ObjectiveTo summarize perioperative management experience of 16 patients undergoing surgical correction of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). MethodsWe performed a retrospective analysis of 16 patients who received surgical correction of ALCAPA between January 2005 and December 2013 in Cardiovascular Center of Children's Hospital of Fudan University. There were 6 males and 10 females with their age ranging from 2 months to 13 years (mean age of 23.25±0.63 months) and body weight ranging from 5 to 30 kg (mean body weight of 19.77±0.75 kg). All the patients underwent direct implantation of the anomalous coronary artery into the ascending aorta, and received comprehensive management regarding left ventricular ejection fraction (LVEF), heart rate, blood pressure, arterial blood gas, urinary volume, blood lactic acid and central venous pressure. ResultsPostoperative complications were low cardiac output syndrome (LCOS) in 9 patients (including intractable LCOS in 2 patients) and arrhythmia in 1 patient. One patient with intractable LCOS and arrhythmia died postoperatively with the mortality of 6.25%. Cardiopulmonary bypass time was 85-260 (135.61±35.01) minutes, aortic cross-clamping time was 40-97 (57.32±16.02) minutes, mechanical ventilation time was 34-187 (106.34±41.62) hours, length of CICU stay was 2-21 (8.13±5.02) days, and hospital stay was 12-51 (22.14±5.00) days. Postoperative LVEF and left ventricular fractional shortening were significantly higher than preoperative values (P < 0.05). ConclusionKey points for successful surgical correction of ALCAPA include meticulous perioperative management, preoperative heart function improvement, prevention of postoperative complications and use of new techniques.
Objective To compare the changes between deep hypothermic circulatory arrest (DHCA) with deep hypothermic low flow (DHLF) cardiopulmonary bypass (CPB) on pulmonary surfactant (PS) activity in infants with congenital heart disease. Methods Twenty infants with ventricular septum defect and pulmonary hypertension were assigned to either DHCA group or DHLF group according to the CPB methods respectively. Measurements of saturated phosphatidylcholine /total phospholipids (SatPC /TPL), saturated phosphatidylcholine/ total protein (SatPC/TP) and static pulmonary compliance were performed before institution of CPB, 5 minutes after cessation of CPB and 2 hours. Results The length of ICU stay in DHLA group was significantly longer ( P lt;0 05) than that in DHCA group. SatPC/TPL, SatPC/TP and static pulmonary compliance in DHLF group were significantly lower compared with DHCA group ( P lt;0.01). Conclusion DHLF could lower the PS activity level significantly as compared with DHCA in infants with congenital heart disease.
Prevention and treatment of infants and young children can avoid blindness, effectively reduce the incidence of children's blindness and vision loss. Eye diseases causing blindness in infants and young children mainly include retinopathy of prematurity, retinoblastoma, familial exudative retinopathy, persistent embryonic blood vessels, vitreous hemorrhage, congenital cataract, etc. Most of them are preventable and controllable, however, many diseases have strict requirements for the effective treatment time window. The basic form and path to carry out the prevention and control of blinding eye diseases in infants and young children are building a prevention and control system with a combination of multi-party medical forces, referral to pediatric eye disease institutions with relevant technical resources for further diagnosis and treatment, so as to achieve early detection, standardized treatment and visual training.
Objective To investigate the degree of retinal developmen t in pret erm infants and compare the electroretinograms between preterm and fullterm in fants. Methods Flash electroretinogram (ERG) were obtained wit h contact lens el ectrodes in one eye from ten preterm infants (10 eyes) and twenty full-term inf a nts (20 eyes) in seven days after birth. The rod cell, cone cell, maximal combi nation, oscillatory potentials, and 30 Hz flicker responses were recorded. Results Compared with the full-term infants, the implicit time of rod cell respon s e (t=3.216，P=0.003) was longer and the amplitudes were lower (t=6.0 50，P=0.000) in the preterm infants; the difference of implicit time of maximal response was not significant (t=0.465，P=0.650; t=1.068，P=0.295), while th e amplitudes dec reased (t=6.584, P=0.000; t=6.649, P=0.000). The a- and b-wav e implicit time of cone response was not differed much between the two groups (t=0.077, P=0.939; t=0.935,P=0.358); the amplitudes was obvious lower in preterm group (t =3 .417，P=0.002；t=6.310，P=0.000); the difference of implicit t ime of 30 Hz flic ker betw een the two groups was not significant (t=3.745，P=0.001). The difference of b/a value of maximal combination response was not obvious between the two groups ( t=0.215, P=0.831). Conclusions The development of retinal function is slower in preterm infants than that in full-term ones．
OBJCTIVE :To investigate the fundus ocu]i changes in hypnxie isehemic encepbalnpa ally(HIE)of new[x,rns. METHODS:One hundred and two newblt;~rns suffered from HIE were investi- gated to observe lhe pathological neular fundus changes by di~et ophthabnoseopy after mydria~s. RE- SULTS:Seventy seven ca.~s(154 eyes)were found to have ophthalmoscopic changes in the ~ular fundi including papilledema .white retina vaseolar abnormality and hemorrhage. CONCLUSIONS:In clinical view .the severity of HIE depends on the pathological ebanges of the brain .and ftmdus ahnormalby will be very often in middle and .~vere sufforers of HIE.
