infant

摘要： BACKGROUND Symptomatic urachal anomalies are rare disorders.The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life.However,recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management.In this case,we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.CASE SUMMARY Female baby A,weighing 2.88 kg at 38^(+5) wk of gestational age,was referred to the hospital because of a red,swollen umbilicus approximately 2 cm×2 cm in size with yellow purulent exudate.Through physical and ultrasound examination,the baby was finally diagnosed with a urachal anomaly.We first used oxacillin to prevent infection for 3 d.On the 4^(th) day,microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus(MRSA).We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing.After 5 d,the symptoms of the umbilicus disappeared,and we discontinued silver dressing application.On the 12^(th) day,umbilical exudate testing was negative for MRSA.On the 14^(th) day,the baby's blood testing showed a white blood cell count of 14.7×10^(9)/L,neutrophil percentage of 27.8%,and C-reactive protein level of 1.0 mg/L,suggesting that the infection had been controlled.We stopped treatment,and the baby was discharged with no complications.In this case,the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods,which was a different course from that of some other urachal remnant cases.CONCLUSION Anomalies that do not connect with the bladder can be treated with nonoperative management,including application of conservative antibiotics and local intervention with silver-based dressings.Silver sulfate dressings are absolutely safe for neonates with judicious use,and they play an established role in preventing infection without resistance,which is a common problem with other antibiotics and antiseptics.

摘要： Aging is closely related to physiology and disease development in animals.Gut microbiota varies with lifecycle and exerts profound influences on the host.To investigate gut microbial alterations during growth and maturation,41 female cynomolgus monkeys(Macaca fascicularis)ranging in age from 1 month to 15 years were divided into four groups(infant,young,adult,and middle-aged).

摘要： BACKGROUND Congenital tuberculosis(TB),tuberculous meningitis,and situs inversus totalis are rare diseases.We here report a patient who simultaneously suffered from these three rare diseases.There is currently no such report in the literature.Congenital TB is easily misdiagnosed and has a high case fatality rate.Timely anti-TB treatment is required.CASE SUMMARY A 19-day-old male newborn was admitted to hospital due to a fever for 6 h.His blood tests and chest X-rays suggested infection,and he was initially considered to have neonatal pneumonia and sepsis.He did not respond to conventional antiinfective treatment.Finally,Mycobacterium tuberculosis was found in sputum lavage fluid on the 10th day after admission.In addition,the mother's tuberculin skin test was positive,with an induration of 22 mm,and her pelvic computed tomography scan suggested the possibility of tuberculous pelvic inflammatory disease.The child was diagnosed with congenital TB and immediately managed with anti-TB therapy and symptomatic supportive treatment.However,the infant's condition gradually worsened and he developed severe tuberculous pneumonia and tuberculous meningitis,and eventually died of respiratory failure.CONCLUSION If conventional anti-infective treatment is ineffective in neonatal pneumonia,anti-TB treatment should be considered.

摘要： BACKGROUND Visceral leishmaniasis related-hemophagocytic lymphohistiocytosis(VL-HLH)is a hemophagocytic syndrome caused by Leishmania infection.VL-HLH is rare,especially in nonendemic areas where the disease is severe,and mortality rates are high.The key to diagnosing VL-HLH is to find the pathogen;therefore,the Leishmania must be accurately identified for timely clinical treatment.CASE SUMMARY We retrospectively analyzed the clinical data,laboratory examination results,and bone marrow cell morphology of two children with VL-HLH diagnosed via bone marrow cell morphology at Kunming Children’s Hospital of Yunnan,China.Both cases suspected of having malignant tumors at other hospitals and who were unresponsive to treatment were transferred to Kunming Children’s Hospital.They are Han Chinese girls,one was 2 years old and the other one is 9 mo old.They had repeated fevers,pancytopenia,hepatosplenomegaly,hypertriglyceridemia,and hypofibrinogenemia over a long period and met the HLH-2004 criteria.Their HLH genetic test results were negative.Both children underwent chemotherapy as per the HLH-2004 chemotherapy regimen,but it was ineffective and accompanied by serious infections.We found Leishmania amastigotes in their bone marrow via morphological examination of their bone marrow cells,which showed hemophagocytic cells;thus,the children were diagnosed with VL-HLH.After being transferred to a specialty hospital for treatment,the condition was well-controlled.CONCLUSION Morphological examination of bone marrow cells plays an important role in diagnosing VL-HLH.When clinically diagnosing secondary HLH,VL-HLH should be considered in addition to common pathogens,especially in patients for whom HLH-2004 chemotherapy regimens are ineffective.For infants and young children,bone marrow cytology examinations should be performed several times and as early as possible to find the pathogens to reduce potential misdiagnoses.

