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Utility of fractional exhaled nitric oxide in children with asthma.

Chinese Journal of Contemporary Pediatrics.2015;17(2):134-137.

OBJECTIVETo study the utility of fractional exhaled nitric oxide (FeNO) in young children at different stages of asthma.

METHODSFifty-eight children with newly diagnosed asthma (aged 1-3 years) at the acute exacerbation stage between April and June, 2014 were recruited. After 3 months' treatment, the children switched into the chronic persistent stage (n=34) or remission stage (n=24). Thirty aged-matched healthy children served as controls. FeNO levels and lung function were measured for all subjects. The best cut-off value of FeNO for the diagnosis of asthma was evaluated by receiver operating characteristic (ROC) curve.

RESULTSThe FeNO levels in children with asthma at various stages were higher than controls (P<0.05). The FeNO levels in the acute exacerbation stage were highest, followed by the chronic persistent stage (P<0.05). FeNO level was correlated to the stages of asthma (r=-0.382, P<0.001). The cut-off value of FeNO for the diagnosis of asthma was 22.75 ppb by ROC curve, with the sensitivity of 0.933 and the specificity of 0.388.

CONCLUSIONSThe children with asthma at different stages have different FeNO levels. Measurement of FeNO is useful in the diagnosis of asthma in young children.

Asthma ; diagnosis ; metabolism ; Breath Tests ; Humans ; Nitric Oxide ; metabolism ; ROC Curve

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What is the optimal oxygen saturation for extremely premature infants? A Meta analysis.

Jing-Yang LI ; Zhen-Lang LIN ; Jia WEI ; Yan-Yan YAN ; Jin LIN

Chinese Journal of Contemporary Pediatrics.2015;17(2):128-133.

OBJECTIVETo explore an optimal oxygen saturation for extremely preterm infants based on a systemic review of the published studies.

METHODSA Meta analysis of the published studies by the NeOProM Group which compared the outcomes of extremely preterm infants (gestational age <28 weeks) maintained in either a low (85%-89%) or high (91%-95%) oxygen saturation (SpO2) by using the STATA 12.0. The outcomes measured included the mortality and the incidences of retinopathy of prematurity (ROP), necrotizing enterocolitis of newborn (NEC), broncho-pulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and patent ductus arteriosus (PDA).

RESULTSThree studies were included, in which 2 460 infants were assigned into the low SpO2 group and 2 459 infants in the high SpO2 group. The Meta analysis demonstrated that the risk of mortality before discharge or at the age of 18 months increased in the low SpO2 group compared with the high SpO2 group (RR: 1.19; 95%CI: 1.05-1.35); the risk of ROP decreased in the low SpO2 group (RR: 0.73; 95%CI: 0.53-1.00); the risk of NEC increased in the low SpO2 group (RR: 1.26; 95%CI: 1.06-1.49). There was no significance in the incidences of BPD, IVH and PDA between the two groups.

CONCLUSIONSMaintaining SpO2 at 85%-89% may decrease the incidence of ROP, but increase the mortality rate and the incidence of NEC in extremely premature infants.

Enterocolitis, Necrotizing ; etiology ; Humans ; Infant ; Infant Mortality ; Infant, Extremely Premature ; metabolism ; Outcome Assessment (Health Care) ; Oxygen ; blood ; Retinopathy of Prematurity ; etiology

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Long-term clinical efficacy of mild hypothermia therapy in neonates with hypoxic-ischemic encephalopathy: a Meta analysis.

Chang-Qing CAO ; Yu-Ning LI ; Xue-Mei YANG ; Yi-Gu GONG ; Fang WANG ; Wei-Guo LI

Chinese Journal of Contemporary Pediatrics.2015;17(2):122-127.

OBJECTIVETo systematically evaluate the long-term clinical efficacy and safety of mild hypothermia therapy in neonates with hypoxic-ischemic encephalopathy (HIE).

METHODSAll randomized controlled trials (RCTs) of mild hypothermia therapy for neonatal HIE from inception to March 2014 were retrieved from databases including Cochrane Library, PubMed, Embase, CBMdisc, and Wanfang Data. Meta analysis was performed using RevMan 5.1 Software.

