Objective To discuss the prevalence of melamine-induced urolithiasis in infants and its development and to formulate more effective diagnosis and treatment. Methods A total of 402 cases of melamine-induced infantile urolithiasis were retrospectively analyzed with basic information, blood, urine, urinary B-mode ultrasonic diagnosis, treatment options and prognosis for infant urolithiasis. Results A total of 402 cases of infants had an excessive melamine milk feeding history, in which there were 9 self-discharged cases. The largest calculus diameter was 4 mm × 5 mm × 6 mm. The smallest calculus diameter was 0.5 mm × 0.5 mm × 1 mm. The average calculus diameter was 1 mm × 2 mm × 2 mm. There were 30 cases of abnormal serum creatinine, 27 of abnormal urea, 2 of abnormal uric acid, and urine occult blood positive for 167 cases. There were 395 cases which were administrated medical treatment; 7 cases were administrated surgical treatment; 6 cases had obstructive renal failure. Conclusion Infants whose age is more than six months but less than 12 months with a history of exposure to melamine have the larger risk of urolithiasis. B-mode ultrasonic diagnosis is practically significant on early screening urolithiasis. It is effective to perform surgical treatment for obstructive renal failure caused by calculus.
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.
【Abstract】 Objective Through a retrospective study, to observe the cl inical therapeutic effect for closed reductiontreatment of developmental dislocation of the hip (DDH), and to dynamically analyze characteristics of acetabular development after closed reduction in DDH. Methods A total of 100 single side DDH children who were treated by “the treatment mode of closed reduction” from January 2002 to December 2005 were followed up, including 18 males and 82 females, with the average age of 19.4 months (ranging from 7 months to 36 months). Sixty-eight patients had left side dislocation, while 32 had right side dislocation. According to Zionts dislocation grades, 15 cases were degree I, 50 degree II, 26 degree III and 9 degree IV. Adductor tenotomies and skeletal traction were carried out in 74 cases, while direct closed reduction was performed in 26 cases. The four-level functional evaluation criterion was used to assess the cl inical therapeutic effect. Lesional and homeochronous normal hips were paired, and acetabular index (AI) and AI (D/W) of lesional and normal hips, before the reduction and in the 3rd, 6th, 9th and 12th month, respectively, after the reduction, were dynamically measured. Results The total choiceness rate of 100 children was 88.00%. Twelve months after the reduction, lesional AI decreased from (37.17 ± 2.17) o to (27.02 ± 3.54) o, while lesional AI(D/W) increased from 22.06% ± 1.65% to 29.80% ± 3.56%, and the differences among each time-point had statistical significance (P lt; 0.01). Both rates of lesional AI decrease and AI(D/W) increase were obviously faster than those of normal side physiological development (P lt; 0.01). In all durations after 12 months reduction, the rates of lesional AI were (3.22 ± 1.42) o and (3.41 ± 2.03) o in 1 - 3 months and 10 - 12 months , respectively, and the rates of AI(D/W) were 2.69% ± 1.83%and 2.33% ± 1.13%, respectively, and they were obviously faster than the other durations (P lt; 0.01). Both rates of lesional AI decrease and AI(D/W) increase were obviously faster than the homeochronous rate of normal side physiological development in each duration (P lt; 0.01). The rates of lesional AI were (13.71 ± 3.96) o and (11.48 ± 4.15) o in 7 - 12 age group and 13 - 18 age group, respectively, and the rates of AI(D/W) were 9.95% ± 3.81% and 8.28% ± 3.58%, respectively, and they wereobviously faster than the other age groups (P lt; 0.05). Both changes of lesional AI and AI(D/W) were obviously faster than the homeochronous changes of normal side in each age group(P lt; 0.01). Conclusion There are simple operating requirements and fine therapeutic effect of “the treatment mode of closed reduction” . Within 12-month after the closed reduction treatment, the rate of lesional acetabular development is obviously faster than that of normal side physiological development. The cresttime of lesional acetabular development is during 1 - 3 months and 10 - 12 months, and the best treatment time of closed reduction is the age before 18 months.
Objective To evaluate the effect of exogenous pulmonary surfactant(PS) replacement therapy for infants who suffered pulmonary injury after cardiopulmonary bypass. Methods Seven infants (age 0.49±0 82 year, weight 4.87±2.18kg) who depended on respiratory mechanical support with clinical and radiological evidence of pulmonary surfactant sufficiency were enrolled in the study. Oxygen index(OI), artery oxygen saturation(SaO 2) and artery bicarbonate pressure(PaCO 2) were measured at 4, 6, 12, 24, 48, and 72 h after the first application of PS(100mg/kg). At the meantime, maximum spontaneous respiratory tidal volume, chest X ray changes and ventilator time were recorded. Results Compared to the baseline values, OI and SaO 2 increased significantly 4 h after PS therapy, with a maximal increase slope (34.7%, 6.6%) after 24 h. While PaCO 2 decreased significantly 4 h after PS therapy, with a lowest decrease slope (22.8%) after 6 h ( P lt;0.05, 0.01). Spontaneous tidal volume and chest X ray si...更多gn were improved in all infants. The success rate of extubation was 85 7%. Conclusion Exogenous PS replacement therapy could improve pulmonary function for postoperative infants, and highly decrease the ventilator time.