摘要： Congenital lobar emphysema is characterized by distress due to hyperinflation of the affected lung lobe(s). We report the case of a 2-month-old infant with congenital left lower lobe emphysema. A 2-month-old female infant, born at term without incident, was hospitalized for respiratory distress. On a postnatal day 15, respiratory distress occurred. On admission, he weighed 3400 g and was apyretic. He had a polypnea of 58 cycles/min and a oxygen saturation of hemoglobin of 90% on room air. A chest radiograph revealed hyperclarity of the left lung. Chest CT revealed left lower lobe emphysema. He underwent a left lower lobectomy. The postoperative course was uneventful. He was discharged from the hospital 7 days after surgery without sequelae. Physicians should be aware that congenital lobar emphysema can present with respiratory distress in infants. A chest CT scan confirms the diagnosis. Surgical treatment is effective.

摘要： Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO2) levels are best achieved immediately after starting HFV, avoiding either hypercapnia or hypocapnia. We aimed to determine the initial pCO2 levels after starting HFV, and the time taken to obtain the initial blood gas. Methods: We conducted an observational retrospective study on neonates that required their first episode of HFV. Data included the first blood gas result after starting HFV and when the gas was taken after starting HFV. Results: This study included 112 neonates with a median birth weight of 938 (IQR: 692 - 1549) grams and gestational age of 27.2 (24.6 - 30.7) weeks. The first pCO2 after starting HFV (mean (SD)) was 53.7 (22) mmHg. Of 112, 15 (13.4%) showed initial hypocapnia (pCO2 35 mmHg), and 17 (15.2%) showed hypercapnia (pCO2 > 65 mmHg)—a total of 28.6% unacceptable pCO2 levels. Of 112, the first blood gas was obtained within 30 minutes in 47 (42%) and within one hour in 85 (76%), with a significant delay of two or more hours in eight (7.1%). Conclusion: Many neonates had unacceptable pCO2 levels upon starting first-time HFV. There were significant delays in obtaining the initial gas.

摘要： This work aimed to clarify the interaction between the fetus and pregnant patients with gestational diabetes mellitus(GDM),the lipid metabolomics analysis of the fetal umbilical cord blood of GDM patients and normal pregnant women were performed to screen out the specific lipid metabolites for pathogenesis of GDM.From 2019–2020,21 patients with GDM and 22 normal pregnant women were enrolled in Hexian Memorial Hospital,Panyu District,Guangzhou.The general information such as weight,height,age,body mass index(BMI)before pregnancy were analyzed.Non-targeted metabonomic detection and analysis were performed in umbilical cord plasma using LCMS method.The age,BMI,delivery methods,and infant weight were different between GDM and control.There were 167 lipid metabolites in umbilical cord blood associated with GDM.Among them,158 upregulated and 9 downregulated in GDM.There were 13 dysregulated metabolites with C<30,including Lyso-phosphatidyl-colines LPC 16:0,18:2,18:1,18:0,20:4 and 22:6,glycerophosphocholines PC O-16:1,oleoylcarnitine CAR 18:2 and 18:1,dihexosylceramides Hex2Cer 13:0;2O,phosphatidylethanolamine PE O-22:6_2:0 and PE O-22:6_3:0 and sphingomyelin SM 8:0;2O/11:0.Those metabolites were associated with glycerophospholipid metabolism and sphingolipid metabolism.Therefore,Lyso-phosphatidyl-colines,glycerophosphocholines,oleoylcarnitine,dihexosylceramides,phosphatidylethanolamine,and sphingomyelin were main lipid metabolites of GDM,which might be used for diagnosis and treatment of GDM.

