Objective To identify risk factors for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) colonization in neonates hospitalized in the neonatal intensive care unit (NICU). Methods A case-control study was conducted. The case group included nine patients colonized with KPC-Kp between 1 August 2012 and 31 April 2013 and the controls were selected randomly from patients without KPC-Kp colonization during the same period. Univariable analysis and multivariable logistic regression analysis were conducted to identify risk factors for KPC-Kp colonization. Results The univariable analysis showed 11 factors associated with KPC-Kp colonization:gestational age, birth weight, length of hospital stay, duration of mechanical ventilation, congenital heart disease,peripherally inserted central catheter, surgical operation, duration of intravenous nutrition, carbapenems use, duration of carbapenems use and glycopeptides use. The multivariable logistic regression analysis showed that exposure to more than 4 days of carbapenems use (OR=18.7, 95%CI: 1.98-175.5, P=0.01) was an independent risk factor for KPCKp colonization. The intervention to control KPC-Kp colonization included contact isolation, active surveillance, and rational use of antibiotics. Conclusions Exposure to prolonged use of carbapenems is an independent risk factor for the development of KPC-Kp colonization in neonates hospitalized in the NICU.

Objective To study the clinical characteristics of whooping cough in neonates and the antimicrobial resistance of the bacterial isolates. Methods Clinical information of 7 neonates with whooping cough confirmed by bacterial culture was collected. The antimirobial resistance of the isolates was tested using E-test and disk diffusion methods. Results The children's mothers or other family members had cough for more than 10 days in 6 neonates, in which four neonates contacted with 3 or more family members with cough. All the neonates had rhinobyon and slight cough at the beginning of the disease. Five cases presented typical spasmodic cough after 4-7 days of the onset. Five cases displayed cyanosis, four cases occurred apnea, three cases suffered breath holding, and only two cases had fever. Nares flaring and three depression signs were found in the physical examination. No bacteriostatic ring around the erythromycin disks were found for five bacterial isolates. The minimal inhibitory concentration (MIC) for erythromycin, azithromycin, clarithromycin and clindamycin were all >256 mg/L against the five isolates. Conclusions Whooping cough should be considered for neonates with respiratory symptoms and a history of close contact with respiratory infection patients. Macrolide-resistant Bordetella pertussis is common in children with whooping cough.

Objective To compare the clinical manifestations between inhaled and blood-borne Staphylococcus aureus pneumonia (SAP) and the antibiotic resistance between the isolates of inhaled and blood-borne Staphylococcus aureus. Methods The clinical data of 44 pediatric SAP cases in the Children's Hospital, Chongqing Medical University from January 2008 to December 2013 were retrospectively analyzed. Twenty-four cases were identified as inhaled SAP, and 20 cases as blood-borne SAP. Results Inhaled SAP was more common in children younger than 3 years of age, while blood-borne SAP was more prevalent in children older than 6 years of age. Patients with inhaled SAP had significantly higher incidence rates of cough, wheeze, moist rales, dyspnea and empyema than those with blood-borne SAP (P<0.05). The patients with blood-borne SAP were more vulnerable to severe fever, unconsciousness, dysfunction of liver and kidney, pyogenic osteomyelitis, septic arthritis, sepsis, and abscess of skin and soft tissues (P<0.05). Inhaled SAP isolates had significantly higher rates of resistance to amoxicillin/clavulanic acid, oxacillin, and cefoxitin than blood-borne SAP isolates (P<0.05), while the latter had a higher rate of resistance to cotrimoxazole (P<0.05). Conclusions Inhaled SAP often occurs in children younger than 3 years of age, and the respiratory manifestations are commonly seen. Blood-borne SAP often occurs in children older than 6 years of age, with the infectious-toxic symptoms that result in multiple organ infection and dysfunction. The isolates of inhaled and blood-borne SAP have different antibiograms.

