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Rong Z.,Huazhong University of Science and Technology | Liu H.,Wuhan Childrens Hospital | Chang L.,Huazhong University of Science and Technology
Child's Nervous System | Year: 2012

Objective The aim of this study is to identify prenatal and perinatal risk and protective factors for the development of IVH, using a retrospective and case-control clinical study. Methods Prenatal and perinatal data were collected from three NICUs between January 2010 and December 2010. Univariate analysis was performed between case and control groups, and multivariate analysis was done to find out risk and protective factors for development of IVH. Further analysis of these variables was undertaken for gestational age strata <30, 30-34, and 35-37 weeks. Results By univariate analysis, factors related with IVH were C-section, prenatal steroid, pregnancy-induced hypertension, transport from other hospital, hypothermia, Apgar score at 1 and 5 min<4, luminal, pathological jaundice, RDS, hypotension, volume expansion/inotropics, PO 2, repeat suctioning, and mechanical ventilation (P<0.05). Five variables remained significant in multivariate analysis. Csection and prenatal steroid use were protective variables while mechanical ventilation, hypotension, and transport from other hospital were risk factors. Further analysis of these variables was undertaken for gestational age strata <30, 30-34, and 35-37 weeks. Prenatal steroid use remained significant as a protective variable in gestational age less than 35 weeks; hypotension was shown to be a risk factor just in the time period between 30-34 weeks; transport from other hospital was a risk factor in gestational age more than 30 weeks; mechanical ventilation remained non-significant during the gestational age strata studied. Conclusion In the present study, factors that related to neonatal IVH included hypotension, prenatal steroid use, and transportation. © Springer-Verlag 2012.


Xiang Q.,Wuhan Childrens Hospital | Huang D.Y.,Wuhan Childrens Hospital | Zhao Y.L.,Huazhong University of Science and Technology | Wang G.H.,Wuhan Childrens Hospital | And 3 more authors.
British Journal of Anaesthesia | Year: 2013

BackgroundCaudal bupivacaine is widely used for inguinal hernia repair in children, but often cannot totally eliminate responses to hernial sac traction. The current study examined whether supplementation of caudal bupivacaine with dexmedetomidine could achieve better results.MethodsSixty children aged 12-72 months undergoing unilateral inguinal hernia repair received standardized premedication with midazolam, i.v. ketamine anaesthesia, and then were randomly assigned to receive either bupivacaine 0.25% (1 ml kg-1; Group B) or bupivacaine plus dexmedetomidine (1 μg kg-1; Group BD). The response to hernial sac traction was defined as an increase in heart rate or systolic arterial pressure by >20%, and was treated with ketamine rescue (2 mg kg-1). After the surgery, fentanyl was administered as needed with a nurse-controlled analgesia pump.ResultsOnly one subject in Group BD (3.33%) needed ketamine rescue, as opposed to 13 subjects in Group B (43.33%; P<0.001). The first fentanyl injection occurred at a much later time point in Group BD (median: 860 vs 320 min in Group B; P<0.001). Total fentanyl consumption of fentanyl was significantly lower in Group BD [2.5 (1.2) vs 6.9 (1.6) μg kg-1 24 h-1 in Group B; P=0.008]. ConclusionsThe addition of dexmedetomidine to caudal bupivacaine could reduce the response to hernial sac traction, and prolong the duration of postoperative analgesia in children undergoing inguinal hernia repair. © The Author [2012].


Xing H.,Wuhan Childrens Hospital
Medical Journal of Wuhan University | Year: 2013

Objective: To explore the correlation between obstructive sleep apnea-hypopnea syndrome (OSAHS) and behavioral problems among children. Methods: A total of 28 children with OSAHS aged 6-12 years were randomly selected from our department and 28 healthy children were enrolled as control group. Achenbach child behavior checklist (CBCL) were filled out by the parents. Results: The scores of OSAHS children in social withdrawal, body complaint, attack and aggression were significantly different from those of the health children (P<0.05).The scores in activity ability, social skills, and study skills had no statistical difference between the two groups. Conclusion: Compared with the health children, the OSAHS children have certain problems of behavior. It's essential to take some mental and behavioral interventions on OSAHS children with behavioral problems.