Objective To observe the characteristics of images of ocular fundus obtained by computer-assisted imaging system of binocular indirect ophthalmosco p y (CABIO) in the healthy premature infants and the ones with retinopathy of prem aturity(ROP), and evaluate the value of the clinical practice of CABIO in ROP s creening. Methods From January, 2006 to December, 2006, we exa mined 150 prematur e infants in ROP screening procedure by using the computerassisted imaging sys t em of binocular indirect ophthalmoscope, beginning at the infantsprime;age of postn a tal 4-6 weeks or the corrected age above 32 weeks. The follow-up duration was co nfirmed according to the first examination results. The procedure of the operati on was recorded and the typical pictures were shot to obtain the images of the o cular fundus of the healthy premature infants and the ones with ROP. The charact eristics of the images were retrospectively analyzed and compared. Resu lts The typical images of normal ocular fundus and that with ROP in the 150 premature i nfants were successfully obtained by indirect ophthalmoscope. In normal fundus o f infants, the color of optic disc was pale, peripheral retina was not completel y vascularized and presented gray-tone in color;while all stages of ROP present ed dif ferent appearances under the indirect ophthalmoscope. Conclusions Computer-ass isted imaging system of the binocular indirect ophthalmoscopy can clearly observ e the characteristics of normal ocular fundus of premature infants and the ocula r fundus with ROP, and can save the objective examination results, which may pro vide significant references in screening and treating ROP.
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 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.
Objective To explore the effectiveness and appropriate energy parameters of high-intensity focused ultrasound (HIFU) in treating infant hemangiomas. Methods Between January 2009 and September 2010, 60 infants with hemangioma were treated. There were 23 boys and 37 girls, aged from 3 to 30 months with an average of 10 months. These hemangiomas were located at head and face (24 cases), trunk (15 cases), l imb (16 cases), buttocks (2 cases), perineum (1 case),and multiple lesions (cervix, abdomen, and upper l imbs, 2 cases). The size of hemangiomas ranged from 0.8 cm × 0.6 cm to 6.0 cm × 5.0 cm. The 60 infants were randomly divided into 3 groups: groups A, B, and C (n=20) based on different ultrasound energies used in treatment. The lesion surface was irradiated with 3-5 mm/second for 5 continuously by ultrasonic therapeutic apparatus at a frequency of 9 MHz, impulse of 1 000, and 10% of scanning overlap; the powers of 3.5, 4.0, and 4.5 W were used in groups A, B, and C, respectively, 3 times as a course of treatment with 1 month interval. The effect and ulcer and scar risk in irradiation region were observed after 6 months of treatment. Results All cases were treated for one course. After 6 months of treatment, no significant difference in the effect was found among 3 groups based on hemangioma treatment judging criterion (P gt; 0.05). Neither ulcer nor scar occurred in group A; ulcer occurred in 4 cases (20%) of group B with superficial scars, and in 7 cases (35%) of group C with obvious scars. The rates of ulcer and scar in groups B and C were significantly higher than that in group A (P lt; 0.05). Conclusion HIFU irradiating is one of effective methods for treating infant hemangioma, but the appropriate energy was below 3.5 W.
Objective To observe the retinal function of infa nts with retinopat hy of prematurity (ROP). Methods A total of 78 infants (156 ey es) aged from 4-5 months underwent full-field flash electroretinogram (ERG) examination. The am p litude and implicit time of a-and b-wave of ERG were detected to evaluate the i nfants' retinal function. Seventy-eight infants (156 eyes) included 33 healthy a nd full-term infants (66 eyes), 25 healthy premature children (50 eyes), and 20 infants (40 eyes) with ROP. Results Obvious ERG waveforms were recorded in all the fullterm and healthy premature children. Amplitude of combined b-wave wa s 388.7 mu;V in full-term infants and 336.7 mu;V in healthy premature children, whi c h was 64.4% and 55.6% of that of the healthy adults respectively. In infants wit h ROP, ERG was nonrecordable in 20 eyes (50％); amplitude of combined b-wave was 183.8 mu;V in the other 20, whose implicit time delayed obviously compared with that of fullterm infants. The amplitude of ERG of healthy premature infants de c reased significantly compared with that of the full-term infants. Conclusions Retina keeps growing after birth. ERG of healthy full-term chi ldren is not as developed as those of adults. The progress of retinal maturation in infants with ROP is slower than that in the full-term infants. ERG examination is an effecti ve method in evaluating retinal function of infants with ROP.
Objective To study the feasibility, indication, technique of emergency operation and the perioperative management on critical congenital heart disease in infants. Methods From May 1998 to May 2003, 67 emergency operations of critical congenital heart disease were performed in infants . The age was 14d-32 months (mean , 11.8±8.9 months), the weight was 2.6-14.8 kg( mean, 8.4±3.0 kg). The diagnosis included ventricular septal defect in 39, tetralogy of Fallot in 13, complete atrioventricular septal defect in 5, total anomalous pulmonary venous drainage in 4, atrial septal defect with pulmonary valve stenosis in 3, D-transposition of the great arteries in 2, and postoperative pulmonary valve vegetation in 1. Corrective operation in 64 and palliative operation in 3 were done. Results The preoperative managing time was 0-9 d(mean , 3.7±2.6 d), the lasting time of intubation was 1-14d( mean, 3.8±3.2 d), and ICU staying time was 2-18 d (mean, 5.7±2.8 d). The operative mortality was 7.5% (5/67), the postoperative complications in other infants include 14 low cardiac output syndrome, 14 atelectasis, 8 lung infection, 2 worsened pulmonary hypertension, 1 pneumothorax , and 1 phrenic nerve paralysis. Following up 2-60 months with 1 case late death, the cardiac function of the others were class Ⅰ-Ⅱ/Ⅵ, the operative result was satisfactory. Conclusions The emergency operation on critical congenital heart disease in infants is safe, and can save most of their lives, the good result can be obtained from surgical treatment. Accurate choice of indications, and perioperative good nutritional and cardiorespiratory function support are important.