摘要： BACKGROUND Epiglottic cysts is a rare but potentially lethal supraglottic airway pathology in infants due to the high risk of cannot intubation or cannot ventilation.Awake fiberoptic intubation appeared to be the safest technique,but it is very challenging in infants with large epiglottic cysts.Even it has the risk of airway loss.We report that cyst aspiration is an effective treatment as the first-choice procedure for airway management in an infant with large epiglottic cysts.CASE SUMMARY A 46-day-old male infant weighing 2.3 kg presented to the emergency room with difficulty feeding,worsening stridor,and progressive respiratory distress.Epiglottic cysts was diagnosed,but fibro bronchoscopy examination failed,as the fiberoptic bronchoscope was unable to cross the epiglottic cysts to the trachea.The infant was transferred to the operating room for emergency cystectomy under general anesthesia.Spontaneous respiration was maintained during anesthesia induction,and cyst aspiration was performed as the first procedure for airway management under video laryngoscopy considering that the preoperative fibro bronchoscopy examination failed.Then,the endotracheal tube was intubated successfully.Cystectomy was performed uneventfully,and the infant was safely transferred to the intensive care unit after surgery.The infant was extubated smoothly on the third postoperative day and discharged on the eighth day after surgery.On follow-up 1 year after the surgery,a normal airway was found by fibro bronchoscopy examination.CONCLUSION Epiglottic cyst aspiration can be considered the first procedure for airway management in infants with large epiglottic cysts.

摘要： Background and Aim: Ecthyma gangrenosum (EG) is a rare necrotic skin infection caused by Pseudomonas aeruginosa occurring on healthy skin mainly, but not exclusively, in immunocompromised patients. We report the case of EG of unusual presentation in a 12-month-old infant. Case Presentation: This was a 12-month-old male infant who was referred from a peripheral structure for the treatment of facial swelling associated with fever. In his antenatal and intra nasal history, there was a notion of hospitalization for 15 days for early neonatal infection and a delay in psychomotor development. The admission examination showed the fair general condition, hyperthermia at 39°C, tachycardia at 136 beats/minute, and polypnea at 48 cycles/minute. The weight-for-height index with a z-score of 3DS was also found. The dermatological examination at the entrance found an extensive brownish inflammatory tense infiltrated plaque taking the mandibular, submental, retro-auricular occipital regions rapidly evolving towards necrosis, a significant swelling predominant on the upper right eyelid preventing the opening of the associated eyes to mouth ulceration. Biological abnormalities were predominantly neutrophilic leukocytosis, elevated CRP, and elevated muscle enzymes. Microbiological examination of skin samples had isolated Pseudomonas aeruginosa. He had received antibiotic therapy, and a necrosectomy under general anesthesia. The evolution was favorable and he was discharged from the hospital on D26 of hospitalization. Conclusion: This observation is rare due to its location, its early onset, and non-neutropenic background.

摘要： BACKGROUND Fibrous hamartoma of infancy(FHI)is a rare disease of infancy with unknown etiology.The disease mainly involves soft tissue,has no specific clinical manifestations,and is difficult to diagnose.At present,the diagnosis is mainly confirmed by histopathological examination,and the main treatment is surgical resection of the pathological tissue,which is prone to recurrence.CASE SUMMARY A five-month-old female patient was admitted to our hospital with swelling in the right calf.Two biopsies were performed in our hospital and another hospital,respectively,confirming the diagnosis as fibrous hamartoma.After exclusion of surgical contraindications,resection was performed with clear margins of 1 cm.Radiographic examination showed tumor recurrence more than four months after the operation,and surgery was performed again to extend the resection margins to 1.5 cm.The patient is recovering well,and after a follow-up of 36 mo,shows no signs of recurrence.CONCLUSION Our case report demonstrates that FHI should be considered in the differential diagnosis for a lower extremity mass with bone destruction.For FHI with bone destruction and unclear boundaries,excision margins of 1.5 cm could be superior to margins of 1 cm.