2011年 · 第49卷第12期

A 4-year-old and 1-month-old male was admitted to the hospital due to pruritic erythema generalized for 1 d, bullae and epidermal exfoliation for 2 h. Three days before admission, the child was treated with anthelmintic treatment, and the oral anthelmintic drug "Albendazole Tablets 200 mg" was taken. One day before admission, pruritic erythema appeared on the skin of the face, neck and chest, which gradually developed to the whole body. He was treated with oral cyproheptadine, vitamin C, calcium gluconate, and external application of oscillating lotion. Because the symptoms did not alleviate and abdominal pain appeared, he was given "prednisone acetate 1 tablet/d", "nitrofurancillin solution" wet compress on the affected area on the morning of admission, and orally administered "metoclopramide and nitrofurantoin tablets" for treatment. At about 21: 00 on the night of admission, the child had lax bullae and epidermal exfoliation of different sizes on the face, neck, chest and back, and the outpatient clinic was admitted to the hospital with "severe drug eruption (epidermolysis bullosa)". Since the onset of the disease, he has suffered from lack of energy and poor diet. This case had been hospitalized with "chickenpox" 2 months ago, and was cured and discharged. There was no history of drug allergy, no history of living in epidemic area, no history of toxic contact, and no bad habits. Physical examination: body temperature 37.2℃, pulse 118 beats/min, breathing 20 beats/min, specialist examination: no yellowing, spider nevus and bleeding spots on the skin of the whole body, especially the skin lesions on the face, neck, chest, axils and back are heavy, diffuse large erythema can be seen, loose blisters and epidermolysis of different sizes can be seen on the spots, and a little skin erosion and exudation. Niss's sign is positive, which can be pushed by hand, and the epidermis can be wiped off with a little force, such as scalding. Admission diagnosis of severe drug eruption epidermolysis bullosa type. Electrocardiogram after admission: sinus rhythm, unbiased electric axis; Blood routine: total number of white blood cells 9.0×10⁹/L, lymphocyte classification 0.098, neutrophil classification 0.891, monocyte classification 0.011; Urinary routine: 0~2 white blood cells per high magnification microscope, 0~1 white blood cell tube type per high magnification microscope; Alanine aminotransferase 21 U/L, hepatitis B central antibody negative. Normal kidney function; Blood glucose 9.6 mmol/L; Electrolytes: potassium 3.55 mmol/L, sodium 143 mmol/L, chlorine 105.2 mmol/L, calcium 2.3 mmol/L. After admission, anti-infection, fluid rehydration and symptomatic treatment were given: room temperature was kept at 28℃, ultraviolet disinfection was performed twice/d for 20 minutes each time, 500 ml of glucose injection, vitamin C and vitamin B₆200 mg intravenous drip, once/d, cefazolin sodium intravenous drip, twice/d, dexamethasone 7.5 mg intravenous drip, twice/d, after 4 days of treatment, it was changed to oral prednisone acetate 10 mg, three times/d, reducing 1 tablet every 3 days until discontinuation; At the same time, topical nitrofurazine solution, calcium supplementation, promethazine 18 mg intravenous drip twice/d, nitrofurazine solution and physiological saline wet compress were given at the erosive area alternately with exposure, 4 times/d, to reduce exudation. The temperature of the solution is 35~37 ℃, and the wet compress is 20~30 min each time. When wet compress, cut the sterile gauze into squares of different sizes, then immerse it in the medicinal solution, stick the gauze to the skin lesion, replace it in time after drying or expose the wound surface to the infrared lampshade. The child was cured and discharged.

Pulmonary hypertension is an important pathological link in the occurrence and development of many clinical cardiopulmonary vascular diseases, which has an important influence on the development and prognosis of the disease. It is an important scientific problem to elucidate its mechanism. Abnormal pulmonary vasoconstriction, remodeling of pulmonary vascular structure, oxidative stress and vascular inflammation are important pathophysiological links in the occurrence and development of pulmonary arterial hypertension. The lung is an important place of gas exchange and metabolism, and the influence of gas signal molecules on pulmonary circulation is more important. In the past decade, following nitric oxide (NO) and carbon monoxide (CO), endogenous hydrogen sulfide (H₂S) and its cardiovascular regulatory effects have further facilitated the study of the mechanism of pulmonary hypertension. This article focuses on the important pathological links in the formation of pulmonary hypertension, and reviews H₂S and the mechanism of pulmonary hypertension.

With the development of perinatal medicine and the improvement of neonatal monitoring, the survival rate of premature infants has been greatly improved, but more and more survivors are facing the risk of disease brought by monitoring and treatment methods. Among them, the incidence of fungal infection is increasing year by year, especially Candida infection, which has become the third most common pathogen of late-onset sepsis in neonatal intensive care unit (NICU)^[1,2]It is one of the important causes of disease and death in premature infants^[1,3]。

Invasive fungal infection (IFI) refers to a pathophysiological process in which fungi invade the human body, grow and multiply in tissues, organs or blood, resulting in inflammatory response and tissue and organ damage. Because of their immature immune system and weak biological barrier, premature infants often need invasive operations (including venipuncture, catheterization, etc.), and more antibiotic use, they become a high-risk group of fungal infections. How to prevent the disease and reduce the damage of IFI to premature infants has become a hot spot for neonatal workers. There are few relevant studies in China. The present situation and progress of invasive fungal infection in premature infants in epidemiology, detection methods and preventive treatment are summarized as follows.

