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 evaluate the effect and safety of infantile femoral vein blood sampling with vacuum versus disposable needle. Methods Such databases as VIP, CNKI, CBM, Google Academic and Wanfang data were searched to collect the randomized controlled trials (RCTs) about infantile femoral vein blood sampling with vacuum versus disposable needle published from January 2000 to July 2010. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the methodology quality was assessed, and meta-analysis was conducted by using RevMan 5.0 software. Results A total of 15 RCTs were included. Of 3 490 patients in all, 1 770 were in the treatment group and 1 726 were in the control group. The baseline conditions were reported in 14 studies, and the random methods were mentioned in 11 RCTs. All studies didn’t report the allocation concealment and blind method. Only 2 RCTs reported separately that, the degree of neonatal pain was lower in the treatment group (Plt;0.01), and the satisfaction of parents was higher in the treatment group (Plt;0.01). Four RCTs compared the sampling time between the two groups without meta-analysis mentioned due to the disunity of standard, only the descriptive outcomes showed a shorter time in the treatment group. The meta-analysis showed that, compared with the control group, the reject rate of sample quality was lower (RR=0.20, 95%CI 0.15 to 0.26), the success rate of one time sampling was higher (RR=1.20, 95%CI 1.16 to 1.24), the injury of local tissue was slighter (RR=0.62, 95%CI 0.45 to 0.86), and the iatrogenic contamination was lower (RR=0.62, 95%CI 0.45 to 0.86) in the treatment group. Conclusion This review shows that the vacuum sampling is superior to the disposable needle sampling for domestic infantile femoral vein blood collection. Due to the low quality of the included studies with high possibility of bias, this conclusion needs to be further verified by performing more high-quality studies.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Objective To systematically review the effects of the early childhood physical activity program (ECPAP) on gross motor skill (GMS) in preschool children. Methods We searched Web of Science, PubMed, Cochrane Library, EBSCO SPORTDiscus with Full Text, CNKI, WanFangData and VIP databases to collect randomized controlled trails (RCT) about ECPAP for improving GMS in preschool children from the establishment of the database to August 8, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4.1 and Stata 15.0 software. Results A total of 18 studies including 1 141 children in experimental group and 1 135 children in control group were included. The results of meta-analysis showed that after ECPAP, the GMS (SMD=1.96, 95%CI 1.44 to 2.49), locomotor skills (SMD=1.15, 95%CI 0.83 to 1.46) and manipulative skills (SMD=1.25, 95%CI 0.84 to 1.65) of the experimental group were significantly better than those of the control group (P<0.05). Conclusion ECPAC is considered to significantly promote the GMS of preschool children. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the effect of artificial colloid on coagulation function in pediatric patients weighing less than 5 kg with congenital heart disease during cardiopulmonary bypass in congenital heart disease surgery by using artificial colloid instead of human serum albumin.MethodsA total of 65 pediatric patients with weight less than 5 kg who underwent congenital heart disease surgery in our hospital from September 2016 to December 2017 were included in the study. They were randomly divided into two groups: an artificial colloid group (the experimental group, n=33) and a human serum albumin combined artificial colloid group (the control group, n=32). Perioperative hemoglobin concentration (Hb), blood products and hemostatic drugs used, postoperative coagulation function index and pleural fluid volume 24 hours after surgery were monitored.ResultsThere was no significant difference in perioperative Hb and chest tube drainage between the two groups. The platelet utilization rate in the experimental group was significantly lower than that in the control group (P<0.05). No significant difference was found in the dosage of other blood products and hemostatic drugs between the two groups during the perioperative period. There was no significant difference in coagulation parameters between the two groups before and after surgery (P>0.05).ConclusionThe use of artificial colloid as colloid priming solution during cardiopulmonary bypass has no adverse effect on coagulation function in pediatric patients weighting less than 5 kg with congenital heart disease.
ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.