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Helmet Ventilation in a Child with COVID-19 and Acute Respiratory Distress Syndrome. 对一名患有 COVID-19 和急性呼吸窘迫综合征的儿童进行头盔通气。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5519254
Ke-Yun Chao, Chao-Yu Chen, Xiao-Ru Ji, Shu-Chi Mu, Yu-Hsuan Chien

Background: In pediatric patients with severe COVID-19, if the respiratory support provided using high-flow nasal cannula (HFNC) becomes insufficient, no definitive evidence exists to support the escalation to noninvasive ventilation (NIV) or mechanical ventilation (MV). Case Presentation. A 9-year-old boy being treated with face mask-delivered biphasic positive airway pressure ventilation developed fever, tachypnea, and frequent desaturation. The COVID-19 polymerase chain reaction test and urine antigen test for Streptococcus pneumoniae were both positive, and sputum culture yielded Pseudomonas aeruginosa. The do-not-resuscitate order precluded the use of endotracheal intubation. After 2 h of HFNC support, the respiratory rate oxygenation (ROX) index declined from 7.86 to 3.71, indicating impending HFNC failure. A helmet was used to deliver NIV, and SpO2 was maintained at >90%. Dyspnea and desaturation gradually improved, and the patient was switched to HFNC 6 days later and discharged 10 days later.

Conclusion: In some cases, acute respiratory distress syndrome severity cannot be measured using the oxygenation index or oxygenation saturation index, and the SpO2/FiO2 ratio and ROX index may serve as useful alternatives. Although NIV delivered through a facemask or HFNC is more popular than helmet-delivered NIV, in certain circumstances, it can help escalate respiratory support while providing adequate protection to healthcare professionals.

背景:对于患有严重 COVID-19 的儿科患者,如果使用高流量鼻插管 (HFNC) 提供的呼吸支持不足,则没有确切的证据支持升级到无创通气 (NIV) 或机械通气 (MV)。病例介绍。一名正在接受面罩双相气道正压通气治疗的 9 岁男孩出现发热、呼吸急促和频繁的饱和度降低。COVID-19 聚合酶链反应检测和肺炎链球菌尿抗原检测均呈阳性,痰培养结果为铜绿假单胞菌。由于下达了 "禁止复苏 "的命令,因此无法进行气管插管。HFNC 支持 2 小时后,呼吸频率氧合(ROX)指数从 7.86 降至 3.71,表明 HFNC 即将失效。患者使用头盔进行 NIV,SpO2 保持在 90% 以上。呼吸困难和饱和度降低的情况逐渐好转,6 天后患者转为高频自然呼吸,10 天后出院:结论:在某些情况下,急性呼吸窘迫综合征的严重程度无法用氧合指数或氧合饱和度指数来衡量,SpO2/FiO2 比率和 ROX 指数可作为有用的替代指标。虽然通过面罩或 HFNC 提供的 NIV 比头盔提供的 NIV 更受欢迎,但在某些情况下,它可以帮助升级呼吸支持,同时为医护人员提供足够的保护。
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引用次数: 0
Acute Disseminated Encephalomyelitis Presenting with Neuropsychiatric Symptoms. 出现神经精神症状的急性播散性脑脊髓炎。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-09-17 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9810844
Mrinal Shrestha, Anish Joshi, Ajit Pandey, Aashutosh Chaudhary, Aman Raj Shrestha, Naman Koju, Sujan Timilsina, Ashlesha Chaudhary

Background: Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated pathology involving inflammatory demyelination of the central nervous system. Case Presentation. In this case report, we present the case of a nine-year-old female who exhibited altered mental status and focal neurological deficit, subsequently diagnosed as ADEM based on clinical presentation and magnetic resonance imaging (MRI) findings. The patient was managed symptomatically along with glucocorticoids.

Conclusion: ADEM must be suspected when a patient, especially a child, presents with prodromal symptoms followed by multifocal neurological symptoms. Diagnosis can be established with an MRI brain scan. Most patients respond to high-dose intravenous glucocorticoids.

