Reporter Wang Xiaomeng.
Influenza A, influenza B, adenovirus, respiratory syncytial virus, ......This winter's co-infection is very obvious, resulting in more cases of severe pneumonia, acute respiratory distress syndrome, acute necrotizing encephalopathy and other critical cases than in previous years. Jin Youpeng, director and chief physician of the Department of Pediatric Intensive Care Medicine of the Provincial Hospital Affiliated to Shandong First Medical University, said that the struggle with infection and severe disease is still ongoing.
In the pediatric intensive care unit of Shandong Provincial Hospital, medical staff are busy and busy.
Attack: A 5-year-old child was infected with 8 pathogens.
You see his lungs, there is a large area of white, which is commonly known as white lung. Jin Youpeng pointed to Xiao Yi's (pseudonym) lung CT image while explaining that the lung imaging of normal people should be black, and when severe pneumonia, there is a lot of lung inflammation and exudation, and even leads to large-scale consolidation of the lungs, which will appear as "white lung" on the image, which often means that the condition is very serious.
Xiao Yi (pseudonym), 5 years old and 2 months old, suddenly had a fever 1 month ago, and his body temperature reached 39 at the peak5. Fever four or five times a day, and occasional headache.
Cough, phlegm that can't come out, especially in the morning. Seeing that the child's spirit was getting worse and worse, and the symptoms were not relieved after four days of antibiotics in the local clinic, Xiao Yi's parents hurriedly took him to the local hospital, did a lung CT examination, and found obvious inflammation in both lungs, and was diagnosed with severe pneumonia.
Since he was sick for a month, Xiao Yi has lost 7 pounds and has become thinner. On January 25, Xiao Yi, who was on a ventilator, was transferred from Jining to the pediatric intensive care unit of Shandong Provincial Hospital.
After that, we performed a broad-spectrum pathogenic genetic test on the child's sputum, and the test results surprised everyone, and 8 pathogens were detected in the child's sputum, including Streptococcus pneumoniae, Staphylococcus aureus, Proteus mirabilis, adenovirus, classical coronavirus, Mycoplasma pneumoniae, MECA and cytomegalovirus. Jin Youpeng said that although not all of them are pathogenic bacteria, it is certain that there will be mixed infections, which will cause such severe pneumonia. And a variety of pathogen infections also make ** very tricky.
Immunity Challenge:
mixed infection, severe disease".
Positive for influenza B, severe pneumonia, sepsis" ......These keywords on the case of 1-year-old and 5-month-old Xiao Qi (pseudonym) mean that he also has a tough battle to fight.
Xiao Qi had a fever patch on his head, and the tracheal intubation propped up his small mouth wide, and he kept lying prone on the bed in order to improve ventilation. Underneath the quilt is his tiny body, which fluctuates slightly with the rhythm of his breathing. **Put the phlegm collector on his back, perhaps feeling the vibration of the expectorator, his little feet kicked around, ** while evacuating phlegm while gently patting to soothe.
The child was transferred from Jining and was infected with influenza B virus, which led to severe pneumonia and acute respiratory distress syndrome. Jin Youpeng introduced that when the child first came, he was given 100% pure oxygen, and the oxygen saturation could barely reach 780%, and the parents were once very worried about whether they were going to ECMO (artificial membrane lung).
After blood purification, human immunoglobulin, active anti-infection and prone position, etc....After a week, Xiaoqi's breathlessness began to improve. "Now the ventilator parameters are also decreasing, adjusting to 70% oxygen, and the oxygen saturation can reach more than 95%."
Jin Youpeng introduced that his department has 20 beds, and there are 178 children who have been admitted to the intensive care unit due to severe pneumonia recently.
Viral infections open a gap in the body's immune system, and then thousands of bacteria and fungi will follow.
Most of the critically ill children admitted to our department have a significant decrease in cellular immunity. In this state of immune collapse, other pathogens are particularly susceptible to taking advantage of the weakness. Jin Youpeng said that this year's mixed infections are usually viruses plus bacteria and fungi, and the proportion of mixed infections is as high as 10 percent, much higher than in previous years.
