2011年 · 第49卷第01期

Severe Infection (Servere Infection) and Septic Shock (Septic Shock) are clinical syndromes characterized by multiple organ failure caused by systemic Infection. The mortality rate is as high as 40% ~65%, and they are the main causes of death of children in PICU^[1,2,3]。 The average number of children dying of sepsis in the United States is about 4,400 each year. Although there is no epidemiological data available in China, it is estimated that more than 26,000 children may die of sepsis each year^[4]。 As the most powerful weapon of PICU, antimicrobial drugs have played a huge role in saving the lives of infected children. However, with the widespread application of antimicrobial drugs and the rising infection rate of multi-drug resistant bacteria, we are facing confusion such as the increasingly severe situation of bacterial drug resistance, the exhaustion of newly developed antimicrobial drugs, and the lack of significant progress in empirical treatment of severe infections. How to use the existing antimicrobial drug resources to improve the curative effect on severe infections, its goals and methods have far exceeded the previous concept of "choosing antimicrobial drugs", and clinical treatment has also developed from rational use of antimicrobial drugs to optimized use of antimicrobial drug strategies, entering a new era of medication schemes based on the principle of "antimicrobial drugs-human body-pathogenic microorganisms".

Reading the article "Questions and Answers to the Expert Consensus on the Diagnosis and Treatment Principles of Children's Diarrheal Diseases" (hereinafter referred to as "Answers") in the 4th Issue of Chinese Journal of Pediatrics, 2010, we think that the author's concepts of "complications" and "comorbidities" in the "Answers" are worthy of discussion.

The pediatric acute lung injury and sepsis investigator network (PALISI) reported that 17% of children admitted to ICU required mechanical ventilation for at least 24 h^[1]。 Mechanical ventilation management in children, based primarily on previous experience and inferential adult data, with less objective evidence regarding clinical studies in children. Progress in mechanical ventilation treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in children is reviewed below, and compared with current relevant studies of mechanical ventilation strategies in adults.

On August 13th, 2010, CCTV News Network reported for the first time that "superbug spread worldwide". Since then, many domestic media have reported the infection of "NDM-1 superbug" and gradually attracted people's attention. NDM-1, the full name of which is New Delhi metallo-β-lactamase 1, is a metallo-β lactamase with the scientific name of "type I New Delhi metalloproteinase". It can hydrolyze the commonly used third generation cephalosporins and carbapenem antibiotics at present, and its genes can be transmitted among different bacterial species, thus making bacteria containing this enzyme widely resistant to drugs^[1]。 "Superbugs" are primarily those that carrybla_NDM－1Gram-negative bacilli such as Klebsiella pneumoniae, Escherichia coli or Acinetobacter can cause serious respiratory tract infection, urinary tract infection and blood poisoning in patients, and their extensive drug resistance brings great difficulties to clinical treatment.

A 6-year-old male was admitted to the hospital mainly for "intermittent melena with yellowing complexion for 15 months and aggravated for 1 week". Fifteen months ago, parents accidentally found that the child's stool was black and his complexion was yellow, so they went to the local hospital for treatment. Hemoglobin was 34 g/L, and fecal occult blood was positive. Diagnosis and treatment of "gastrointestinal bleeding" for 3 weeks, stool and complexion returned to normal. Melena appeared again 7 months ago, gastrointestinal angiography,^99mTechnetium isotope scan, abdominal B-ultrasound and other auxiliary examinations showed no abnormalities. After more than 20 days of symptomatic treatment such as hemostasis and acid suppression, the symptoms disappeared. The above situation occurred again 5 months and 1 month ago respectively. One week ago, the frequency of melena in the child increased compared with before, ranging from 3 to 5 times a day, and the amount was not much, accompanied by left upper abdominal pain, which was paroxysmal dull pain, without hematemesis, abdominal distension, fever, rash and other symptoms. He came to our hospital for further diagnosis and treatment.

Respiratory distress syndrome (RDS) is caused by pulmonary surfactant (PS) deficiency and immature lung structure development. It is more common in premature infants. The natural course of the disease is that it onsets at or soon after birth, and progressively worsens within 2 days after birth. If not treated in time, it will die due to progressive hypoxia and respiratory failure. The survivors will begin to improve in 2 to 4 days after birth. The smaller the gestational age, the higher the incidence of RDS. Data from Euro NeoStat in 2006 showed that the incidence of RDS in premature infants with a gestational age of 23 to 25 weeks was 91%, that in premature infants with a gestational age of 26 to 27 weeks was 88%, that in premature infants with a gestational age of 28 to 29 weeks was 74%, and that in premature infants with a gestational age of 30 to 31 weeks was 52%. Respiratory distress such as cyanosis, moaning, cavity and shortness of breath appear in the early stage of clinical manifestations of RDS, and then further develop into respiratory failure. Blood gas analysis can suggest the severity of respiratory failure. Pulmonary X-rays typically showing ground glass-like changes and bronchial inflation signs can confirm the diagnosis. The Vermont Oxford Neonatal Collaborative Network defines neonatal RDS as: PaO when inhaling air₂<50 mm Hg (6.6k Pa) (1 mm Hg =0.133 kPa), central cyanosis, oxygen inhalation required to maintain PaO₂>50 mm Hg (6.6 kPa) with typical chest X-ray findings. However, it is worth noting that classical RDS is rare due to early intervention.

Fan Xunmei, editorial board member of Chinese Journal of Pediatrics, chief physician and professor of Beijing Children's Hospital, died of illness on December 5, 2010.

(Continued on page 959 of No. 12, 2010)

A child, male, 18 h, was admitted to hospital because of increased white blood cells found in postnatal umbilical cord blood examination for 10 h. The child was pregnant 2 and gave birth 2, with a gestational age of 38 weeks. Because of the "scar uterus" of her mother, she was delivered by cesarean section in an outside hospital, and she cried loudly after birth. The Apgar score was 1 min 9 points and 5 min 10 points. There was no umbilical cord around the neck, and there were no abnormalities in placenta and amniotic fluid. The parents requested to store cord blood, so routine cord blood examination was performed, and the result showed "WBC 242×10⁹/L, L 147.9×10⁹/L, RBC 3.3×10¹²/L, Hb 129 g/L, PLT 171×10⁹/L ", considering congenital leukemia, transferred to our hospital. Parents are healthy, non-intimate marriage, 1 brother is 5 years old, healthy; His mother is 27 years old, individual business, denies the history of exposure to radiation, drugs and poisons during pregnancy, and has no history of genetic disease and malignant tumor in the family; The family living environment is not special.