Objective To investigate the risk factors of infantile urolithiasis resulted from taking milk powder with melamine. Methods The clinical data of infant and young children who took free-screening for melamine associated urolithiasis in the Lanzhou University Second Hospital from September 14th, 2008 to January 6th, 2009 were collected, while the infants without urolithiasis in the same number as those with urolithiasis were also randomly collected into the control group. Then both univariate and multivariate analyses were performed with a logistic regression model to assess the independent risk factors for urolithiasis. Results Of the screened children, 647 children were included in the urolithiasis group and 647 were in the control group. There were 678 boys and 616 girls with an average age of 19.27 months. The results of logistic regression analysis showed that, the children fed with Sanlu powdered infant milk formula which contained a high level of melamine were more likely to suffer from urolithiasis than those took other melamine-contaminated formula (OR=6.09, Plt;0.01); boys were more than girls (OR=1.39, Plt;0.01), and children fed with formula alone were more than those fed with both formula and breast milk (OR=1.61, Plt;0.01). The risk of urolithiasis decreased gradually with age, and the OR value of children in age of smaller than 6 months, 6 to 12 months, 12 to 24 months were 5.23 (Plt;0.01), 2.73 (Plt;0.01), and 1.60 (Plt;0.01), respectively. The risk of urolithiasis increased gradually with the time lengthening of taking melamine-contaminated formula, and the OR value of children who had took melamine-contaminated formula for 3 to 6 months, 6 to 12 months and more than or equal to 12 months were 2.10 (Plt;0.01), 2.81 (Plt;0.01), and 4.75 (Plt;0.01), respectively. Conclusion It shows that feeding with high melamine infant formula (Sanlu powdered infant milk formula), artificial feeding and male children are the risk factors of infantile urolithiasis. Additionally, the risk of urolithiasis decreases with age and increases with time of formula feeding
Objective To discuss the prevalence of melamine-induced urolithiasis in infants and its development and to formulate more effective diagnosis and treatment. Methods A total of 402 cases of melamine-induced infantile urolithiasis were retrospectively analyzed with basic information, blood, urine, urinary B-mode ultrasonic diagnosis, treatment options and prognosis for infant urolithiasis. Results A total of 402 cases of infants had an excessive melamine milk feeding history, in which there were 9 self-discharged cases. The largest calculus diameter was 4 mm × 5 mm × 6 mm. The smallest calculus diameter was 0.5 mm × 0.5 mm × 1 mm. The average calculus diameter was 1 mm × 2 mm × 2 mm. There were 30 cases of abnormal serum creatinine, 27 of abnormal urea, 2 of abnormal uric acid, and urine occult blood positive for 167 cases. There were 395 cases which were administrated medical treatment; 7 cases were administrated surgical treatment; 6 cases had obstructive renal failure. Conclusion Infants whose age is more than six months but less than 12 months with a history of exposure to melamine have the larger risk of urolithiasis. B-mode ultrasonic diagnosis is practically significant on early screening urolithiasis. It is effective to perform surgical treatment for obstructive renal failure caused by calculus.
Objective To investigate the incidence of urolithiasis in infants aged 0-3 years old fed by milk powder tainted with melamine in the middle area of the Anhui province, as well as its relationship to gender, age, milk powder consumption and drinking water. Methods Questionnaires were distributed to 1079 infants who were screened for urolithiasis by ultrasound examination from September 25, 2008 to October 17, 2008. Data was collected by Epidata and analyzed by SPSS 13.0 software. Results A total of 646 (59.87%) male infants and 433 (40.13%) female infants underwent ultrasound examination in Anhui Provincial Hospital. Of these, 86 infants were diagnosed with urolithiasis with an incidence of 7.97%, including 62 males (72.09%) and 24 females (27.91%). The mean age of those infants with urolithiasis was 1.85±0.77, and all of calculus was located in kidney. The relationship between the incidence of urolithiasis and gender, age, drinking water, feeding bottle sanitation, birth status, as well as the amount of milk powder intake was assessed by using the Pearson Chi-square test. Results showed that significant differences were noted in the incidence of urolithiasis among infants of different genders or with different drinking water sources (Plt;0.05). The result of multiple logistic regression analyses indicated that gender was related to the incidence of urolithiasis (Plt;0.05). The incidence of urolithiasis in female infants was only 58.7% of that in male infants (OR 0.587, 95%CI 0.359 to 0.959). Conclusion The incidence of urolithiasis in infants aged 0-3 years of old in the middle area of Anhui province is relatively high and has anatomical specificity. Further data during the follow-up of these cases should be collected.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.
