhage syndrome occurred commonly in severe anemia (16.3％,15/92).Early anemia was more than late anemia(182 vs 82).Hemorrhagic anemia in early anemia (64.3％,117/82)occurred mainly.Late anemia with infection mainly (67.1％,55/82).Fetomaternal hemorrhage syndrome were all early anemia and term to account for a higher proportion (94.4％,17/18);twin-to-twin transfusion syndrome occurred commonly among preterm term infants (96.7％,29/30).Conclusion Blood loss anemia was the main etiological factor resulting in neonatal anemia.The incidence of mild and medium neonatal anemia was quite high.Early anemia was more than late anemia.There might be some differences in the etiology between term and perterm infants.

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Signal transducers and activators of transcription(STAT) family and pathogenesis of asthma

Nan ZHANG ; Simin WAN ; Suwan ZHANG

Chinese Pediatric Emergency Medicine.2013;20(5):535-537. doi:10.3760/cma.j.issn.1673-4912.2013.05.033

Bronchial asthma(asthma for short) is a chronic inflammatory disease of the lung,which is involved with various cells and cytokines.Now,the related genes of asthma is not well-known yet.But research shows that there are related genes to airway hyperreactivity,IgE regulation and atopic reaction.These genes play an important role in asthma.In recent years,it is recognized that STAT family plays an important role in inflammatory and immunological diseases.In this article the role of STAT family played in asthma pathogenesis will be reviewed.

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Post-cardiac arrest syndrome

Jun WEN ; Lu GAO ; Wenyi CHANG

Chinese Pediatric Emergency Medicine.2013;20(5):537-540. doi:10.3760/cma.j.issn.1673-4912.2013.05.034

Post-cardiac arrest syndrome (PCAS) is one of the most common medical emergencies in children.The fatality rate and disability rate are extremely high.Pathogenesis of PCAS remains incompletely clear,and clinical manifestation is complicated.The treatment is mainly limited to supportive care.In recent years,the phases of PCAS are defined according to the pathophysiological changes and clinical prognosis.Investigators also made some advances in the fields of pathophysiological changes and clinical treatment of brain damage and myocardial damage.For the treatment of PCAS,early therapeutic hypothermia,glucose control and seizure control,and reasonable cardiopulmonary support are promoted.In this article,we reviewed the advances in the above fields and the latest advance on the management of PCAS in foreign countries.

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The role of myocardial metabolism activating drugs in children with severe angiocardiopathy

Xuemei LI ; Xianyi YU

Chinese Pediatric Emergency Medicine.2013;20(5):464-467. doi:10.3760/cma.j.issn.1673-4912.2013.05.006

Myocardial metabolism activating drugs can increase the energy supply and decrease the energy consumption of the myocardial cells,playing a role in the nourishment and protection of cardiac muscles and the optimization of the energy metabolism.It is the adjuvant drug in treatment of myocarditis,myocardiosis,severe arrhythmia,acute or chronic heart failure and cardiosurgery,with an irreplaceable role in the salvage therapy of severe angiocardiopathy.Due to its safety and little side effects,it has been widely used in pediatrics.

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Application progress of β-blocker in pediatric heart failure therapy

Huilin YIN ; Jie TIAN

Chinese Pediatric Emergency Medicine.2013;20(5):468-471. doi:10.3760/cma.j.issn.1673-4912.2013.05.007

Heart failure is becoming an increasingly common and significant problem in the field of pediatric cardiology,β-blockers as one of the most important cardiovascular drags in the pharmacopoeia,can not only obviously relieve symptoms of severe heart failure,but also reduce cardiovascular events and allcause mortality significantly,the efficacy is effective and high security.This article reviewed β-blockers in the treatment of children heart failure mechanism,the clinical application evaluation,the basic principles and relevant issues in use process,the appropriate choice and usage according to the clinical indications.

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Effectiveness of intravenous low-dose erythromycin for feeding intolerance in preterm infants:a meta-analysis

Jun WEN ; Yufei SU ; Wenyi CHANG ; Lie WANG ; Shaoning LI ; Hua LI ; Jian XU

Chinese Pediatric Emergency Medicine.2013;20(5):479-483. doi:10.3760/cma.j.issn.1673-4912.2013.05.010

Objective To evaluate the effectiveness of low-dose erythromycin for the treatment of feeding intolerance in preterm infants in China.Methods In this study,random clinical trials on the treatment of feeding intolerance in preterm infants with intravenous low-dose erythromycin published were searched at Chinese Journal Full-text Database,Chongqing Weipu Database and Wanfang database by using the methods of Cochrane systematic review.At the same time the information from related journals,professional data and network were hand-searched.The publishing deadline for the literatures reviewed in this study was August 2012.Statistical analysis of clinical data was performed by using RevMan 4.2 software provided by the Cochrane Collaboration.Results A total of 9 studies were included.The results showed that compared with the group of comprehensive therapy,the group of low-dose erythromycin was superior in the following aspects with significant differences(P ＜ 0.05):the average length of hospital stay,time of parenteral nutrition,time to full feeding,the incidence rate of feeding intolerance (Z =3.44,P =0.000 6 ; Z =6.78,P ＜0.000 01 ; Z =3.96,P ＜ 0.000 1 ; Z =2.51,P =0.01).Conclusion Low-dose erythromycin therapy for feeding intolerance in preterm infants is superior to the comprehensive therapy.It provides a prospective therapeutic method for feeding intolerance in preterm infants.However,large scale,multicenter and well-designed clinical trials should be adopted to confirm the conclusions.

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