Xu E.M.,Wuhan Childrens Hospital
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery | Year: 2012

To explore the best methods and skill for the removal of difficult and high risk tracheobronchial foreign body under bronchoscope. A retrospective review was performed between August 1995 to August 2012. There were 4217 children with tracheobronchial foreign body, among them, 272 were diagnosed as high-risk, highly difficult tracheobronchial foreign bodies confirmed by clinical manifestations, foreign body type and bronchoscopy. In 271 children, the tracheobronchial foreign body was removed under bronchoscope, the success rate was 99.6%; only one child with a pen cap blocking the left lower lobe bronchus was transferred to the department of thoracic surgery, and the foreign body was finally removed by thoracotomy. Eighty-five children (among them, 82 children were under 1 year of age) had II-II degree laryngeal obstruction, the emergency surgery was performed to remove the foreign body and to relieve the laryngeal obstruction. Twenty-six children had lung infection and 27 children had failed foreign body removal surgery before, in all these children, the foreign body was removed after infection control. There were 17 children with the pen cap as the tracheobronchial foreign body, direct removal was successful in 12 children with the history less than two weeks; in 4 children, the foreign body was removed after 0.1% epinephrine saline flush, and 1 case with the homemade bronchial foreign body hook remove. There were 26 children with the whistle as the foreign body, and 32 children had large and sharp foreign bodies. In these cases, the foreign bodies were removed together with the bronchoscope. Forty-two children had multiple or fragile foreign bodies, and 16 children had subsegmental bronchial foreign bodies. In these cases, the foreign bodies were removed with forceps under direct vision and intraoperative bronchial lavage.In This series, 129 children received intraoperative bronchial lavage, among them, 127 children showed normal X-ray changes one week after operation. Two children with a history of more than 1 month complicated with pulmonary consolidation. After bronchial lavage, pneumothorax and subcutaneous emphysema occurred, which recovered after treatment. No glottic edema, asphyxia, and other complications were found, the complication rate of surgery was 0.7%. For the removal of highly difficult and high risk tracheobronchial foreign bodies, preoperative analysis and discussion should be sufficient, appropriate surgical skill and surgical instruments may improve the success rate of the surgery and prevent the operation complications.


Wei Y.,Wuhan Childrens Hospital
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery | Year: 2012

The goal was to know more about the characteristic of auditory neuropathy spectrum disorder (ANSD) for high risk infants. The newborn hearing screening was performed with automatic auditory brainstem response (AABR) and transient evoked otoacoustic emission(TEOAE) for the infants in the NICUs from August 2007 to January 2011. After subsequent rescreening, children with AABR test referred were perform hearing test set including high frequency (1000 Hz) tympanometry, ABR, DPOAE and/or Cochlear Microphonics (CMs) in 3 months old. Only infants demonstrated severely abnormal ABRs along with preserved DPOAEs and/or CMs were scheduled for re-examination in 6-8 months old and Behavior audiometry in 8-12 months old. Eighteen infants (14 cases were bilateral and 4 cases were unilateral) considered as suffering from AN in 3 months old. All of them showed ABR thresholds > or = 80 dB nHL or absent at maximum test intensity. Follow-up examination revealed 9 cases (18 ears) with restoration of ABR to normal or a lower ABR thresholds and a resolution of ANSI) in 11 out of 18 infants retested in 6-8 months old. CMs were present in all ears but DPOAE were not present in 4 ears with middle ear pathology in 3 months test. Behavioral hearing of 10 cases ranged from mild (n = 2), moderate(n = 4) to severe and profound loss (n = 4). ANSD in high risk neonates could show the temporary character. It was too difficult to forecast the prognosis, they would be to follow up to at least 3 years old for newborn ANSD.


Li G.,Wuhan Childrens Hospital
Zhonghua nan ke xue = National journal of andrology | Year: 2012

To evaluate the efficacy of recombinant human growth hormone (rhGH) in the postoperative treatment of hypospadias in children. A total of 84 male children with hypospadias treated by surgery were randomly divided into a control and an rhGH group of equal number, the former treated with antibiotics plus hemostatics with usual wound care, while latter, in addition, by subcutaneous injection of rhGH at 0.2 U/kg/d qd before bedtime for 7 days. Then we compared the two groups in the clinical efficacy, urinary symptoms, peripheral WBC count, C-reactive protein (CRP) level, ratio of CD4+ to CD8+ T lymphocytes in the peripheral blood, contents of serum albumin and total protein, and levels of IgM, IgG and IgA in the serum. The total effectiveness rates in the rhGH and control groups were 81.0% and 66.7%, respectively, significantly higher in the former than in the latter (P<0.05). The levels of WBC and CRP in the peripheral blood were increased after treatment, but with no significant difference. The contents of serum albumin and total protein were higher before than after surgery. The levels of IgM, IgG and IgA were markedly elevated in the rhGH group as compared with the control. The ratio of CD4+ to CD8+ was significantly increased while the level of CD8+ remarkably decreased after treatment in comparison with pre-treatment. RhGH is effective and safe in the postoperative treatment of hypospadias in children, and its action mechanisms are associated with its promotion of protein synthesis, improvement of negative nitrogen balance and enhancement of immune function.