There is a consensus on the management of obstetric inpatient delivery of term infants and the implementation of maternal-infant compartmentalization and breastfeeding after birth. However, there are still many doubts and objections as to whether premature infants, low birth weight infants and other critically ill infants admitted to the neonatal intensive care unit (NICU) or intensive care unit (ICU) can still be subjected to maternal-infant co-rooming and breastfeeding. After literature review^{[1,2,3,4,5,6,7,8]}And field comparative studies, our opinion is that maternal-infant co-rooming and breastfeeding can and should be performed in the NICU and ICU or Pediatric Intensive Care Unit (PICU) ward management.

pulmonary hypertension (PH) refers to pulmonary circulatory pressure exceeding normal, which can be caused by a variety of heart, lung and other diseases. In severe cases, it can lead to increased right ventricular load and right ventricular dysfunction, resulting in a series of clinical manifestations. pulmonary arterial hypertension (PAH), which refers to increased pressure and resistance in the pulmonary arteries, is a type of PH^[1]。 The widely adopted hemodynamic definition of PAH today is: mean pulmonary artery pressure (mPAP) above 25 mm Hg (1 mm Hg =0.133 kPa) measured by right cardiac catheter at sea level rest, pulmonary capillary wedge pressure (PCWP) Less than or equal to 15 mm Hg or pulmonary vascular resistance (PVR) greater than 3 Wood units^[1,2]。 A registered study from France showed a prevalence of PAH of 15 per million^[3]With a prevalence of 3.7/million in children^[4]。 At present, there is no epidemiological data of childhood PAH in China, and the registration study of childhood PAH has yet to be carried out. In view of the fact that PH is increasingly a common disease that threatens human health, the World Health Organization (WHO) updated the clinical classification of PH at the 4th Conference on Pulmonary Hypertension in 2008. On this basis, new expert consensus and diagnosis and treatment guidelines for PH were published in the United States and Europe in 2009^[1,2]。 These documents are extremely useful to standardize clinicians' diagnosis and treatment behavior, and a brief introduction to childhood PAH is also provided. PAH can occur at different ages in childhood, and it is a pulmonary vascular disease that seriously threatens children's health. The WHO classification of PH is also applicable to childhood cases. Among them, congenital systemic-to-pulmonary shunts, namely congenital heart disease (CHD) -related PAH (CHD-PAH) and idiopathic PAH (IPAH) are the most common. There are few clinical research data on PAH in children, but PAH in children has its own characteristics in epidemiology, diagnosis and treatment, which need to be studied in depth.

Children have two characteristics: growth and development, and their individual development includes the development of drug metabolizing enzymes, transporters, receptors and organs. The growth and development of children make the absorption, distribution, metabolism and excretion of drugs and the efficacy of drugs on developing organs in different developmental stages of children are significantly different from those of adults. The International Conference on Harmonization (ICH) defines five age stages for children, namely: preterm neonatal period (less than 36 weeks of pregnancy, 0-27 d), full-term neonatal period (0-27 d), infancy period (28 d-23 months), school age (2-11 years), and adolescent period [12- (16 or 18)] years, with specific reference to the laws of the corresponding countries. According to the effective dose in adults, the dose in children based on the method of halving body weight often results in overdose or underdose in children, resulting in toxic side effects or ineffective medication. Therefore, according to the characteristics of different age groups of children's continuous growth and maturity (such as body size and organ function), clinical trials in children should be carried out and implemented at different age stages.

Neonatal respiratory failure (NRF) is a common condition in the neonatal intensive care unit (NICU), which is characterized by high morbidity, high mortality and high treatment costs. The prognosis of these critically ill children can directly reflect the level of perinatal services and the efficacy of NICU. From 2007 to 2008, 14 hospitals at or above the prefecture level with NICU establishment and assisted ventilation facilities and technology in Hebei Province formed an NRF investigation collaboration group to carry out this NRF multi-center clinical epidemiological investigation. It is hoped that through this investigation, the data of NICU in prefectural and municipal hospitals treating neonatal critical illness before the implementation of new rural cooperative medical care can be obtained, so as to promote the medical model of multi-center clinical collaborative research.

Sponsored by the Editorial Committee of Chinese Journal of Pediatrics of Chinese Medical Association and the Respiratory Group of Pediatrics Branch of Chinese Medical Association, and co-organized by Yuhuangding Hospital of Yantai City, Shandong Province, the academic seminar on prevention and treatment of pediatric bronchiolitis was successfully held in Yantai City, Shandong Province from September 8-11, 2011. A total of 142 doctors from 16 provinces and municipalities directly under the Central Government attended this meeting, and most of the participating doctors were deputy chief physician or above. At this meeting, the participating doctors extensively discussed the concept, category, pathophysiology, pathogenesis, etiology, clinical characteristics, diagnosis, treatment and prevention of pediatric bronchiolitis.