In order to guide diagnosis and treatment in children with sleep disordered breathing aged 1 to 23 months, the European Respiratory Society(ERS) summarized the evidence and released the European Respiratory Society statement based on clinical experience in 2016. This article aims to interpret the ERS statement. Children with apparent upper airway obstruction during wakefulness and those with SDB symptoms and complex conditions requires treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions. Obstructive SDB in children aged 1 to 23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities.
Objective To explore the treatment method of congenital heart disease (CHD) with pulmonary artery hypertension (PAH) in infants with Down syndrome (DS). Methods The clinical data of 60 CHD patients with PAH from March 2015 to August 2016 in our hospital were retrospectively analyzed. There were 30 infants with DS classified as a DS group (trial group, 17 males and 13 females with a mean age of 1.15±0.25 years) and the other 30 patients without DS were classified as a control group (20 males and 10 females with a mean age of 1.24±0.30 years). All the patients underwent surgical treatment and fasudil combined with sildenafil were used to prevent pulmonary hypertension crisis postoperatively. Results There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, modified ultrafiltration time and the incidence of postoperative respiratory complications between the two groups. The pulmonary systolic blood pressure significantly decreased at 24 h after operation in the two groups (both P<0.05). The arterial oxygen pressure and oxygenation index of the trial group were lower than those of the control group at 6 h after operation (both P<0.05). The mechanical ventilation time and intensive care time of the trial group were significantly longer than those of the control group (P=0.007 and P=0.000, respectively). There were no reoperations or early death. Conclusion The effects of surgical repair of CHD with PAH in infants with DS are satisfactory by grasping the indication, protecting lung function and controlling PAH in the early postoperative period, although there is a high incidence of pulmonary complications.
ObjectiveTo evaluate the safety of modified blood-sparing approach in cardiac surgery with cardiopulmonary bypass (CPB) in low-weight infants (≤15 kg) with congenital heart disease. MethodsA total of 283 infants were applied a new blood-sparing approach, known as without homologous blood priming, during the cardiac surgery with CPB between August 2012 and October 2013. There were 154 males and 129 females with a median (interquartile range) age of 13 (9, 20) months. The infants were assigned to an intraoperative transfusion (IT) group once having transfusion during operation. And the infants without transfusion during operation were assigned to a postoperative transfusion (PT) group or a transfusion-free (TF) group according to post-operative transfusion. All infants experienced routine heart surgery with CPB. Blood samples were collected at following time points, ie. pre-CPB, 10 minutes after CPB, before termination of CPB, and after modified ultrafiltration. Clinical data and transfusion requirements were collected and compared between three groups. ResultsA total of 106 infants (53 males and 53 females) completed bloodless surgery. The median (interquartile range) age was 14 (9, 22) months. A total of 121 infants (71 males and 50 females) received red blood cell (RBC) transfusion intraoperatively. The median (interquartile range) age was 10 (8, 12) months. A total of 56 infants (30 males and 26 females) at age of 15 (7, 20) months received RBC transfusion postoperatively. The intraoperative transfusion (IT) group had lower body weight (9 (7,10) kg vs. 12.6 (9,14) kg) and size (72 (68, 80) cm vs. 86 (78, 97) cm), younger age (10 (8, 12) months vs. 14 (9, 22) months), and higher 24-hour chest tube drainage volume (89 (40, 122) ml vs. 58 (30, 106) ml, P<0.05) than those in the transfusion free (TF) group. Pre-operative hematocrit was also lower in the IT group than that in the PT group and the TF group (32% (29%, 37%) vs. 39% (34%, 41%) vs. 36% (33%, 38%), P<0.05). The hospital stay in the PT group and the IT group was longer than that in the TF group, respectively (13 (8, 23) d vs. 14 (11, 22) d vs. 11(8, 20) d, P<0.05). ConclusionAlthough applied with blood-sparing approach, perioperative transfusion is required in some infants. Infants who are free from transfusion have shorter hospital stay and less 24-hour chest tube drainage volume. Consideration of risk factors of transfusion in this population may benefit further reduction in blood transfusion in the future.
ObjectiveTo systematically evaluate the efficacy and safety of anatomical landmark method (ALM) versus ultrasound (US)-guided internal jugular vein (IJV) catheterization in pediatric patients. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, CBM, WanFang Data and CNKI were searched from inception to October 2016 to collect randomized controlled trials (RCTs) of landmark-guided versus ultrasound-guided IJV catheterization in pediatric patients who underwent elective surgery. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. ResultsA total of 13 RCTs involving 1 026 pediatric patients were included. The results of meta-analysis showed that, the overall success rate (RR=1.21, 95%CI 1.09 to 1.34, P=0.000 5) and arterial puncture rate (RR=0.19, 95%CI 0.07 to 0.50, P=0.000 7) of US-guided IJV catheterization were both significantly superior to the ALM group. Whereas there was no significant difference between two groups as for the incidence of hematoma formation (RR=0.35, 95%CI 0.09 to 1.31, P=0.12). ConclusionCurrent evidence shows that, for IJV catheterization of pediatric patients, both the effectiveness and safety of ultrasound-guided technique are better than the landmark-guided. Since the quantity and quality of included studies are limited, the conclusion of this study needs more high quality studies to verify.
Objective To evaluate the surgical approach of left superior vena cava（LSVC） distal abnormalities in infant and young children. Methods From April 1999 to December 2004, 19 cases of LSVC distal abnormalities were corrected by primary repair. There were 10 males and 9 females. Their age ranged from 2.7 months to 6.5 years and body weight from 3. 1 to 15.0 kg. Diseases complicated with LSVC included complex congenital cardiac disease 9 cases, ostium secundum atrial septal defect 4, partial abnormal pulmonary venous drainage （PAPVD） with atrial septal defect（ASI）） 2, tetralogy of Fallot（TOF） 3, and double outlet of right ventricle （DORV） 1 case. The ways for surgical treatment of distal abnormalities of LSVC were reconstruction of atrial septum, translocation of LSVC and reconstruction of atrial septum, right atrium and LSVC anastomosis, cavopulmonary anastomosis and repair of partially unroofed coronary sinus. Results One patient died and the diagnosis for the patient was LSVC with DORV and pulmonary hypertension （PH）. This patient died from crisis of PH , obstruction of blood flow in the left cavopulmonary anastomosis, severe low cardiac output,low arterial oxygen saturation and abnormal function of kidney. The mean pressure of right atrium was 9 to 18 mmHg. The percutaneous oxygen saturation （SpO2） was 0.98 1.00 for biventricular repair and 0.79-0. 88 for single ventricular repair and palliative repair. The echocardiography showed no obstruction of the blood flow in LSVC and pulmonary veins. The results of follow-up were satisfactory, from 3 months to 2 years. Conclusions Key for success of surgical approach of LSVC distal abnormalities is precise evaluation of different kinds of LSVC and different surgical approaches. Cavopulmonary anastomosis can not be used in the case of LSVC with PH.