Abstract： Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants （body weight＜2 500 g） and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks （ranging from 26 to 42 weeks） and mean age at operation of 24.9±12.5 d（ranging from 4 to 55 d）. Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g（ranging from 640 to 2 500 g）and mean weight at operation of 1 953.2±463.6 g （ranging from 650 to 2 712 g）. All the patients received preoperative treatment in newborn intensive care unit（NICU） and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass （CPB）and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%（13/60）, including 4 intra-operative deaths, 6 early deaths （within 72 h postoperatively） and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44.7 min, and postoperative mechanicalventilation time was （136.9±138.1）h. Thirteen patients underwent delayed sternal closure. Eight patients underwentreexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes, and all the patients were alive during follow-up. Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.
Abstract： Objective To identify the risk factors for shortterm adverse events in infants with congenital heart diseases receiving open heart surgical correction with cardiopulmonary bypass (CPB), in order to improve the outcome by adopting appropriate treatment measures. Methods We retrospectively analyzed the clinical data of 98 consecutive children with congenital heart diseases who underwent surgical correction with CPB in Beijing Fu Wai Hospital from November 2009 to December 2009. The patients were divided into two groups according to the postoperative complications. Among the patients without complications（n=40）: there were 24 males and 16 females with an age of 7.60±0.40 months and a weight of 7.80±0.30 kg. In the patients with complications (n=58): there were 42 males and 16 females with an age of 6.20±0.40 months and a weight of 6.70±0.20 kg. In both groups, perioperative data were recorded, including preoperative fast blood glucose, creatinine, time of aortic crossclamp, modified or zerobalanced ultrafiltration, postoperative glucose level, concentration of lactate, notrope score and complications. Risk stratification was performed by Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1). Univariate analysis and logistic regression analysis were used to identify the risk factors for shortterm adverse events. Results One patient(1.02%) died of circulatory failure during the perioperative period. Thirtyseven patients [CM(159mm]were supported by at least 2 vasoactive drugs for more than 48hours,29 by mechanical ventilation for more than 24 hours, 5 needed reintubation, 1 experienced tracheotomy, 31 suffered from noscomial infection, 4 had wound infection, 3 developed renal failure, and 1 developed hepatic dysfunction. By logistic regression analysis, age (OR=0.750, P=0.012), percutaneous oxygen saturation (OR=0.840,P=0.005), aortic crossclamp time (OR=1.040, P=0.008), postoperative glucose level (patients with a mean glucose level lower or equal to 8.33 mmol/L had a probability of developing adverse outcomes five times higher; OR=5.051, P=0.011) were found to be the risk factors for shortterm adverse outcomes. Conclusion Age, percutaneous oxygen saturation and aortic crossclamp time are associated with the shortterm adverse outcome of infants undergoing congenital heart disease correction with CPB. The present results do not support perioperative hyperglycemia as a risk factor for adverse outcome.