Objective To analyze serum vancomycin concentration after administration of different therapeutic doses in children with Staphylococcus aureus pneumonia (SAP) in order to determine the appropriate dose of vancomycin in clinical administration. Methods The clinical data of 35 children who were diagnosed with SAP and treated with vancomycin from January 2008 to December 2013 were retrospectively analyzed. Results Among the 35 SAP cases with vancomycin therapy, 22 cases (63%) had serum vancomycin trough concentration monitored. The numbers of cases with vancomycin at 10, 12.5, and 15 mg/(kg·dose) × every 6 hours (q6h) were 11, 4 and 7, respectively. The mean serum trough concentration of vancomycin in the 15 mg/(kg·dose) group was 14.98 mg/L, which was significantly higher than in the 10 mg/(kg·dose) and 12.5 mg/(kg·dose) groups (4.97 and 8.00 mg/L respectively; P<0.05). The percentage of cases that reached the expected trough concentration in the 15 mg/(kg·dose) group (71%) was significantly higher than that in the 10 mg/(kg·dose) group (9%), but there was no significant difference in this percentage between the 15 mg/(kg·dose) and 12.5 mg/(kg·dose) groups (71% vs 25%). Conclusions The reasonable dosage of vancomycin for the treatment of pediatric SAP is 15 mg/(kg·dose) × q6h or 60 mg/(kg·d).

Objective To investigate nasopharyngeal carriage rate, antimicrobial resistance and serotype distribution of Streptococcus pneumoniae among children with upper respiratory infection. Methods Nasopharygeal swabs were collected from children with upper respiratory infection visiting the outpatient department of Beijing Children's Hospital between March 2013 and February 2014. The antibiotic susceptibility was tested by Etest method, and the serotype was determined by Quellung reaction. Results The nasopharyngeal carriage rate for Streptococcus pneumoniae was 23.8% (699/2 941). One hundred isolates were randomly chosen for antimicrobial susceptiblity test and serotyping. Up to 98.0% isolates were susceptible to parenteral penicillin. The susceptible rate against oral penicillin, however, was 33.0%. The non-susceptible rate to erythromycin and azithromycin was 97.0%. The multi-drug resistance rate was up to 86.0%. The common serotypes were 6A(12.0%), 19F(12.0%), 6B(10.0%), 23F(9.0%) and 14(8.0%). The coverage rates of 7-, 10- and 13-valent pneumococcal conjugate vaccine were 41.0%, 42.0% and 59.0% respectively. Conclusions About 25% of children with upper respiratory infection are nasopharyngeal colonized by Streptococcus pneumoniae. The isolates show a high antimicrobial resistance. The 13-valent pneumococcal conjugate vaccine covers about 60.0% of the isolates.

Objective To explore the features of pulmonary dysfunction in children with Mycoplasma pneumoniae pneumonia (MPP) with different chest imaging findings. Methods The clinical data from 215 children with MPP were reviewed. These patients were grouped based on chest image findings (bronchopneumonia, n=125; lobar pneumonia, n=69; interstitial pneumonia, n=21). Lung function parameters including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and the maximum mid-expiratory flow rate (MMEF 25%-75%) were compared between the groups. Results In the acute stage, patients with bronchopneumonia had significantly lower PEF values (measured value and measured value/predicted value) than the other two groups of patients, children with lobar pneumonia had a significant lower MMEF 25%-75% than other patients, and children with interstitial pneumonia had a significantly lower FVC. All patients experienced an improvement in lung function parameters except FEV1 of the lobar pneumonia group in the recovery stage. Conclusions Various features of pulmonary dysfunction can be observed among children with MPP with different chest imaging findings. Patients with bronchopneumonia mainly exhibit large airway dysfunction. The ones with lobar pneumonia mainly suffer small airway dysfunction, and those with interstitial pneumonia demonstrate both airway obstruction and restrictive ventilatory dysfunction.

