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Chiari II malformation in infant:a case report

Journal of Clinical Pediatrics.2014;(3):284-286. doi:10.3969/j.issn.1000-3606.2014.03.023

Objective To analyze the clinical data of an infant with Chiari II malformation so as to deepen understanding of this disease in pediatrics. Methods The clinical, laboratory and imaging data of an infant with Chiari II malformation were retrospectively analyzed and a literature review was performed. Results A 2-month-old male infant was admitted to our hospital due to a neck tumor for two months. Brain magnetic resonance imaging (MRI) showed herniation of the cerebellar tonsils into the foramen magnum. The infant was finally diagnosed with Chiari II malformation based on the result of MRI and the presence of myelomeningocele. After repair of spinal cord and meninges and decompression of pillow macroporous by surgery, the infant presented with intermittent fever and progressively enlarged anterior fontanel, with culture-positive cerebrospinal fluid for bacte-ria and hydrocephalus diagnosed by CT, and intracranial infection was considered. Ventriculoperitoneal shunt was not performed due to uncontrolled intracranial infection after treatment, and motor retardation was found during the follow-up. Conclusions Chiari II malformation may results in nervous system dysfunction with poor diagnosis and high case fatality rate. Early diagnosis and operation may be helpful to the improvement of prognosis.

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Effect of delayed cord clamping in term infants:a meta-analysis

Zhangbin YU ; Shuping HAN ; Li SHA ; Xiaoyue DONG ; Yulin CHEN ; Yufang QIU

Journal of Clinical Pediatrics.2014;(3):278-283. doi:10.3969/j.issn.1000-3606.2014.03.022

Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.

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Value of 99mTc-EC dynamic renography in diagnosis of renal scars in children

Yang FENG ; Xiao SU ; Jianing LI

Journal of Clinical Pediatrics.2014;(3):232-234. doi:10.3969/j.issn.1000-3606.2014.03.010

Objective To evaluate the diagnostic value of 99mTc-EC dynamic renography for renal scars in children with urinary tract infection. Methods The 99mTc-EC and 99mTc-DMSA renographic results of 67 children diagnosed with urinary tract infection were retrospectively studied. In comparison with 99mTc-DMSA cortical images, the value of 99mTc-EC dynamic renogra-phy for the diagnosis of urinary tract infection, hydronephrosis and renal scars was analyzed. Results The sensitivity and speci-ficity of the initial 2 minutes summed images in the 99mTc-EC images for the diagnosis of renal scars was 80.28%and 88.89%re-spectively, and the likelihood ratio was 7.23. Renal scars were more likely to be formed in patients with obstructed upper urinary tracts, as compared with patients with unobstructed upper urinary tracts and unsmooth upper urinary tracts (P<0.05). The inci-dence of renal scar formation was not significantly different among groups with hydronephrosis of varying degrees (P>0.05). Conclusions For children with urinary tract infection, the diagnostic sensitivity and specificity of the initial summed images of 99mTc-EC dynamic renography are high. Furthermore, the excretion of upper urinary tract showed by 99mTc-EC dynamic renogra-phy is valuable for the diagnosis of renal scars.

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Analysis on clinical manifestations and drug resistance of Escherichia coli pneumonia in infants

Sheng LIU ; Yali ZHANG ; Haifang CAI

Journal of Clinical Pediatrics.2014;(3):228-231. doi:10.3969/j.issn.1000-3606.2014.03.009

