Clinical and pathologic characteristics of pancreatic necrosis in critically ill children

BACKGROUND：Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.METHODS： We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children＇s Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed. RESULTS： The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein （CRP）. B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis （AHNP）; children 3-5 died of multiple organ dysfunction syndrome （MODS） due to pancreatic necrosis. CONCLUSION： Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.

Exhaled nitric oxide in neonates with or without hypoxemic respiratory failure

BACKGROUND： Exhaled nitric oxide （eNO） is one of the airway condensate derived markers, reflecting mainly airway inflammation in asthma and other lung diseases. The changes of eNO levels as pathophysiology of neonatal hypoxemic respiratory failure （HRF） in early postnatal life have not been thoroughly studied. The present study was to establish a method for measuring eNO concentrations in neonates with or without HRF. METHODS： Twenty-two newborn infants with HRF and 26 non-NRF controls were included within the first 24 hours of postnatal life. Their eNO levels were detected with a rapid-response chemiluminescence analyzer daily during the first week of their postnatal life, and lung mechanics and gas exchange efficiency were monitored at the same time, such as pulse oxygen saturation （SpO2）, inspired fraction of oxygen （FiO2） and other parameters. RESULTS：During the first two days of postnatal life, eNO values of HRF neonates were significantly higher than those of the control neonates （day 1,7.9±3.2 vs. 5.8±1.8 parts per billion [ppb], P〈0.05; day 2, 8.8±3.2 vs. 6.0±2.4 ppb, P〈0.05）, but there were no significant differences in the following days. With SpOJFiO2 increasing, difference of eNO values between the HRF and non-HRF neonates became narrowed, but there was still a two-fold difference of eNO/[SpO2/（FiO2×100）] on days 5-7. CONCLUSION： We established a method for measuring eNO and found difference in neonates with or without HRF, which diminished with prolonged postnatal days, reflecting pathophysiological characteristics of HRF.

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China： A Multi-center Study

Background： With the progress ofperinatal medicine and neonatal technology, more and more extremely low birth weight （ELBW） survived all over the world. This study was designed to investigate the short-term ontcomes of ELBW infants during their Neonatal Intensive Care Unit （NICU） stay in the mainland of China. Methods： All infants admitted to 26 NICUs with a birth weight （BW） 〈1000 g were included between January 1,2011 and December 31,2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors. Results： A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age （GA） was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants （23.3%） died and another 69 infants （26.7%） died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas （53.6% vs. 35.3%, P = 0.019）. BW 〈750 g and GA 〈28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization. Conclusions： Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.

Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury

Background：Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound （cUS） variables and neurodevelopmental outcomes of very preterm infants.Methods：Totally 129 very preterm infants （gestational age ≤28 weeks） in neonatal intensive care unit of Hunan Children’s Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS （weekly before discharge and monthly after discharge） was performed on the infants until 6 months or older. Magnetic resonance imaging （MRI） was performed on the infants at approximately the term-equivalent age. The mental developmental index （MDI） and psychomotor developmental index （PDI） were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.Results：The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage （GMH） Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis （MDI： odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI： OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively）. At the last cUS, gestational age, extensive cystic periventricular leukomalacia （c-PVL）, and moderate and severe hydrocephaly are significantly correlated with MDI （OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively）. Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI （OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively）.Conclusions：Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.