ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery.
MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared.
ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010).
ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective To determine the extent of off-label drug use in pediatric outpatients of West China Second University Hospital in 2010, and to analyze its possible risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China and developing policy of off-label drug use. Methods The stratified random sampling was conducted to select prescriptions of children aged 0 to 18 years in pediatric outpatients of the West China Second University Hospital in 2010. According to drug instructions, off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs. In addition, an analysis was conducted to check the relationship between off-label use and following possible risk factors: age, sex, essential medicines and over-the-counter drugs. Results A total of 2 640 prescriptions with 8 588 medical advices involving 329 drugs were extracted and analyzed, with incidence rates of off-label drug use accounting for 76.59%, 40.88% and 83.89%, respectively. The main categories of off-label drug use were no pediatric information (35.57%), indication (25.44%), and dosage (25.31%). The top 2 age groups with highest incidence rate of off-label drug were neonates (54.35%) and adolescents (49.64%). The top 4 drugs with highest incidence rate of off-label drug were respiratory system medicines (48.12%), Chinese patent medicines (48.12%), digestive and metabolic system medicines (33.36%), and systemic anti-infectives (16.27%). The off-label use risks in all age groups in the hospital were indifferent, and the essential medicines and prescription medicines were likely to present higher risks of drug off-label. Conclusion Off-label drug use in pediatric outpatients is common with growth trend in pediatric outpatients of the West China Second University Hospital. On the one hand, drug instructions lack pediatric information, and on the other hand, it’s badly in need of developing relevant legislation, regulations or guidelines to regulate off-label drug use, providing more evidence by conducting clinical trials on pediatric drugs, encouraging the development and production of the applicable drugs and dosage forms for children, and establishing the children essential medicine list, so as to avoid doctor’s professional risk and ensure the safety of pediatric drug use.
The clinical practice guideline on traditional Chinese medicine alone or combined with antibiotics for patients with acute upper respiratory infection in children was issued by China Association of Chinese Medicine in June 2017. Base on the evidence, consensus and experience, five manage groups, steering committee, consensus expert group, systematic review group, drafting group and secretary group, have promoted the project. The main work process refers to up-to-date clinical practice guideline definitions of institute of medicine and quick recommendations guide of guidelines international network and WHO. In order to provide readers with a better understanding of the guideline, the drafting process of guideline principle, main work process, and basis policy were described in detail in this paper. The guidelines’ scientific characteristics, accuracy and practicability were better exhibited in attempt to enhance its promotion and application.
ObjectiveTo investigate the effectiveness and safety of Perampanel (PER) add-on treatment in the pediatric patients with uncontrolled epilepsy. MethodsPatients aged 0 ~ 18 years who visited the Xi'an Children's Hospital between June 2021 and December 2024 were recruited. They had uncontrolled seizures and were treated with PER as add-on therapy. The outcomes included response rate, seizure-free rate, and retention rate at 3, 6, and 12 months, and at the last visit. Tolerability was also assessed throughout follow-up. ResultsA total of 105 pediatric patients with epilepsy were followed up for at least 6 months. Eighty-three cases were aged ≥4 years while 22 cases were aged <4 years. Focal seizures occurred in 76 (72.4%) cases and 29 (27.6%) cases suffered other seizure types. The cause of epilepsy was clarified in 46 (43.8%) cases. The diagnosis of epileptic syndrome could be established in 34 (32.4%) cases at the time of PER add-on. The median seizure frequency per 28 days was 8 at baseline. The median number of prior antiseizure therapy before PER add-on was 3. The overall response rates at 3, 6 and 12 months were 61.9%, 63.8%, and 64.7%, respectively. The seizure-free rates were 39.0%, 42.9%, and 52.9%, respectively. There was no significant difference in the response rate between focal seizures and other seizure types at the last visit (69.7% vs. 51.7%, P=0.084). No significant difference was perceived in the response rate between patients aged ≥4 years and those aged <4 years as well (68.7% vs. 50%, P=0.103). Multivariate Logistic regression analysis showed that the effectiveness of PER was probably related to the maintenance dose and numbers of pervious treatments. At the last visit, the retention rate of PER was 80.0% and the adverse events (AEs) occurred in 30.0% patients. The most common AEs include somnolence/sleepy in 12 (11.4%) cases and dizziness in 8 (7.6%) cases. ConclusionPER add-on treatment has a good effectiveness, safety and tolerability in the pediatric patients with epilepsy. It is probably that the effectiveness is related to the maintenance dose and previous treatment numbers.