Objective To investigate the clinical features of Escherichia coli pneumonia, the positive rate of extend-spectrumβ-lactamase (ESBLs) produced by Escherichia coli and antimicrobial resistance of Escherichia coli. Methods Three hundred and thirty-six infants with Escherichia coli pneumonia were divided into community acquired infection group and hos-pital acquired infection group from Jun 2003 to Jun 2013. The clinical data of those patients were collected and analyzed. The ESBLs were examined, and drug susceptibility results were analyzed. Results Infants under 6 months had higher infective rate of Escherichia coli. The Escherichia coli pneumonia had similar clinical manifestations as Gram negative bacterial pneumonia. ESBLs were found in most strains (58.3%, 196/336), positive rate of ESBLs of hospital acquired infection group (84.00%) was higher than that of community acquired infection group (50.96%) (χ2=26.17, P<0.05). There was no difference of ESBLs posi-tive rate between the community acquired infection groups during Jun 2003-May 2008 and those during Jun 2008-Jun 2013 (χ2=0.30, P>0.05). The ESBLs positive rate of hospital acquired infection group was significantly increased from 76.74%(Jun 2003-May 2008) to 93.75% (Jun 2008-Jun 2013) (χ2=3.95, P<0.05). The most sensitive antibiotic was carbapenem. Conclusions Escherichia coli pneumonia mainly occurs in infants, usually with severe clinical situations and more persistent. The hospital acquired infection is the high risk factor of acquiring ESBLs. Antibiotics should be prescribed depending on community acquired infection or hospital acquired infection.

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Distribution and drug resistance of pathogens in 132 cases of neonatal sepsis

Ting CHEN ; Qin LU ; Li YANG ; Wenjun XU ; Mingxia SHI

Journal of Clinical Pediatrics.2014;(3):220-223. doi:10.3969/j.issn.1000-3606.2014.03.006

Objective To investigate the distribution and antibiotic resistance of isolated pathogens in neonatal sepsis. Methods The results of blood culture and drug susceptibility test in neonates sepsis from January 2012 to June 2013 were retro-spectively analyzed. Results One hundred and thirty-two strains were detected in the blood samples, with 100(75.76%)Gram-positive bacteria, 30 (22.73%) Gram-negative bacteria and 2 (1.52%) fungus. Staphylococcus epidermidis, Escherichia coli and Staphylococcus aureus were the three most common pathogens. Gram-positive cocci was strongly resistant to penicillin (100.00%), erythromycin, selectrin and ampicillin/sulbactam (62.50%-100.00%), but still sensitive to vancomycin and teico-planin. The resistance rate of Gram-negative bacilli to ampicillin was 100.00%, and the resistance rate to cefatriaxone, selectrin and cefuroxime was 61.54%-100.00%. The resistance rate to imipenem and piperacillin/tazobactam was lower. Conclusions The selection of sensitive antibiotics should be based on the pathogens and drug resistance testing for the treatment of neonatal sepsis.

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Clinical analysis of Langerhans cell histiocytosis in one newborn

Ying WANG ; Zhiguang ZHAO ; Zhongmin SUN

Journal of Clinical Pediatrics.2014;(3):218-219. doi:10.3969/j.issn.1000-3606.2014.03.005

Objective To understand the clinical features and laboratory examination and diagnosis of Langerhas cell histio-cytosis (LCH) in newborns. Methods Retrospective analysis of the clinical data of a neonatal case of LCH was performed. Results A one-day-old girl was admitted with chief complaint of eating less, less crying and skin rash for one day. The unequal sized rash was on the head, limbs, trunk, toe and oral mucosa. The skin rashes were protruding from the skin and were partially broken and crusted. Biopsy of the skin tissue showed the expression of S-100 and CD1α, consistent with the diagnosis of LCH. Conclusions When new-borns have special rash after birth, LCH should be considered. To avoid misdiagnosis, skin biopsy should be performed.

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Analysis of risk factors of late preterm infants with hyperbilirubinemia

Shujie YANG ; Haiying YI ; Zhenzhen WANG ; Jie HUANG ; Yuan HE ; Xian WEI ; Yanhua WANG

Journal of Clinical Pediatrics.2014;(3):214-217. doi:10.3969/j.issn.1000-3606.2014.03.004