Yan S.Q.,Wuhan Childrens Hospital
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine / Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban | Year: 2012

To observe the clinical effects of Linda Mixture (LM) on cholestatic liver diseases caused by cytomegalovirus (CMV) infection. Totally 240 CMV infected cholestatic liver diseases infants, who were hospitalized at the Department of Integrated Traditional Chinese and Western Medicine, Wuhan Children's Hospital from January 2008 to June 2011, were randomly assigned to the treatment group (120 cases) and the control group (120 cases). Patients in the treatment group were treated by LM combined ganciclovir, while those in the control group were treated by ganciclovir alone. The therapeutic course was 2 months. The patients were assigned to 3 sub-groups according to the quantification standards of symptoms and signs, i. e., the No. 1 treatment group (mild, 30 cases), the No. 1 control group (mild, 30 cases), the No. 2 treatment group (moderate, 30 cases), the No. 2 control group (moderate, 30 cases), the No. 3 treatment group (severe, 30 cases), the No. 1 control group (severe, 30 cases). The clinically cured rate and the total effective rate, the jaundice subside time, the retraction time for Gan and Pi, the body weight growth, the indices of the liver function, and lab indices of CMV infection were observed before and after treatment. After treatment the cured rate was 77.50% and the total effective rate was 88.33% in the treatment group, while they were 60.83% and 76.67% in the control group. There was statistical difference between the two group (P<0.05, P<0.01). There was some improvement in the jaundice subside time, the retraction time for Gan and Pi, the body weight growth, the indices of the liver function in the two groups. Better results were obtained in the treatment group than in the control group, showing statistical difference (P<0.05, P<0.01). The lab indices of CMV infection showed negative to some degrees. The negative rates of serum IgM (83.54% in the treatment group and 63. 64% in the control group) and the serum CMVDNA (84.52% in the treatment group and 67.47% in the control group) were better in the treatment group than in the control group, showing statistical difference (P<0.01). There was no obvious difference in the negative rate of CMV antigen in urine between the two groups (P>0.05). LM combined ganciclovir therapy showed definite effects in treating cholestatic liver diseases caused by CMV infection. Early treatment for severe infants might change their prognosis. LM also could alleviate adverse reactions during the therapeutic course.


Zhao Y.L.,Huazhong University of Science and Technology | Xiang Q.,Wuhan Childrens Hospital | Shi Q.Y.,Huazhong University of Science and Technology | Li S.Y.,Huazhong University of Science and Technology | And 4 more authors.
Anesthesia and Analgesia | Year: 2011

BACKGROUND: Certain anesthetics exhibit neurotoxicity in the brains of immature but not mature animals. γ-Aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the adult brain, is excitatory on immature neurons via its action at the GABAA receptor, depolarizing the membrane potential and inducing a cytosolic Ca increase ([Ca]i), because of a reversed transmembrane chloride gradient. Recent experimental data from several rodent studies have demonstrated that exposure to isoflurane during an initial phase causes neuronal excitotoxicity and apoptosis. GABAA receptor-mediated synaptic voltage-dependent calcium channels' (VDCCs) overactivation and Ca influx are involved in these neural changes. METHODS: We monitored [Ca]i using Fluo-4 AM fluorescence imaging. Using whole-cell patch clamp techniques, IVDCC (voltage-dependent calcium channel currents) were recorded from primary cultures of rat hippocampal neurons (5-day culture) exposed to isoflurane. To further investigate the neurotoxicity of high cytosolic-free calcium after isoflurane in a dose- and time-dependent manner, the possibility of increased caspase-3 levels was evaluated by Western blot and quantitative real-time polymerase chain reaction. Statistical significance was assessed using the Student t test or 1-way analysis of variance followed by the Tukey post hoc test. RESULTS: Under control conditions, isoflurane enhanced the GABA-induced [Ca]i increase in a dose-dependent manner. Dantrolene and nicardipine markedly inhibited this enhancement mediated by isoflurane. Moreover, in Ca-free media, pretreatment with isoflurane did not show any influence on the caffeine-induced increase of [Ca]i. Similarly, using whole-cell recording, isoflurane increased the peak amplitude of IVDCC in the cultured neurons from rat hippocampus by depolarization pulses. Isoflurane (0.25, 0.5, 0.75, and 1 minimum alveolar concentration [MAC]) potentiated IVDCC peak current amplitude by 109.11% ± 9.03%, 120.56% ± 11.46%, 141.33% ± 13.87%, and 146.78% ± 15.87%, respectively. To analyze variation in protein levels, the effect of treatments with isoflurane on caspase-3 activity was dose- and time-dependent, reaching a maximal caspase-3 activity after exposure to 1 MAC for 6 hours (P < 0.001). However, in the mRNA levels, hippocampal caspase-3 mRNA levels began to be significantly increased in isoflurane-treated developing rat hippocampal neurons after 6 hours of exposure to 0.25 MAC isoflurane (P < 0.001). CONCLUSIONS: Isoflurane-mediated enhancement of GABA-triggered [Ca]i release results from membrane depolarization with subsequent activation of VDCCs and further Ca-induced Ca release from the ryanodine-sensitizing Ca store. An increase in [Ca]i, caused by activation of the GABAA receptor and opening of VDCCs, is necessary for isoflurane-induced calcium overload of immature rat hippocampal neurons, which may be involved in the mechanism of an isoflurane-induced neurotoxic effect in the developing rodent brain. Copyright © 2011 International Anesthesia Research Society.