背景:急性播散性脑脊髓炎(ADEM急性播散性脑脊髓炎(ADEM)是一种罕见的免疫介导病理,涉及中枢神经系统的炎性脱髓鞘。病例介绍。在本病例报告中,我们介绍了一名九岁女性的病例,她表现出精神状态改变和局灶性神经功能缺损,随后根据临床表现和磁共振成像(MRI)结果被诊断为 ADEM。患者接受了对症治疗和糖皮质激素治疗:结论:当患者(尤其是儿童)出现前驱症状,继而出现多灶性神经症状时,必须怀疑 ADEM。核磁共振脑部扫描可确定诊断。大多数患者对大剂量静脉注射糖皮质激素有反应。
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引用次数: 0
Gross Hematuria and Hemolytic Anemia in Infectious Mononucleosis. 传染性单核细胞增多症中的毛细血尿和溶血性贫血。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-09-12 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5236969
Chinmayi Sharma, Navneet Venugopal, Shivaiah Balachandra

Introduction. Infectious mononucleosis (IM), caused by the Epstein-Barr virus (EBV), typically presents with fever, tonsillopharyngitis, and lymphadenopathy while rare, renal, and hematological complications such as gross hematuria and hemolytic anemia can occur, particularly in children. Case Presentation. We describe a 15-year-old male with infectious mononucleosis presenting with abdominal pain, sore throat, and red-colored urine for three days. Laboratory findings revealed leukocytosis, elevated liver enzymes, and hemoglobinuria. Serological testing confirmed EBV infection. Despite intravascular hemolysis, the patient's anemia was mild, and he responded well to supportive care. Discussion. Gross hematuria and hemolytic anemia are uncommon in IM, with limited reports. Proposed mechanisms include viral-induced renal injury and autoimmune hemolysis. Differential diagnosis should consider other causes of hematuria, which can be differentiated through urine microscopy and serological tests. IM should be considered in patients with pharyngitis and hematuria, especially when other causes are excluded.

导言。由 Epstein-Barr 病毒(EBV)引起的传染性单核细胞增多症(IM)通常表现为发热、扁桃体咽炎和淋巴结病,也可出现罕见的肾脏和血液并发症,如毛细血尿和溶血性贫血,尤其是在儿童中。病例介绍。我们描述了一名 15 岁男性传染性单核细胞增多症患者的病例,患者出现腹痛、咽喉痛,尿液呈红色,已持续三天。实验室检查结果显示白细胞增多、肝酶升高和血红蛋白尿。血清学检测证实患者感染了 EBV。尽管出现了血管内溶血,但患者贫血症状轻微,对支持性治疗反应良好。讨论在 IM 中,毛细血尿和溶血性贫血并不常见,相关报道也很有限。建议的发病机制包括病毒引起的肾损伤和自身免疫性溶血。鉴别诊断应考虑引起血尿的其他原因,这些原因可通过尿液显微镜检查和血清学检测加以区分。对于咽炎合并血尿的患者,尤其是在排除了其他病因的情况下,应考虑到 IM。
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引用次数: 0
A Case Report of Thoracic Ectopia Cordis in a Hospital in Zanjan, Iran. 伊朗赞詹市一家医院的胸廓脐带外翻病例报告。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-09-10 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3912085
Mehdi Hosseini, Hassan Zamani, Shadi Moghimi, Aref Nekoufar

Methods: A 17-week-old female neonate with a history of prenatal diagnosis of congenital heart anomaly was admitted to Ayatollah Mousavi Hospital in Zanjan, Iran. For the diagnosis of thoracic ectopia, cordis fetal echocardiography and ultrasonography were performed. Moreover, the noninvasive prenatal testing (NIPT) genetic test performed in the 10th week of pregnancy was evaluated.

Results: The neonate was diagnosed with thoracic ectopia cordis, with the heart located outside the thoracic cavity and covered by a thin membrane. The Z scores of the analyzed maternal venous blood chromosomes were between +6 and -6, and all chromosomes had a low risk in terms of the risk of birth defects. The results of this study revealed that genetic test analysis is not enough to diagnose and predict congenital anomalies and defects. Furthermore, the findings showed that the fetus's mother continued to take folic acid after the first 3 months of pregnancy. This can be one of the risk factors involved in causing this heart defect.

Conclusion: One of the important results of this study was that the diagnostic findings of ultrasound were normal, but the findings of echocardiography were reported as abnormal. This shows that fetal echocardiography is better than ultrasound imaging in diagnosing ectopia cordis. In addition, it is recommended that pregnant women should avoid taking folic acid after the first trimester of pregnancy.