Abstract: Objective To discuss whether priming solution with blood can reach a physiologic state after ultrafiltration and investigate the influence of this method on electrolytes, acidbase balance and cardiopulmonary function in patients in perioperative period. Methods Forty patients with congenital heart diseases treated in our hospital from February to June 2009 were enrolled in this study. The weight of these patients was less than 8 kg. They were randomly divided into two groups: the experimental group (n=20, 12 males and 8 females; age: 131.00±103.00 d; weight: 4.14±0.96 kg） and the control group (n=20, 11 males and 9 females; age: 127.00±88.00 d; weight: 4.38±1.05 kg). For patients in the experimental group, the priming solution was filtered with a blood ultrafilter in the cardiopulmonary bypass(CPB) circuit for twenty minutes, while the priming solution circulated in the CPB circuit without filtration for patients in the control group before operation. Data were obtained from the priming solution before and after ultrafiltration. Blood gas analysis was done and indexes like the electrolytes were detected during the operation. Fractional shorting (FS), ejection fraction (EF) and cardiac output (CO) were measured by echocardiography. Pulmonary function change was also observed. Results No death occurred in both groups. Mechanical ventilation time for the experimental group was significantly shorter than that of the control group (2.7±0.3 d vs. 4.1±0.4 d，Plt;0.05). After ultrafiltration for the experimental group, all indexes of the priming solution reached normal values: pH increased (from 6.89±0.22 to 7.40±0.57, P=0.001); base excess increased (from -16.12±0.98 mmol/L to +0.31±2.40 mmol/L, P=0.000); potassium concentration decreased (from 10.33±2.13 mmol/L to 4.27±0.93 mmol/L, P=0.000); interleukin8 (IL-8) decreased (from 78.40±6.10 pg/ml to 64.30±48.10 pg/ml, P=0.036); and bradykinin decreased (from 5 982±1 353 pg/ml to 531.00±35.00 pg/ml, P=0.031). The decrease of FS, EF and CO in the experimental group was smaller than that of the control group. Four hours after surgery, CO in the experimental group was significantly higher than that in the control group (2.77±0.95 L/min vs. 1.66±0.75 L/min, P=0.001). Twentyfour hours after surgery, EF in the experimental group was significantly higher than that in the control group (67.44%±6.89% vs. 61.17%±9.02%, P=0.003). Six hours after surgery, alveolararterial oxygen difference (A-aDO2) and respiratory index (RI) increased significantly (Plt;0.05) in both groups, and then started to drop to normal. Patients in the experimental group recovered gas exchange earlier than patients in the control group. Fortyeight hours after operation, A-aDO2 and RI in the experimental group were significantly lower than those in the control group (Plt;0.05). Conclusion Ultrafiltration of priming solution may confer an advantage in maintaining more physiological conditions, reducing inflammatory mediators, and improving cardiopulmonary function after operation, which is very important in performing cardiac surgery on the newborn and infants with complex congenital heart diseases.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Corresponding author: Y I Ding -hua, E -mail: yidh@fmmu. edu. cnAbstract: Objective To investigate the optimal surgical approaches for coarctation of aorta (CoA ) associated with heart anomalies (CoA -HA ) in infants through analyzing the immediate and long-term outcome post-operation. Methods From May 1998 to November 2006, 29 patients with CoA -HA were admitted to this institute. Subclavian flap angioplasty was performed in three patients, excision of coarctation and end-to-side anastomoses in six pat ients,and end-to-end anastomoses in the remaining 20 pat ients. Their clinical data were retrospect ively reviewed and the long-term follow -up results obtained through telephone o r letters. Results Three patients died of operations, of whom one died of low cardiac output syndrome, one died of sepsis and one died of multiple organs failure. In two months’to eight years’follow -up , no later death and severe neurological complications were found. Two patients suffered from recurrent coarctation, but had no sense of symptoms and free from re-operation. In all pat ients neither systemic hypertension, nor arterial aneurysm and aortic valve regurgitation were found. Conclusions Mortality of surgical corrections is accepted fo r CoA -HA in infants. Preoperative heart dysfunction and prolonged mechanical ventilation are the high risks of operative death. Recurrent coarctation is the major later comp lication.