Objective To explore the treatment method of congenital heart disease (CHD) with pulmonary artery hypertension (PAH) in infants with Down syndrome (DS). Methods The clinical data of 60 CHD patients with PAH from March 2015 to August 2016 in our hospital were retrospectively analyzed. There were 30 infants with DS classified as a DS group (trial group, 17 males and 13 females with a mean age of 1.15±0.25 years) and the other 30 patients without DS were classified as a control group (20 males and 10 females with a mean age of 1.24±0.30 years). All the patients underwent surgical treatment and fasudil combined with sildenafil were used to prevent pulmonary hypertension crisis postoperatively. Results There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, modified ultrafiltration time and the incidence of postoperative respiratory complications between the two groups. The pulmonary systolic blood pressure significantly decreased at 24 h after operation in the two groups (both P<0.05). The arterial oxygen pressure and oxygenation index of the trial group were lower than those of the control group at 6 h after operation (both P<0.05). The mechanical ventilation time and intensive care time of the trial group were significantly longer than those of the control group (P=0.007 and P=0.000, respectively). There were no reoperations or early death. Conclusion The effects of surgical repair of CHD with PAH in infants with DS are satisfactory by grasping the indication, protecting lung function and controlling PAH in the early postoperative period, although there is a high incidence of pulmonary complications.
In order to guide diagnosis and treatment in children with sleep disordered breathing aged 1 to 23 months, the European Respiratory Society(ERS) summarized the evidence and released the European Respiratory Society statement based on clinical experience in 2016. This article aims to interpret the ERS statement. Children with apparent upper airway obstruction during wakefulness and those with SDB symptoms and complex conditions requires treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions. Obstructive SDB in children aged 1 to 23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities.
Objective To systematically evaluate the clinical effect and safety of Bifidobacterium tetravaccine tablets in the treatment of antibiotic associated diarrhea (ADD) in infants in China. Methods Randomized controlled trials (RCTs) of treatment of AAD by Bifidobacterium tetravaccine in infants were searched by computer from China Knowledge Resource Integrated Database, VIP and Wanfang Data from their inception to November 2016. Meta-analysis of the data was carried out by RevMan 5.3 software. Results Twelve RCTs were chosen, which included 1 761 infant patients. The Meta analysis showed that the effects of treatment of ADD were significantly superior to those of the control group [OR=5.74, 95%CI (4.14, 7.96),P<0.000 01]. Among the 12 RCTs, 8 had no adverse reactions, while the rest4 articles did not mention adverse reactions. Conclusions Based on the present clinical evidences, treatment of ADD by Bifidobacterium tetravaccine in infants is effective and safe. But due to the small number and different quality of RCTs, this conclusion still needs to be confirmed by large sample, multicenter, and high-quality clinical RCTs.
ObjectivesTo systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection.MethodsThe clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis.ResultsA total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection.ConclusionsThe clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.
Objective To investigate the application and curative effect ofnasoalveolar molding plate in the presurgical orthodontic treatment of completeunilateral cleft lip and palate in infants. Methods From January 2003 to March 2004, 100 infants with complete unilateral cleft lip and palate received presurgical orthopedics by using nasoalveolar molding plate. According to the age, 100 infants(aging 10 days to 3 months, including 60 males and 40 females) were divided into the test group (10 days to 1 month) and the control group (1.3 months). The widths of lip cleft and dentoalveolar cleft and the rate of satisfaction for nose wing were compared between 2 groups before treatment and after the treatment.Results The widths of cleft lip and dentoalveolar cleft before orthodontic (5.0±1.6 mm,6.9±2.6 mm) and after orthodontics (4.1±2.7 mm, 6.4±29 mm）in the test group were less than those in the controlgroup（7.5±3.1 mm, 12.5±4.0 mm and 8.3±3.0 mm,10.8±2.6 mm）, being statistically different(Plt;0.05). The satisfactory rate of nose wing inthe test group (86.3%) was significantly higher than that in the control group(62.4%，Plt;0.05). Conclusion The advantagesof presurgical orthodontic treatment of complete unilateral cleft lip and palate in infants are as follows: repositioning the premaxillary segment, reducing the width of palate cleft, correcting the nasal deformities and facilitating surgical repair of cleft lip and palate.
ObjectiveTo analyze the results of surgical treatment of severe aortic stenosis in infants.MethodsFrom August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed.ResultsTwenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation.ConclusionInfants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.
ObjectiveTo observe the efficacy and safety of lacosamide (LCM) as a monotherapy or as an add-on in the treatment of focal epilepsy in children aged 4 months to 4 years. MethodsThe study included 20 children with focal epilepsy who received oral LCM monotherapy or add-on therapy in Children's Hospital Affiliated to Soochow University from March 2022 to September 2022, including 9 males and 11 females with an average age of (22.4±13.0) months. The curative effects and adverse reactions at 1, 2, 3, 4, and 6 months after LCM treatment were analyzed. The initial dose of LCM was 2 mg/(kg·d) and increased by 2 mg/(kg·d) every week, maintenance dose 6 ~ 12mg/(kg·d). Results During the follow-up period of this study, the total effective cases were 17 (85.00%), and the number of control-free cases was 15 (75.00%). Conclusion LCM can effectively reduce the frequency of epileptic seizures in the monotherapy or add-on treatment of infants and young children with focal epilepsy, with few adverse reactions and high retention rate, which has high clinical application value.