手术方法伊朗赞詹市 Ayatollah Mousavi 医院收治了一名 17 周大的新生女婴,产前诊断为先天性心脏畸形。为诊断胸廓异位,进行了脐带胎儿超声心动图和超声波检查。此外,还对怀孕第 10 周时进行的无创产前检测(NIPT)基因检测进行了评估:结果:新生儿被诊断为胸廓脐带异位,心脏位于胸腔外,被一层薄薄的膜覆盖。所分析的母体静脉血染色体的 Z 评分在 +6 和 -6 之间,所有染色体发生出生缺陷的风险都很低。这项研究结果表明,基因检测分析不足以诊断和预测先天性畸形和缺陷。此外,研究结果表明,胎儿的母亲在怀孕头 3 个月后继续服用叶酸。这可能是导致这种心脏缺陷的风险因素之一:本研究的重要结果之一是超声诊断结果正常,但超声心动图检查结果却异常。这表明胎儿超声心动图在诊断脐带外翻方面优于超声成像。此外,建议孕妇在怀孕头三个月后应避免服用叶酸。
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引用次数: 0
Successful Repair and Management of Severe Scalp Avulsion Incurred during Birth in an Extremely Low Birth Weight Infant. 成功修复和处理极低出生体重儿在出生时发生的严重头皮撕脱。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-09-10 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8122801
Shoko Takahashi, Yu Kanai, Yayoi Miyazono, Daisuke Hitaka, Yuki Fujita, Yoichiro Shibuya, Hidetoshi Takada

Introduction: Minor head trauma, such as scalp abrasion, is relatively common during vaginal delivery, whereas fatal head trauma is rare. This case report describes the successful repair and management of severe scalp avulsion that occurred during vaginal delivery and consequent hemorrhagic shock in an extremely low birth weight infant. Case Presentation. An extremely low birth weight infant (26 weeks' gestational age) sustained extensive scalp avulsion during vaginal delivery that exposed the skull. The scalp laceration began in the frontal temporal region and extended bilaterally along the temporal region for 20 cm. The infant experienced hemorrhagic shock soon after birth due to bleeding from the wound and was placed in a closed incubator for intensive care. At 7 h after birth, the wounds were repaired using sutures. Bleeding was quickly controlled, and the infant recovered from hemorrhagic shock. A wet dressing was applied to the wound, and the flap healed without necrosis.

Conclusion: We successfully repaired severe scalp avulsion in this case. Scalp avulsion can cause severe bleeding and death. Bleeding control and the preservation of circulation are the most important factors in its repair and maintenance. In this case, suturing the wound effectively controlled the bleeding, and the application of wet dressing and a high-humidity environment thereafter may have contributed to the scalp's engraftment.

导言:轻微的头部创伤,如头皮擦伤,在阴道分娩过程中比较常见,而致命的头部创伤则很少见。本病例报告描述了一名极低出生体重儿在阴道分娩过程中发生严重头皮撕脱并导致失血性休克的成功修复和处理过程。病例介绍。一名极低出生体重儿(胎龄 26 周)在阴道分娩时头皮大面积撕裂,头骨外露。头皮撕裂伤从颞前部开始,沿颞部向双侧延伸 20 厘米。由于伤口出血,婴儿出生后不久就出现了失血性休克,并被送入封闭式保育箱接受重症监护。出生后 7 小时,使用缝合线修复了伤口。出血很快得到控制,婴儿也从失血性休克中恢复过来。对伤口进行了湿敷,皮瓣愈合后没有坏死:结论:我们成功修复了本例严重的头皮撕脱伤。头皮撕脱可导致大出血和死亡。控制出血和保护血液循环是修复和维持伤口的最重要因素。在本病例中,缝合伤口有效地控制了出血,之后的湿敷和高湿度环境可能有助于头皮的移植。
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引用次数: 0
Hepatic Failure and Hyperbilirubinemia Secondary to Hemolytic Disease of the Newborn. 新生儿溶血病继发肝功能衰竭和高胆红素血症。
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9180404
Matthew Reinhardt, Marya L Strand, Dajana Sabic

Anti-D antibody is the most common cause of hemolytic disease of the newborn (HDN). Other antigens have emerged, causing significant damage to the newborn. We report a case of a 31-week dichorionic diamniotic twin born emergently to a mother with anti-C and anti-D antibodies who required multiple percutaneous umbilical cord blood sampling (PUBS) and transfusions. Extensive resuscitation at birth was required due to severe anemia, hypovolemia, and prematurity. Ensuing liver damage occurred with subsequent profound coagulopathy, transaminitis, and direct hyperbilirubinemia that required significant support. This patient developed several unique findings including the inability to monitor oxygen saturations due to dermal bilirubin deposits and staining of baby teeth. This case report highlights the importance of early identification of additional Rh antibodies due to concern for development of more severe forms of HDN.