The fight that can't be stopped".
Since the National Day holiday, it has entered a period of high incidence of respiratory diseases, and several waves of virus infections have occurred one after another. Dr. Xin Xiaowei of the Pediatric Intensive Care Department of Shandong Provincial Hospital said that in previous years, the infection could be alleviated after snowfall, but this year there is no sign of abating.
The 20-bed pediatric intensive care unit at Shandong Provincial Hospital has been full since the winter, sometimes with extra beds. In the winter of 2023, pediatrics is tightly tied to one word, and that is "exceptionally busy".
Monitoring data shows that after peaking in early December 2023, respiratory diseases in China have declined for two consecutive weeks, and there was a slight rebound at the end of December, which continued to fluctuate at a high level. At present, influenza is the main acute respiratory illness. Among them, the proportion of influenza B has increased recently.
Dr. Pan Guimei, from the Department of Pediatric Intensive Care Medicine at Qingdao Women's and Children's Hospital, said that children with underlying medical conditions are more likely to be infected with the virus and cause severe disease, such as premature babies or children with epilepsy and muscle weakness.
Jin Youpeng found that in the past two weeks, there has been an increase in the number of patients with B-related acute necrotizing encephalopathy compared with previous years. "Acute necrotizing encephalopathy often has a very acute onset, and some children will fall into a coma after a day of fever, which is one of the worst complications of infection, severely affecting the nervous system, and doctors often do not have time to react."
Experts especially remind that for children with "colds", we must pay attention to observe the child's mental state, "as long as the child is alive and jumping, even if the fever is not too worried, once the headache or malaise, then you need to be alert to whether the virus has attacked the nervous system, and you need to go to the hospital in time." Jin Youpeng said that once acute necrotizing encephalopathy occurs, the mortality rate will be very high, and the prognosis is also very poor, reminding parents to pay great attention to it.
The violent boy who had been on ECMO was withdrawn.
Fulminant myocarditis, commonly known as "violent heart" by doctors, can occur at any age, mainly caused by viral infection, with a rapid onset and extremely rapid progression, which can rapidly progress to severe heart failure and cardiogenic shock within a short time after the onset of the disease, and the case fatality rate can be as high as 80%.
A 3-year-old boy, Lele (pseudonym), suddenly cried while playing with his brother at home, and when his father went over to coax him, the child suddenly turned blue and couldn't be called out, so he was rushed to the hospital. The doctor carried out an emergency rescue of the child, and improved the relevant examinations while rescuing, and found that the electrocardiogram and cardiac enzymes were abnormal, and the initial consideration was fulminant myocarditis. After nearly 4 hours of rescue, I finally got on ECMO.
It is understood that the child had a cold half a month before the onset of the disease, and the minorant myocarditis is mostly caused by viral infection, so it is highly suspected that the cause of the child's "violent heart" is related to the virus ** outbreak.
When the child was first transferred, the cardiac ejection fraction was only 13%, which should be 60%-70% under normal circumstances, indicating that the heart was basically not working, and after ECMO**, the heart function was slowly recovering, and it recovered to 20% the next day, and then 35%. Pan Guimei said that the medical staff accompanied the child through one difficulty after another.
Most of this disease will be combined with pneumonia, on the one hand, ** pneumonia, slowly able to breathe on its own, and if the pneumonia improves, you can withdraw the ventilator. In addition, there will be many complications after ECMO, such as gastrointestinal bleeding, to slowly stop bleeding, protect the gastric mucosa, if you can't eat independently, we need intravenous nutrition or lower nasojejunal tube, give enteral nutrition, etc. On February 1, the reporter learned that after positive **, the child has been successfully removed from ECMO, blood purification and ventilator have also been withdrawn, and his vital signs have been stabilized.
Now that the child can open his eyes, the plasticity of the child is relatively strong, and there is still hope. Pan Guimei expects that influenza activity will show a downward trend as the number of holiday gatherings in various places decreases.
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