Objective To study the changes in serum tumor necrosis factor-α (TNF- α), interleukin-6 (IL-6) and galctin-3 (Gal-3) concentrations in children with Mycoplasma pneumoniae pneumonia (MPP), and their roles in MPP. Methods Serum TNF-α, IL-6 and Gal-3 concentrations were measured using double antibody sandwich ELISA in 48 children with acute MPP (severe: 21 cases; mild: 27 cases) and in 30 healthy children (control group). Results Serum concentrations of TNF-α, IL-6 and Gal-3 in both the severe and mild groups were significantly higher than in the control group before treatment. The concentrations of the three indexes in the severe group were significantly higher than in the mild group. Serum concentrations of the three indexes decreased significantly after treatment in both groups. Conclusions Serum TNF-α, IL-6 and Gal-3 play important roles in the occurrence and development of pediatric MPP and their levels are associated the severity of this disorder.

Objective To describe the epidemiology and severity of illness of children hospitalized with respiratory syncytial virus (RSV) infection, including those who received palivizumab prophylaxis, at Royal University Hospital (RUH), Saskatoon and Regina General Hospital (RGH) from July 2002 to June 2005. Methods Children hospitalized for ≥ 24 hours with laboratory-confirmed RSV infection were enrolled, and their health records were retrospectively reviewed for patient demographics and referral patterns, use of palivizumab prophylaxis, severity of infection (length of hospitalization, need for and duration of pediatric intensive care and mechanical ventilation) and outcome of infection. Results A total of 590 children (324 males) were hospitalized over the three years. The median chronological age at admission was 5.3 months, and median hospital stay was 4.0 days. Gestational age at birth was ≥ 36 weeks in 82.4% of patients. RSV disease severity was mild to moderate in 478 patients (81.0%) and severe in 110 (18.6%). Thirty-nine patients (6.6%) required pediatric intensive care unit admission, for a median of 5.0 days. Twenty-two of these patients (56%) were mechanically ventilated for a median of 6.0 days. Two children died, not attributed to RSV infection. Twenty-two patients had received palivizumab prophylaxis before hospital admission, with 18 completing at least 2 of the monthly doses. Most of these children (17/22) had mild to moderate illness. Conclusions RSV causes significant morbidity in Saskatchewan, affecting predominantly term infants. The majority of illness is mild to moderate. Some patients who have received palivizumab may still develop significant RSV disease.

Objective To explore the influencing factors for the severity of bronchopulmonary dysplasia (BPD) in preterm infants. Methods The clinical data of 110 preterm infants who were diagnosed with BPD and had a hospital stay of over 28 days between January 2011 and December 2013 were analyzed. These BPD infants were divided into 3 groups according to the clinical criteria: mild group (n=52), moderate group (n=44), and severe group (n=14). The relationship between the severity of BPD and the gestational age, birth weight, asphyxia, oxygen therapy, pregnancy complications, intrauterine pneumonia and mechanical ventilation was analyzed. Results The severity of BPD was correlated with the following factors: gestational age, birth weight, prenatal infection, duration of oxygen inhalation with a concentration of >40%, use of mechanical ventilation, parameters and duration of mechanical ventilation, duration of continuous positive airway pressure, adoption of intubation surfactant extubation (INSURE) approach, Ureaplasma urealyticum infection, intrauterine pneumonia and patent ductus arteriosus. Logistic regression analysis indicated that the mechanical ventilator parameter peak inspiratory pressure (OR=1.260, 95%CI: 1.096-1.448) and duration of mechanical ventilation (OR=1.010, 95%CI: 1.005-1.016) were independent risk factors for the severity of BPD, while the INSURE approach was a protective factor (OR=0.208, 95%CI: 0.060-0.923). Conclusions The severity of BPD is associated with various factors in preterm infants. The important measures for preventing BPD include avoiding the birth of preterm infants with a very low birth weight, shortening the duration of mechanical ventilation, preventing and reducing pulmonary infections, and applying the INSURE approach.