抗 D 抗体是导致新生儿溶血病(HDN)的最常见原因。其他抗原的出现也会对新生儿造成重大损害。我们报告了一例母亲患有抗-C 和抗-D 抗体的 31 周二绒毛膜双胎急产新生儿,该新生儿需要多次经皮脐带血采样(PUBS)和输血。由于严重贫血、血容量不足和早产,出生时需要进行大量复苏。随后出现的肝损伤导致严重的凝血功能障碍、转氨酶炎和直接高胆红素血症,需要大量的支持治疗。该患者出现了一些独特的症状,包括由于皮肤胆红素沉积和乳牙染色而无法监测血氧饱和度。本病例报告强调,由于担心会发展成更严重的高胆红素血症,早期识别额外的 Rh 抗体非常重要。
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引用次数: 0
SARS-CoV-2-Triggered Hemophagocytic Lymphohistiocytosis with Complications of Posterior Reversible Encephalopathy Syndrome. SARS-CoV-2引发的嗜血细胞淋巴组织细胞增多症并发后可逆性脑病综合征
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-07-30 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8829060
Ross M Perry, Scott D Casey, Alex Q Lee, Sylvia P Bowditch, Mary A Rasmussen, Viyeka Sethi, Arun R Panigrahi

In this article, we describe a novel case of SARS-CoV-2-associated-hemophagocytic lymphohistiocytosis (HLH) complicated by posterior reversible encephalopathy syndrome (PRES). Initially diagnosed with multisystem inflammatory response in children (MIS-C), the patient received a large corticosteroid dose days before the onset of neurological symptoms. After developing PRES, the patient was treated with antihypertensives, antiepileptics, dexamethasone, and anakinra, leading to neurologic normalization. We propose that given the challenging diagnostic picture of PRES developing in patients with HLH or MIS-C, institutionalized standards for blood pressure management during corticosteroid induction may significantly improve outcomes in patients being treated for hyperinflammatory syndromes who develop neurological symptoms.

本文描述了一例新型 SARS-CoV-2 相关性嗜血细胞淋巴组织细胞增多症(HLH)并发后可逆性脑病综合征(PRES)的病例。患者最初被诊断为儿童多系统炎症反应(MIS-C),在出现神经系统症状前几天接受了大剂量皮质类固醇治疗。在出现 PRES 后,患者接受了降压药、抗癫痫药、地塞米松和阿纳金雷的治疗,最终神经功能恢复正常。我们建议,鉴于 HLH 或 MIS-C 患者出现 PRES 的诊断情况极具挑战性,在皮质类固醇诱导期间对血压进行制度化管理可能会显著改善因高炎症综合征接受治疗并出现神经症状的患者的预后。
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引用次数: 0
Preductal Hemodynamic Redistribution in Preterm Infants with Patent Ductus Arteriosus. 动脉导管未闭早产儿的导管前血流动力学再分布
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/7239698
Aimann Surak

A patent ductus arteriosus is a common entity in preterm infants. Literature is lacking regarding physiological effects on preductal circulation. This report describes 3 patients with abnormal flow Doppler pattern in brachiocephalic artery. Further research is warranted to better understand the impact of PDA on preductal circulation.

动脉导管未闭是早产儿的常见病。目前还缺乏有关导管前循环生理影响的文献。本报告描述了 3 例肱动脉多普勒血流模式异常的患者。为了更好地了解 PDA 对导管前循环的影响,有必要开展进一步研究。
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引用次数: 0
Severe Acquired Hypothyroidism and Van Wyk-Grumbach Syndrome in Two Children. 两名儿童的严重后天性甲状腺功能减退症和范-维克-格伦巴赫综合征
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-07-09 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8919177
Corina Ramona Nicolescu, Lucie Bazus, Jean-Louis Stephan

The primary manifestations of chronic hypothyroidism in children include growth arrest, delayed skeletal maturity, and delayed puberty. In 1960, Van Wyk and Grumbach reported three girls with hypothyroidism and a combination of incomplete isosexual precocious puberty (early breast development, menstruation, and absence of pubic hair), galactorrhea, delayed bone age, and pituitary enlargement. All abnormalities regressed after appropriate thyroid hormone replacement therapy. Over the years, an increasing number of reported cases has allowed for a more precise understanding of the clinical, biochemical, and radiological phenotypes of the Van Wyk-Grumbach syndrome (VWGS). These varying clinical manifestations are thought to result from a unique pathophysiological process where the thyroid-stimulating hormone (TSH) is a key element. We describe the cases of two patients (a boy and a girl) with severe autoimmune thyroiditis and VWGS. The clinical, biochemical, and radiological imaging characteristics were similar in both patients and included growth failure, absence of clinical goiter, markedly elevated TSH concentrations >100 mIU/L, undetectable free thyroxine levels, "normal" thyroglobulin levels, high follicle-stimulating hormone (FSH) and prolactin levels, prepubertal levels of luteinizing hormone (LH), delayed bone age, and hyperplasia of the pituitary gland. The two patients displayed differences, especially in the absence of clinical pubertal development, moderate anemia, abnormal renal function, and moderate goiter detected via ultrasonography (in the female patient). Thyroxine replacement therapy reversed the VWGS phenotype and hypothyroidism, with satisfactory growth velocity, strictly normal thyroid function, and normal pituitary size detected via magnetic resonance imaging at the 6-month follow-up visit.