Abstract： Objective To identify the risk factors for shortterm adverse events in infants with congenital heart diseases receiving open heart surgical correction with cardiopulmonary bypass (CPB), in order to improve the outcome by adopting appropriate treatment measures. Methods We retrospectively analyzed the clinical data of 98 consecutive children with congenital heart diseases who underwent surgical correction with CPB in Beijing Fu Wai Hospital from November 2009 to December 2009. The patients were divided into two groups according to the postoperative complications. Among the patients without complications（n=40）: there were 24 males and 16 females with an age of 7.60±0.40 months and a weight of 7.80±0.30 kg. In the patients with complications (n=58): there were 42 males and 16 females with an age of 6.20±0.40 months and a weight of 6.70±0.20 kg. In both groups, perioperative data were recorded, including preoperative fast blood glucose, creatinine, time of aortic crossclamp, modified or zerobalanced ultrafiltration, postoperative glucose level, concentration of lactate, notrope score and complications. Risk stratification was performed by Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1). Univariate analysis and logistic regression analysis were used to identify the risk factors for shortterm adverse events. Results One patient(1.02%) died of circulatory failure during the perioperative period. Thirtyseven patients [CM(159mm]were supported by at least 2 vasoactive drugs for more than 48hours,29 by mechanical ventilation for more than 24 hours, 5 needed reintubation, 1 experienced tracheotomy, 31 suffered from noscomial infection, 4 had wound infection, 3 developed renal failure, and 1 developed hepatic dysfunction. By logistic regression analysis, age (OR=0.750, P=0.012), percutaneous oxygen saturation (OR=0.840,P=0.005), aortic crossclamp time (OR=1.040, P=0.008), postoperative glucose level (patients with a mean glucose level lower or equal to 8.33 mmol/L had a probability of developing adverse outcomes five times higher; OR=5.051, P=0.011) were found to be the risk factors for shortterm adverse outcomes. Conclusion Age, percutaneous oxygen saturation and aortic crossclamp time are associated with the shortterm adverse outcome of infants undergoing congenital heart disease correction with CPB. The present results do not support perioperative hyperglycemia as a risk factor for adverse outcome.
Objective To explore the evaluation value of burden of amplitudes and epileptiform discharges score (BASED) in the efficacy of adrenocorticotropic hormone (ACTH) combined with magnesium sulfate therapy for infantile epileptic spasms syndrome (IESS). Methods Retrospective collection the clinical and EEG data of 124 patients admitted to the Dongguan Maternal and Child Health Care Hospital from 2015 to 2023, who were diagnosed with IESS and treated with ACTH combined with magnesium sulfate. According to whether there were epileptic seizures 14 days after ACTH treatment, the patients were divided into two groups: non seizure group (n=74 cases) and seizure group (n=50 cases). The BASED system was used to evaluate the relationship between changes in EEG before and after ACTH treatment and clinical efficacy in both groups. The analysis of electroencephalogram included: ① abnormally high amplitude background waves, ② >3 spike foci , ③ grouped multifocal spikes, ④ paroxysmal voltage attenuation. ResultThe control rate of ACTH combined with magnesium sulfate in the treatment of IESS was 59.7% (74/124), and there was no statistically significant difference in the control rate among children with different etiologies (P=0.09). The BASED score suggests that the overall response rate of electroencephalogram (EEG) in infants with epileptic spasm syndrome after treatment was 57.2%. The EEG remission rate in the seizure control group was 81% (60/74), while in the uncontrolled group was 22% (11/50). The EEG remission rate in the seizure control group was significantly higher than that in the uncontrolled group after treatment (P<0.001), and the EEG score was closely related to clinical efficacy (Spearman correlation coefficient rp=0.601, P<0.001). ConclusionThe BASED score is related to clinical efficacy, and it can provide a quantitative basis for evaluating the efficacy of ACTH combined with magnesium sulfate in the treatment of IESS.