Objective To study the long-term efficacy of CAMSBDH-ALL chemotherapy protocol for the treatment of childhood acute lymphoblastic leukemia (ALL). Methods Three hundred and eighteen children who were newly diagnosed with ALL between January 1999 and December 2007 were enrolled in this study. Among the 318 children, 83 children who hospitalized before December 2002 were treated with CAMSBDH-ALL99 protocol, including 48 patients of standard risk and 35 patients of high risk. The patients (n=235; 131 in standard risk and 104 in high risk) who hospitalized after December 2002 were treated with CAMSBDH-ALL03 protocol. Patients in the CAMSBDHALL99 protocol group were treated with conventional chemotherapy. CAMSBDH-ALL03 protocol was modified based on the CAMSBDH-ALL99 protocol. Results The long-term overall survival (OS) and event-free-survival (EFS) in the CAMSBDH-ALL03 group was significantly higher than in the CAMSBDH-ALL99 (P<0.01). The long-term OS and EFS of standard risk and high risk patients in the CAMSBDH-ALL03 protocol group were significantly higher than in the CAMSBDH-ALL99 protocol group (P<0.01). The CAMSBDH-ALL03 protocol group showed a significantly lower recurrence rate (28.9%) than in the CAMSBDH-ALL99 protocol group (50.6%) (P<0.05). The mortality rate in the CAMSBDH-ALL03 protocol group was 28.5% vs 56.6% in the CAMSBDH-ALL99 protocol group (P<0.05). Conclusions The therapeutic effect of the CAMSBDH-ALL03 protocol is supior to the CAMSBDH-ALL99 protocol group for childhood ALL, with a higher long-term survival rate.

Objective To study the death risk factors in children with severe hand, foot and mouth disease (HFMD). Methods A total of 164 children with severe HFMD between May 2010 and September 2012 were recruited and classified into death and survival groups according to their prognosis. The differences in general information, clinical signs and symptoms and laboratory examinations were compared between the two groups. The multivariate logistic regression analysis was used to identify death risk factors in children with severe HFMD. Results There were significant differences in the incidences of atypical rash, persistent fever, dyspnea, pulmonary hemorrhage, heart rate increase, blood pressure abnormalities, cold sweat, capillary refill time>3 seconds and frequent seizures, and blood glucose, serum creatine kinase and serum lactate levels between the death and the survival groups (P<0.05). The multivariate logistic regression analysis showed three independent death risk factors for children with severe HFMD: pulmonary hemorrhage (OR=9.466, 95%CI: 1.786-21.256), abnormal blood pressure (OR=5.224, 95%CI: 1.012-28.985) and elevated serum lactate level (OR=2.154, 95%CI: 1.020-8.253). Conclusions Pulmonary hemorrhage, abnormal blood pressure and elevated serum lactate are major death risk factors for children with severe HFMD.

Objective To study the significance of urine screening for school-age children by analyzing urine screening results of school-age children from Zhucheng City, Shandong Province, China, in 2013. Methods A total of 37 344 school-age children were randomly selected from children 6 to 12 years of age in Zhucheng City. Morning urine was tested by routine screening test, and the children who tested positive were re-tested after two weeks. Results There were 2 388 children (6.39%) tested positive in the first screening, and 388 children (1.04%) tested positive again in the second screening. The positive rates in the first and second screening tests were 9.52% and 2.01%, respectively, in girls, which were significantly higher than those in boys (3.79% and 0.23%, respectively; P<0.05). Among the children who had positive test results in the second screening, 302 (0.81%) were diagnosed with urinary system diseases. Conclusions Urine screening is an effective way for the early detection of some occult kidney diseases, which provides great benefits for early prevention and treatment of kidney diseases in children.