RESULTSEight RCTs met the search criteria. The results of Meta analysis showed that, compared with the control group, systemic hypothermia significantly reduced the mortality rate and the incidence of growth delay (RR=0.73, 95% CI: 0.61-0.89; RR=0.70, 95%CI: 0.54-0.93); selective head or systemic hypothermia therapy significantly reduced the incidence of cerebral palsy (RR=0.65, 95%CI: 0.46-0.94; RR=0.67, 95%CI: 0.52-0.86) up to 12-24 months of age. One study reported that hypothermia reduced the mortality rate and the rate of a composite end point of death or severe disability compared with the control group at 6 to 7 years of age. The incidence of adverse events including sinus bradyarrhythmia, thrombocytopenia and hypoglycemia was significantly higher in the hypothermia group than in the control group, whereas the incidence of cardiac arrhythmia, hypotension, thrombosis or bleeding, hypokalemia, sepsis, and liver dysfunction showed no significant differences between the two groups.

CONCLUSIONSMild hypothermia therapy demonstrates a significant efficacy in children with HIE up to 12-24 months of age, but there is still a need for further research on childhood outcomes after mild hypothermia for neonatal HIE. This therapy has few adverse effects and a high clinical tolerability.

Child ; Child, Preschool ; Female ; Humans ; Hypothermia, Induced ; adverse effects ; Hypoxia-Ischemia, Brain ; mortality ; therapy ; Infant ; Infant, Newborn ; Male

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Changes of plasma cardiotrophin-1 levels in neonates with myocardial ischemic injury.

Yu-Qiao DIAO ; Lian JIANG ; Hui-Fen ZHANG ; Fan QU ; Ying SHEN ; Qin SHAO

Chinese Journal of Contemporary Pediatrics.2015;17(2):118-121.

OBJECTIVETo study the changes and significance of plasma cardiotrophin-1 (CT-1) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury.

METHODSForty-five neonates with HIE (15 mild cases, 24 moderate cases and 6 severe cases) were enrolled and divided into two subgroups based on the presence of myocardial injury (n=19) and not (n=26). Twenty healthy neonates were used as the control group. Plasma CT-1 levels were measured using double-antibody sandwich enzyme immunoassay method. Serum creatinine kinase MB (CK-MB) and cardiac troponin I (CTnI ) levels were also measured.

RESULTSPlasma CT-1 levels in the mild HIE (169±20 pg/mL) and moderate/severe HIE subgroups (287±44 pg/mL) were significantly higher than those in the control group (30±8 pg/mL), and plasma CT-1 levels were associated with the severity of HIE (P<0.01). Plasma CT-1 levels were positively correlated with serum CK-MB and CTnI levels in neonates with HIE in the acute phase (r=0.565 and 0.621 respectively; P<0.01). Plasma CT-1 levels in neonates with myocardial injury were significantly higher than those without myocardial injury (249 ±35 pg/mL vs 177±26 pg/mL; P<0.01). Plasma CT-1 levels were significantly reduced in neonates with myocardial injury in the convalescent phase (157±19 pg/mL) compared with those in the acute phase (249±35 pg/mL; P<0.01).

CONCLUSIONSDetection of plasma CT-1 levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.

Creatine Kinase, MB Form ; blood ; Cytokines ; blood ; Female ; Humans ; Infant, Newborn ; Male ; Myocardial Ischemia ; blood ; Troponin I ; blood

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Clinical analysis of 101 cases of neonatal intestinal perforation.

Ya DONG ; Yin-Quan XU ; Zhen-Lang LIN

Chinese Journal of Contemporary Pediatrics.2015;17(2):113-117.

OBJECTIVETo analyze the clinical characteristics of neonatal intestinal perforation and to provide a theoretical basis for improving the prognosis of this disease.

METHODSThe clinical data of 101 patients with neonatal intestinal perforation who were hospitalized in the Neonatal Intensive Care Unit between January 2000 and June 2014 were retrospectively reviewed.

RESULTSThe main causes of neonatal intestinal perforation were neonatal necrotizing enterocolitis (NEC, 41 cases, 40.6%), idiopathic intestinal perforation (17 cases, 16.8%), and congenital megacolon (10 cases, 9.9%). The average birth weight and average gestational age of the idiopathic intestinal perforation group were significantly higher than those of the NEC group (P<0.05). The main pathogen of the NEC group was enterococci, which accounted for 57% (13/23), while in the idiopathic intestinal perforation group Gram-negative bacteria became the major pathogen; the distribution of pathogens were significantly different between the two groups (P<0.05). Multiple logistic regression analysis found that acidosis, multi-site intestinal perforation, and prolonged perforation-operation interval were independent risk factors for death due to neonatal intestinal perforation.