儿童慢性甲状腺功能减退症的主要表现包括生长停滞、骨骼成熟延迟和青春期延迟。1960年,Van Wyk和Grumbach报道了三名患有甲状腺功能减退症的女孩,她们同时患有不完全异性性早熟(乳房发育早、月经初潮、无阴毛)、半乳糖性闭经、骨龄延迟和垂体增大。在接受适当的甲状腺激素替代治疗后,所有异常情况都得到了缓解。多年来,越来越多的病例报道让人们对范-维克-格伦巴赫综合征(VWGS)的临床、生化和放射学表型有了更准确的认识。这些不同的临床表现被认为是独特的病理生理过程所致,而促甲状腺激素(TSH)是其中的关键因素。我们描述了两名患有严重自身免疫性甲状腺炎和 VWGS 的患者(一男一女)的病例。这两名患者的临床、生化和放射影像学特征相似,包括生长发育障碍、无临床甲状腺肿、促甲状腺激素(TSH)浓度明显升高(>100 mIU/L)、检测不到游离甲状腺素水平、甲状腺球蛋白水平 "正常"、促卵泡激素(FSH)和催乳素水平高、青春期前黄体生成素(LH)水平高、骨龄延迟和垂体增生。两名患者表现出差异,尤其是女性患者没有临床青春期发育、中度贫血、肾功能异常以及通过超声波检查发现的中度甲状腺肿。甲状腺素替代疗法逆转了 VWGS 表型和甲状腺功能减退症,患者的生长速度令人满意,甲状腺功能严格正常,6 个月随访时通过磁共振成像检测到垂体大小正常。
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引用次数: 0
Cardiac Myxoid Spindle Cell Tumor in a Neonate. 新生儿心脏肌样纺锤细胞瘤
IF 0.7 Q4 PEDIATRICS Pub Date : 2024-06-26 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8630268
Reza Abbaszadeh, Fatemeh Naderi, Amir Hossein Jalali, Yaser Toloueitabar

Introduction: Different subtypes of cardiac tumors containing spindle cells have been described as cardiac sarcoma. However, benign types have not been reported so far. We described a neonate with progressive respiratory distress who had a PDA and was finally diagnosed with a right atrial spindle cell tumor. Case Presentation: The patient was a neonate referred with respiratory distress and sepsis. The initial echocardiography demonstrated a small atrial septal defect, patent ductus arteriosus, and a heterogeneous rounded right atrial mass lesion. Pathologic examination confirmed the right atrial myxoid spindle cell tumor without local invasion. Successful mass resection was performed, and follow-up echocardiography revealed normal cardiac structure and function. Conclusion: In infants with manifestations of possible cardiac anomalies, it is necessary to consider other pathologies, such as neoplastic processes. Spindle cell detection in pathology is not ominous all the time, and there are benign subtypes with favorable outcomes after successful surgical resection.

导言:含有纺锤形细胞的不同亚型心脏肿瘤被描述为心脏肉瘤。然而,良性类型至今尚未见报道。我们描述了一名呼吸窘迫的新生儿,他患有 PDA,最后被诊断为右心房纺锤形细胞瘤。病例介绍:患者是一名因呼吸困难和败血症转诊的新生儿。最初的超声心动图检查显示有一个小的房间隔缺损、动脉导管未闭和一个异质性圆形右心房肿块病变。病理检查证实为右心房肌样纺锤细胞瘤,无局部侵犯。手术成功切除了肿块,随访超声心动图显示心脏结构和功能正常。结论对于可能有心脏畸形表现的婴儿,有必要考虑其他病变,如肿瘤过程。在病理中发现纺锤形细胞并非都是不祥之兆,也有良性亚型,手术切除后效果良好。
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引用次数: 0
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Case Reports in Pediatrics
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