Li Y.,Wuhan Childrens Hospital | Wu S.,Wuhan University | Xiang Y.,Wuhan University | Liang X.,Wuhan University
PLoS ONE | Year: 2014

Objective: Blood lead levels (BLLs) and possible influencing factors in children in Wuhan China were investigated in order to understand current lead pollution exposure and provide a scientific basis for prevention and policy making. Materials and Methods: BLL data were collected from 15,536 out-patients in Wuhan Children Hospital in 2012 full year. All of them were under 18 years of age (Mean 6 SD: 4.3263.2, 64.4% boys). The BLLs were measured by an atomic absorption spectrometry (BH2100). Results: The geometric mean of BLLs for all the subjects was 44.75 mg/L (95%CI: 44.46 mg/L - 45.05 mg/L), much lower than that reported in previous studies. The prevalence of the elevated BLLs ($ 100 mg/L) in the children tested was 2% in 2012 and the prevalence of BLLs ($ 50 mg/L) was 44%. Age and sex could be possible influencing factors for BLLs in the children (p,0.001). In addition, the BLLs in different seasons were different (p,0.001). Conclusions: These results demonstrate that BLLs have significantly decreased in children in Wuhan during recent years. However, we should continuously pay attention to lead pollution and emphasize that prevention is much more important than treatment for controlling children's BLLs. © 2014 Li et al.


Liu Z.S.,Wuhan Childrens Hospital
Zhonghua er ke za zhi. Chinese journal of pediatrics | Year: 2011

To evaluate the efficacy and safety of aripiprazole in the treatment of children with Tourette syndrome. A prospective, multi-center, controlled clinical trial was conducted in 195 children aged 5-17 years with Tourette syndrome. The patients were assigned to two groups: aripiprazole group (n=98) and tiapride group (n=97), with the treatment dosage of 5-25 mg/d and 100-500 mg/d, respectively. After 12 weeks treatment, the clinical efficacy was assessed by the Yale Global Tic Severity Scale (YGTSS) score, and adverse reactions were observed by side effects symptoms scale, blood biochemical indexes, and electrocardiography. Significant pre- and post-treatment differences were ascertained for motor tic, phonic tic, function damage and total scores of YGTSS in the both groups from the second week of treatment (P<0.0001). Compared with the tiapride group, the aripiprazole group showed a more significantly decreased function damage score of YGTSS by the second week of treatment (P<0.05). After 12 weeks treatment, total scores of YGTSS in the aripiprazole group decreased from 53.74±15.71 at baseline to 24.36±16.38, while in the tiapride group from 51.66±13.63 to 23.26±15.31. The mean reduction scores of YGTSS were 29.38 in the aripiprazole group and 28.40 in the tiapride group at the end of treatment, and the clinical response rates were 60.21% and 63.92%, respectively. There were no significant differences between the 2 groups (P>0.05). The incidence of adverse reactions was similar in the aripiprazole and tiapride groups, with 29.6% and 27.8% respectively. There were no significant differences in the incidence of adverse reactions between aripiprazole and tiapride groups and no severe adverse events were found in either group. The results showed that aripiprazole showed similar therapeutic effect to tiapride in treatment of children with Tourette syndrome. Aripiprazole was safe and well tolerated in Chinese population, and can be considered as a new valid option for the treatment of tic disorders.

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