ObjectiveTo investigate the high-risk factors for death in infants with severe pneumonia. MethodsWe analyzed hospitalized infants and young children diagnosed with severe pneumonia from January 2011 to December 2013, and investigated the risk factors for death. ResultsA total of 1 411 infants with severe pneumonia were included in the analysis. The mortality rate was 3.12%. In single factor analysis, the following factors were significant:age, severe infection, artificial feeding, congenital heart diseases, bad habitation, repeated infection history, surgical history, multi-organ dysfunction, internal environment disorder, multiple drug-resistant strains infection. The results of Logistic multiple regression analysis showed that there were statistical significance in severe infection, repeated infection history, Multiple drug-resistant strains infection, multi-organ dysfunction, and internal environment disorder. ConclusionInfants with severe pneumonia should be intensively monitored and actively treated for reducing the mortality rate if they have one of the following high-risk factors:age, congenital heart diseases, repeated infection history, multiple drug-resistant strains infection, surgical history, multi-organ dysfunction, and internal environment disorder.
ObjectiveTo evaluate the safety of modified blood-sparing approach in cardiac surgery with cardiopulmonary bypass (CPB) in low-weight infants (≤15 kg) with congenital heart disease. MethodsA total of 283 infants were applied a new blood-sparing approach, known as without homologous blood priming, during the cardiac surgery with CPB between August 2012 and October 2013. There were 154 males and 129 females with a median (interquartile range) age of 13 (9, 20) months. The infants were assigned to an intraoperative transfusion (IT) group once having transfusion during operation. And the infants without transfusion during operation were assigned to a postoperative transfusion (PT) group or a transfusion-free (TF) group according to post-operative transfusion. All infants experienced routine heart surgery with CPB. Blood samples were collected at following time points, ie. pre-CPB, 10 minutes after CPB, before termination of CPB, and after modified ultrafiltration. Clinical data and transfusion requirements were collected and compared between three groups. ResultsA total of 106 infants (53 males and 53 females) completed bloodless surgery. The median (interquartile range) age was 14 (9, 22) months. A total of 121 infants (71 males and 50 females) received red blood cell (RBC) transfusion intraoperatively. The median (interquartile range) age was 10 (8, 12) months. A total of 56 infants (30 males and 26 females) at age of 15 (7, 20) months received RBC transfusion postoperatively. The intraoperative transfusion (IT) group had lower body weight (9 (7,10) kg vs. 12.6 (9,14) kg) and size (72 (68, 80) cm vs. 86 (78, 97) cm), younger age (10 (8, 12) months vs. 14 (9, 22) months), and higher 24-hour chest tube drainage volume (89 (40, 122) ml vs. 58 (30, 106) ml, P<0.05) than those in the transfusion free (TF) group. Pre-operative hematocrit was also lower in the IT group than that in the PT group and the TF group (32% (29%, 37%) vs. 39% (34%, 41%) vs. 36% (33%, 38%), P<0.05). The hospital stay in the PT group and the IT group was longer than that in the TF group, respectively (13 (8, 23) d vs. 14 (11, 22) d vs. 11(8, 20) d, P<0.05). ConclusionAlthough applied with blood-sparing approach, perioperative transfusion is required in some infants. Infants who are free from transfusion have shorter hospital stay and less 24-hour chest tube drainage volume. Consideration of risk factors of transfusion in this population may benefit further reduction in blood transfusion in the future.
ObjectiveTo observe the ocular clinical features and efficacy of young infants with incontinentia pigmenti (IP). MethodsA retrospective study. Clinical data of 18 young infants with IP aged 0-3 months in the Department of Ophthalmology of Henan Children's Hospital from October 2017 to February 2019 were collected in this study. All patients were underwent fundus examination under topical anesthesia or general anesthesia. Among them, 9 cases were underwent genetic testing. Patients were determined whether to treated with retinal laser photocoagulation (LIO) or intravitreal conbercept (IVC, 0.25 mg/0.025 ml) according to the condition of eyes. The followed-up time ranged from 4months to 43 months. The ocular clinical features and treatment were observed. ResultsThere were 1 male and 17 females of the 18 patients. The age of first visit were 1.2±1.0 months (2 d-3 months). All cases had typical skin lesions, 4 cases had neurological symptoms, 10 cases had tooth abnormalities, and 4 cases had cicatricial alopecia. Among the 9 cases that were underwent genetic testing, 5 cases were deleted in exons 4-10 of the IKBKG gene and 1case were a heterozygous mutation c.1124delT in exon 9 of the IKBKG gene. Among the 36 eyes, 21 eyes of 13 cases with incontinentia pigmenti-associated ocular diseases were all retinopathy (58.3%,21/36). Retinopathy of 9 cases were asymmetrical (69.2%,9/13). Among the 21 eyes, 3 eyes were simple retinal pigment abnormalities (14.3%,3/21) and 18 cases had retinal vascular lesion (85.7%, 18/21). Among the 36 eyes, 8 eyes were treated; 4 eyes were underwent LIO; 3 eyes were treated with IVC; 1 eye was treated with LIO combined with IVC. They were all improved significantly after the operation without serious complications. 1 eye with retinal detachment did not undergo surgical treatment due to guardian reasons. Perceptual exotropia and eyeball atrophy was found during the follow-up. ConclusionsThe onset of IP-related ocular anomalies is early. The early anomalies were mainly retinal vascular abnormalities. Treatment in early time is effective.