Objective To explore the risk factors of hyperbilirubinemia in late preterm infants. Methods Clinical data of 211 cases of late preterm infants with hyperbilirubinemia and 246 cases of late preterm infants without hyperbilirubinemia were retro-spectively analyzed between 2011 and 2012. The risk factors of hyperbilirubinemia were filtered. Results Twenty-seven cases of late premature infants with hyperbilirubinemia were severe. Hospital stay less than 3 days, birth asphyxia history, small for gestatio-nal age, head hematoma, delivery injury, hypoalbuminemia, polycythemia, infection, hemolytic disease, feeding intolerance, and fe-tal excretion delay were associated with hyperbilirubinemia (P<0.05). Rural origin, pregnancy-induced hypertension syndrome and premature rupture of membrane were also associated with hyperbilirubinemia (P<0.05). Multivariate logistic regression analysis showed the history of birth asphyxia , fetal excretion delay, hypoalbuminemia, pregnancy-induced hypertension syndrome were risk factors of hyperbilirubinemia in late preterm infants (OR=2.35-4.05). Pregnancy-induced hypertension syndrome and hemolytic dis-ease were risk factors of severe hyperbilirubinemia in late preterm infants (OR=5.74, 73.64). Conclusions Neonatal asphyxia, fetal excretion delay, hypoalbuminemia and pregnancy-induced hypertension syndrome are risk factors of hyperbilirubinemia in late pre-term infants. Strengthening the management of pregnancy-induced hypertension syndrome and the treatment of newborn hemolytic disease can reduce the occurrence of severe hyperbilirubinemia in late preterm infants.

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The reference ranges of oxygen saturation and heart rate in healthy infants during the first ten minutes after birth

Huijuan WANG ; Yun YANG ; Chengqiu LU ; Hong JIANG ; Zheng ZHANG ; Yongqin MENG ; Jimei WANG

Journal of Clinical Pediatrics.2014;(3):206-209. doi:10.3969/j.issn.1000-3606.2014.03.002

Objective To establish the reference ranges of preductal oxygen saturation (SpO2) and heart rate (HR) for healthy neonates in 10 minutes after birth. Methods SpO2 and HR recordings of 203 term neonates (vaginal group:n=97 and ce-sarean group:n=106) with regular respiratory pattern were evaluated. 10th-95th percentile charts of SpO2 and HR from 1 minute to 10 minutes after birth were drawn. Results The SpO2 of P10, P50 and P95 at 1 minute after birth was 62%, 71%and 85%respec-tively. The heart rate of P10, P50 and P95 at 1 minute after birth was 66 bpm, 98 bpm and 126 bpm respectively. The median time for SpO2 to reach 90%was 5 minutes. The rising trend of HR was evident during 1-5 minutes after birth, and then the HR leveled off. Conclusions The status of newborn can be assessed using the charts of SpO2 and HR combined with clinical manifestations. The oxygen intervention should be used with care to avoid damage caused by hyperoxemia and hypoxemia.

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Evaluation of the therapies for neonatal posthaemorrhagic hydrocephalus

Lijun YU ; Zhenlang LIN

Journal of Clinical Pediatrics.2014;(3):201-205. doi:10.3969/j.issn.1000-3606.2014.03.001

Although the percentage of preterm infants developing intraventricular haemorrhage (IVH) has been greatly re-duced in the past three decades, increased survival of extremely preterms has meant that severe IVH with subsequent posthae-morrhagic hydrocephalus is still one of the serious unsolved problems for managements of preterms. Therapeutic interventions for posthaemorrhagic hydrocephalus include serial lumbar punctures, repeated aspiration through a ventricular access device, ventriculoperitoneal shunting, drainage, irrigation and fibrinolytic therapy, diuretic therapy treatment to reduce cerebrospinal fluid production, intraventricular fibrinolytic therapy, etc. This review summarizes the current concepts on the pathophysiology, inter-vention indications, and the effectiveness and safety of different interventions of subsequent posthaemorrhagic hydrocephalus.

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Research progress in macrosomia growth

Dongxia FU ; Haiyan WEI

Journal of Clinical Pediatrics.2014;(3):293-294. doi:10.3969/j.issn.1000-3606.2014.03.026

The incidence of macrosomia was increasing year by year, which may be associated with gestational diabetes, obesity and pregnancy weight gain. The study showed that macrosomia was prone to obesity in childhood, and diabetes, hypertension and cardiovascu-lar disease in adulthood. The growth and development status of macrosomia in childhood is worthy of attention.

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