Objective To investigate the prevalence of hypertension and the relationship between hypertension and obesity in children and adolescents aged 6-18 years in Nanning, Guangxi Province, China. Methods A stratified cluster random sampling method was adopted in Nanning to select 7 893 children and adolescents aged 6-18 years as research subjects. Questionnaire surveys were conducted, and blood pressure, height, weight, and other indicators of growth and development were measured. Results An increasing trend with age for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed. Detection rates of hypertension, high SBP (HSBP) and high DBP (HDBP) were 6.58%, 4.02% and 3.81%, respectively. The detection rates of hypertension and HSBP in boys were significantly higher than in girls (P<0.05). The detection rates of hypertension in normal, overweight and obesity groups were 3.87%, 9.84% and 19.23%, respectively. The obesity group showed the highest detection rates for hypertension, HSBP and HDBP, followed by the overweight group and normal group. Compared with that in the normal group, the odds ratios (95% CI) for hypertension in the overweight and obesity groups were 2.71 (1.69-5.96) and 5.91 (3.46-7.63), respectively. Blood pressure showed a positive correlation with age, height, weight and BMI (P<0.01). Conclusions The present study provides with the current information and characteristics of blood pressure of children and adolescents aged 6-18 years in Nanning, Guangxi. Blood pressure is correlated with gender, age, height, weight and BMI. Obesity is positively correlated with the prevalence of hypertension and the risk of hypertension increases with body weight.

Objective To observe the long-term changes in anxiety-like behavior and tyrosine hydroxylase (TH) expression in the substantia nigra (SN) after hypoxic-ischemic brain damage (HIBD) in a neonatal rat model and to further explore the relationship between dopamine (DA) level and long-term anxiety-like behavior using the DA receptor (DAR) antagonist. Methods Seven-day-old (P7) neonatal Sprague-Dawley (SD) rats were randomized into normal control, sham-operated, HIBD and HIBD+DAR antagonist groups. HIBD model was prepared by ligating the right common carotid artery and 8% hypoxia exposure. The rats in the sham-operated group were sham-operated and were not subjected to right common carotid artery ligation and hypoxia exposure. The DAR antagonist was injected intraperitoneally before and after inducing HIBD. The same amount of normal saline was given to the other three groups as a control. Anxiety-like behavior was evaluated by elevated plus maze test, and TH expression in the SN was measured by immunohistochemistry on P14, P21, and P28. Results On P21 and P28, the time spent in the open arms and the percentage of open arms entries in the HIBD group were significantly increased compared with those in the normal control, sham-operated and HIBD+DAR antagonist groups (P<0.05); in addition, the HIBD+DAR antagonist group showed a significantly longer time spent in the open arms than the normal control group (P<0.05). On P14, P21, and P28, TH expression in the HIBD and HIBD+DAR antagonist groups was significantly lower than that in the normal control and sham-operated groups, and TH level in the HIBD group was significantly lower than that in the HIBD+DAR antagonist group (P<0.05). Conclusions DAR antagonist allows the restoration of anxiety-like behavior and alleviates the damage to dopaminergic neurons in SD rats after HIBD.

Objective To investigate the expression of nesfatin-1/NUCB2 and ghrelin in the gastric mucosa of rats with intrauterine growth retardation (IUGR) and its significance. Methods The IUGR animal model was established by feeding rats low-protein diets during their pregnancy. Newborn rats were divided into catch-up growth, non-catchup growth and control groups. Protein and mRNA levels of nesfatin-1/NUCB2 and ghrelin in the gastric mucosa of rats were determined by RT-PCR and Western blot, respectively. Results Nesfatin-1/NUCB2 mRNA and protein were expressed in the gastric mucosa of rats immediately after birth, and their expression increased in an age-dependent manner in all three groups. Furthermore, the level of nesfatin-1/NUCB2 in the catch-up growth group was higher than that in the control group before weaning, whereas there was no significant difference in nesfatin-1/NUCB2 expression between the two groups after weaning. The level of nesfatin-1/NUCB2 in the non-catch-up growth group was lower than that in the catch-up growth group during the whole observation period. The level of ghrelin in the catch-up growth group was higher than that in the control group starting from day 12 after birth, whereas there was no significant difference in ghrelin expression between the two groups after weaning. The level of ghrelin in the non-catch-up growth group was lower compared with those in the catch-up growth and control groups from days 12 to 28 after birth. Conclusions Nesfatin-1 and ghrelin are co-expressed in the gastric mucosa of rats with IUGR after birth and interact with each other to produce long-term nutritional regulation.