ObjectiveTo analyze the clinical data of pregnant females and children infected with H1N1 during the global pandemic in 2009, and summarize the epidemiological characteristics.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect studies on H1N1 infection in pregnant females and children during the 2009 pandemic from January 1st, 2009 to February 17th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, epidemiological characteristics were descriptively analyzed.ResultsA total of 33 studies involving 939 children, 5 newborns and 2 416 maternal infections were included. The results showed that the age span of children was 0 to 18, the male-to-female ratio was 1.2:1, and the history of close contact accounts was 18.8% (80/425). The primary symptoms were fever, cough, headache, vomiting and other symptoms in some children. More than half of the children received oseltamivir antiviral treatment (545/807, 67.5%), and 6 died (6/861, 0.7%). The primary symptoms of pregnant females were fever, cough, sore throat, muscle pain, fatigue, headache, diarrhea, and so on. The majority of patients received antiviral therapy (1 571 to 1 783, 88.1%). A total of 178 mortalities (178/2 335, 7.6%), 48 stillbirths (48/966, 5.0%), and 9 live birth mortalities (9/494, 1.8%) were reported. All 5 newborns were positive for RT-PCR detection, including 4 premature infants. The mode of transmission was close contact in 3 cases (including 1 case in contact with sick medical staff), 1 case of vertical transmission from mother to child, and 1 case of unknown. The primary clinical manifestation of newborns was dyspnea. After treatment with oseltamivir, 4 cases were cured and 1 case deceased.ConclusionsPregnant females and children are at high risk of serious complications of H1N1 influenza. H1N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes. The symptoms of H1N1 infection in children and pregnant females are similar to those in adults, primarily respiratory and systemic symptoms. Oseltamivir and zanamivir are effective antiviral drugs.
ObjectiveTo systematically review the protective effect of serum maternal respiratory syncytial virus (RSV) antibodies on infants with RSV infection. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect observational studies on the correlation between serum maternal RSV antibodies and infants with RSV infection from inception to July 18, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, qualitative analysis was performed. ResultsA total of 19 studies were included, and 60% of those studies suggested that a higher level of maternal antibodies could prevent RSV infection. However, the remaining 40% of them showed that there was no significant difference in the level of RSV maternal antibodies between the infected group and the non-infected group. Further more, in the studies of the correlation between maternal antibody level and disease severity after RSV infection, 55% of those showed that maternal antibody level was negatively correlated with disease severity. ConclusionThe protective effect of serum maternal RSV antibodies on infants reported in different studies varies. Whether it can prevent RSV infection and affect the severity of RSV infected children still needs to be explored.
Abstract: Objective To discuss whether priming solution with blood can reach a physiologic state after ultrafiltration and investigate the influence of this method on electrolytes, acidbase balance and cardiopulmonary function in patients in perioperative period. Methods Forty patients with congenital heart diseases treated in our hospital from February to June 2009 were enrolled in this study. The weight of these patients was less than 8 kg. They were randomly divided into two groups: the experimental group (n=20, 12 males and 8 females; age: 131.00±103.00 d; weight: 4.14±0.96 kg） and the control group (n=20, 11 males and 9 females; age: 127.00±88.00 d; weight: 4.38±1.05 kg). For patients in the experimental group, the priming solution was filtered with a blood ultrafilter in the cardiopulmonary bypass(CPB) circuit for twenty minutes, while the priming solution circulated in the CPB circuit without filtration for patients in the control group before operation. Data were obtained from the priming solution before and after ultrafiltration. Blood gas analysis was done and indexes like the electrolytes were detected during the operation. Fractional shorting (FS), ejection fraction (EF) and cardiac output (CO) were measured by echocardiography. Pulmonary function change was also observed. Results No death occurred in both groups. Mechanical ventilation time for the experimental group was significantly shorter than that of the control group (2.7±0.3 d vs. 4.1±0.4 d，Plt;0.05). After ultrafiltration for the experimental group, all indexes of the priming solution reached normal values: pH increased (from 6.89±0.22 to 7.40±0.57, P=0.001); base excess increased (from -16.12±0.98 mmol/L to +0.31±2.40 mmol/L, P=0.000); potassium concentration decreased (from 10.33±2.13 mmol/L to 4.27±0.93 mmol/L, P=0.000); interleukin8 (IL-8) decreased (from 78.40±6.10 pg/ml to 64.30±48.10 pg/ml, P=0.036); and bradykinin decreased (from 5 982±1 353 pg/ml to 531.00±35.00 pg/ml, P=0.031). The decrease of FS, EF and CO in the experimental group was smaller than that of the control group. Four hours after surgery, CO in the experimental group was significantly higher than that in the control group (2.77±0.95 L/min vs. 1.66±0.75 L/min, P=0.001). Twentyfour hours after surgery, EF in the experimental group was significantly higher than that in the control group (67.44%±6.89% vs. 61.17%±9.02%, P=0.003). Six hours after surgery, alveolararterial oxygen difference (A-aDO2) and respiratory index (RI) increased significantly (Plt;0.05) in both groups, and then started to drop to normal. Patients in the experimental group recovered gas exchange earlier than patients in the control group. Fortyeight hours after operation, A-aDO2 and RI in the experimental group were significantly lower than those in the control group (Plt;0.05). Conclusion Ultrafiltration of priming solution may confer an advantage in maintaining more physiological conditions, reducing inflammatory mediators, and improving cardiopulmonary function after operation, which is very important in performing cardiac surgery on the newborn and infants with complex congenital heart diseases.