ObjectiveTo analyze the epidemiological characteristics and injury patterns of eye trauma in children and adolescents in China. MethodsA multicenter cross-sectional, retrospective, observational study. Based on the Chinese Eye Trauma Registry database, 189 patients (189 eyes) aged 0-18 years (13.4%, 189/1 412) of 1 412 patients (1 435 eyes) with eye trauma who were hospitalized from January to December 2023 were included in the study. Patients were recruited from 23 tertiary general hospitals or ophthalmology specialty hospitals located in 17 provincial-level administrative regions across six major geographical areas in China (North China, East China, South China, Central China, Northwest China, and Southwest China). The analysis focused on population characteristics, epidemiological features, injury patterns, and visual outcomes of children from different geographical regions and age groups. Among the 189 eyes, 95 eyes underwent secondary surgery. A total of 23 eyes were excluded due to non-cooperation during examination, no light perception, or only light perception. Ultimately, 72 eyes were included in the statistical analysis. Of these, 36 eyes had follow-up data and were used to observe postoperative visual outcomes. ResultsAmong 189 patients, 143 were males (75.7%, 143/189) and 46 were females (24.3%, 46/189). Age 8.73 (1-18) years old. The gender composition of all age groups was mainly male. The geographical distribution showed that East China had the largest number of cases, 55 (29.1%, 55/189). There were 70 cases (37.0%, 70/189) in 7-10 years old. The type analysis of eye trauma showed that in 189 eyes, mechanical ocular trauma accounted for 130 eyes, of which 105 (80.8%, 105/130) eyes had open globe injuries and 25 (19.2%, 25/130) eyes had closed globe injuries. 122 eyes received emergency surgery within 24 h after injury (accounts for 83.6% of emergency surgical cases, 122/146). In 36 eyes with complete follow-up data, the initial visual acuity distribution was: blind 23 eyes (63.9%), low visual acuity 6 eyes (16.7%), visual acuity ≥0.3 in 7 eyes (19.4%). At the last follow-up, visual acuity improved in 12 eyes (33.3%) with blindness, 8 eyes (22.2%) with low visual acuity, and 16 eyes (44.4%) with visual acuity ≥0.3. The final visual outcome showed that the disability rate was 22.2% (8/36) and the blindness rate was 33.3% (12/36). ConclusionsChildren and adolescents account for 13.4% of the hospitalized patients with eye trauma in the same period, and there is a significant gender difference (male accounted for 75.7%). There are obvious age-specific distribution rules in the causes, locations and clinical features of eye trauma in children and adolescents of different ages.
Objective To evaluate the diagnosis value of purified protein derivative (PPD) antibody tests in childhood tuberculosis. Methods We reviewed 126 cases of hospitalization children tested body fluid PPD antibody by Enzyme-Linked Immunosorbent Assay (ELISA). Twenty-two them were diagnosed with tuberculosis. We determined the sensitivity, specificity, diagnostic likelihood ratio, positive prognostic value, negative prognostic value, post-test probability, respectively. Results The following accuracy statistics for the PPD body liquid antibody tests in this study: sensitivity, 45.45%; specificity, 91.35%; diagnostic likelihood ratio positive, 5.25; diagnostic likelihood ratio negative, 0.597; positive predictive value, 52.63%; negative predictive value, 88.79% and post-test probability, 48.09% in 15% of prevalence. Conclusion This study shows that body fluid PPD tests have limited value for diagnosis of tuberculosis in pediatric tuberculosis. Clinic physicians should be wary of the positive results of body fluid PPD antibody tests. The value of diagnosis is related to prevalence of tuberculosis in the specific hospital.
ObjectiveTo systematically review the research on pediatric treatment satisfaction of medication (TS-M). MethodsThe PubMed, Embase, Cochrane Library, CBM, WanFang Data, VIP, CNKI databases and medical scale websites were electronically searched to collect studies on pediatric TS-M from inception to November 2022. Two reviewers independently screened literature, and extracted data. Using descriptive analysis, we comprehensively reviewed the TS-M assessment tool selected for the studies of children. We evaluated the methodological quality and measurement properties of existing TS-M scales for children using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) assessment criteria. ResultsA total of 157 studies were included, including 150 pediatric studies using TS-M evaluation tools and 7 studies on the development and validation of TS-M scales for children, covering 7 specific TS-M scales for children. Our review revealed that 67.3% of the pediatric studies used unvalidated self-administered TS-M questionnaires or interviews, 24.7% used adult TS-M scales, and only 6.0% used two pediatric-specific TS-M scales. The results of the quality assessment indicated that the development quality of existing TS-M pediatric scales was considered "doubtful" or "inadequate", and the internal consistency was "sufficient" but the structural validity was probably "uncertain". High-quality research on the content validity, test-retest reliability and construct validity of the pediatric TS-M scale was still lacking. ConclusionCurrently, the use of TS-M evaluation tools in pediatric studies has irrationalities: over 90% of pediatric studies use self-made questionnaires or adult scales to evaluate children's TS-M; and the existing pediatric TS-M scales globally have narrow applications, questionable development quality, and lack some measurement performance studies. Pediatric TS-M scales with a wide range of applications are lacking.
ObjectiveTo systematically evaluate the efficacy and safety of anatomical landmark method (ALM) versus ultrasound (US)-guided internal jugular vein (IJV) catheterization in pediatric patients.
MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, CBM, WanFang Data and CNKI were searched from inception to October 2016 to collect randomized controlled trials (RCTs) of landmark-guided versus ultrasound-guided IJV catheterization in pediatric patients who underwent elective surgery. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis.
ResultsA total of 13 RCTs involving 1 026 pediatric patients were included. The results of meta-analysis showed that, the overall success rate (RR=1.21, 95%CI 1.09 to 1.34, P=0.000 5) and arterial puncture rate (RR=0.19, 95%CI 0.07 to 0.50, P=0.000 7) of US-guided IJV catheterization were both significantly superior to the ALM group. Whereas there was no significant difference between two groups as for the incidence of hematoma formation (RR=0.35, 95%CI 0.09 to 1.31, P=0.12).
ConclusionCurrent evidence shows that, for IJV catheterization of pediatric patients, both the effectiveness and safety of ultrasound-guided technique are better than the landmark-guided. Since the quantity and quality of included studies are limited, the conclusion of this study needs more high quality studies to verify.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．