CONCLUSIONSMultiple causes contribute to neonatal intestinal perforation, and NEC is the major one. Neonatal intestinal perforation caused by NEC has different pathogens compared with idiopathic intestinal perforation, and the two diseases may be mutually independent. Early diagnosis and timely operation is the main measure to rescue the lives of patients with neonatal intestinal perforation.

Enterocolitis, Necrotizing ; complications ; Female ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intestinal Perforation ; etiology ; Logistic Models ; Male ; Retrospective Studies

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Research advances in pediatric nonalcoholic fatty liver disease.

Dong-Ling DAI

Chinese Journal of Contemporary Pediatrics.2015;17(1):107-112.

In recent years, nonalcoholic fatty liver disease (NAFLD) has increased because of the growing prevalence of obesity and overweight in the pediatric population. It has become the most common form of chronic liver diseases in children and the related research on NAFLD is expanded. The "two-hit" and "multiple hit" hypothesis have been widely accepted, and some research has shown that genetic, diet structure and environmental factors appear to play a crucial role in the development of pediatric NAFLD. Though it is expected by researchers, there is not an available satisfactory noninvasive marker for the diagnosis of this disease. Fortunately, some new non-invasive prediction scores for pediatric NAFLD have been developed. There is currently no established special therapy, and lifestyle intervention should be adequate for most cases of NAFLD in children. This article reviews the advances in the current knowledge and ideas concerning pediatric NAFLD, and discusses the diagnosis, perspective therapies and scoring methods for this disease.
Child ; Humans ; Non-alcoholic Fatty Liver Disease ; diagnosis ; etiology ; genetics ; Polymorphism, Single Nucleotide ; Risk Factors

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Defectiveness of bone marrow mesenchymal stem cells in acquired aplastic anemia.

Jing-Liao ZHANG ; Xiao-Fan ZHU

Chinese Journal of Contemporary Pediatrics.2015;17(1):100-106.

The defectiveness of bone marrow mesenchymal stem cells (BM-MSCs) in acquired aplastic anemia (AA) has been a frequent research topic in recent years. This review summarizes the defectiveness of BM-MSCs which is responsible for the mechanism of acquired AA and the prospective application of BM-MSCs in the treatment of acquired AA. An increasingly number of laboratory statistics has demonstrated that the defectiveness of BM-MSCs is more likely to play an important role in the pathogenesis of AA, namely, the apparently different biological characteristics and gene expression profiles, the decreased ability of supporting hematopoiesis as well as self-renewal and differentiation, and the exhaustion of regulating immune response of hematopoietic environment. Those abnormalities continuously prompt AA to become irreversible bone marrow failure along with the imbalanced immunity. With deepening research on MSCs, infusion of MSCs for the primary purpose of recovering hematopoietic microenvironment may become a new approach for the treatment of AA.
Anemia, Aplastic ; etiology ; immunology ; therapy ; Bone Marrow ; Cell Differentiation ; Cell Proliferation ; Cytokines ; analysis ; Humans ; Lymphocyte Activation ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; physiology ; T-Lymphocytes, Regulatory ; immunology

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A case report of sigmoid sinus thrombosis following mastoiditis.

Hong-Mei DAI ; Lang TIAN ; Yuan-Ying DENG ; Sheng LIU ; Ming-Yi ZHAO ; Yi-Ding LI ; Ling-Ling ZHAO

Chinese Journal of Contemporary Pediatrics.2015;17(1):97-99.

Child, Preschool ; Humans ; Magnetic Resonance Imaging ; Male ; Mastoiditis ; complications ; Sinus Thrombosis, Intracranial ; etiology

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Cerebral venous sinus thrombosis and pulmanary embolism in a child.

Xi-Cheng TAO ; De WU ; Zi-Yun ZHOU ; Ling-Ling QIAN

Chinese Journal of Contemporary Pediatrics.2015;17(1):95-96.

Adolescent ; Humans ; Male ; Pulmonary Embolism ; etiology ; Sinus Thrombosis, Intracranial ; complications ; diagnosis

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Misdiagnosis of aneurysm of thoracic aorta in 6 children.

Mei ZHONG ; Xiao-Ming ZHONG ; Wen-Jun XIAO

Chinese Journal of Contemporary Pediatrics.2015;17(1):93-94.

Aortic Aneurysm, Thoracic ; diagnosis ; Child ; Child, Preschool ; Diagnostic Errors ; Female ; Humans ; Infant ; Male

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