Source 丨21 Healthnews21 original work
Author 丨Ji Yuanyuan
Editor 丨 Xu Xu
Picture 丨 Figure Worm
In recent days, the number of newly infected people in Shanghai is still at a high level, and as of April 24, the cumulative number of infected people in this round of the epidemic in Shanghai is nearly 500,000.
The new coronavirus Semi-Kejung subtype variant BA.2, with fast transmission speed and strong invisibility, has a large number of infected people in a short period of time, which can lead to a large number of children being infected is also a feature of the Semikron variant strain. According to Xinmin Weekly, as of 24:00 on April 23, the number of positive infected people under the age of 18 in Shanghai exceeded 30,000, accounting for about 6.5% of the total number of positive infections. Up to now, there have been more than 12,000 cases of child infection in the Pudong area of Shanghai.
In this epidemic prevention and control, in addition to children infected with new crown, infants and children with chronic diseases are also another special group worthy of attention. Under the state of sealing and control, how to ensure their emergency medical treatment and daily medical and medication needs is still the focus of attention of many hospital obstetrics and gynecology and pediatric medical staff, especially how to open up a "life safety channel" for them in "safety prevention and control"...
20 hours after birth, face the test of life and death
Xiao Bao (pseudonym) is a full-term baby boy, born due to "shortness of breath" into the neonatal intensive care unit of the Affiliated Obstetrics and Gynecology Hospital of Fudan University, 20 hours after birth, Xiao Bao, who was originally in a stable condition under oxygen inhalation, suddenly appeared cyanosis and irritability, and his blood oxygen saturation fell all the way.
"Your child may have pneumothorax!" You Xueqin, a doctor on duty, and Zhang Zizhen, a nurse, quickly launched rescue, intubated the trachea, pressurized oxygen, and connected to a ventilator, which built a "life channel" for Xiaobao. Dr. Chen Yun immediately confirmed the diagnosis of "pneumothorax" with bedside ultrasound. It is understood that children with pneumothorax often have sudden increased breathing difficulties, and their condition is dangerous and can be life-threatening when severe.
However, the child develops cyanosis again under mechanical endotracheal intubation and oxygen saturation continues to decline.
"I am in a critical condition and need urgent chest closure drainage!" Contact bedside camera! With a solid professional foundation and rich clinical experience, Dr. Wang Huijuan quickly completed the left chest puncture and indwelled water sealing bottle through precise positioning through bedside ultrasound. As the gas in the left chest cavity was continuously pumped out, Xiao Bao's blood oxygen saturation rose to more than 90%, and his face returned to rosy.
Looking at Xiaobao, who was quietly sleeping, the neonatal medical team did not let down their vigilance, and they closely monitored the child's vital signs. During the monitoring process, the child suddenly re-developed symptoms of decreased blood oxygen, cyanosis, and restlessness.
"Adjust ventilator parameters to maintain blood oxygen stability!" In the race against life, every second of treatment time is extremely important to the child.
Soon, the chest x-ray was reported! Originally, after the chest puncture, Xiao Bao's left pneumothorax was significantly improved, but the right lung was compressed by about 50%! "The child is spontaneously bilateral pneumothorax!" Dr. Zhuang Xiaolei immediately made a chest puncture on Xiao Bao's right side, and soon the blood oxygen began to rise, and the breathing gradually improved.
It is well known that neonatal treatment is more difficult than that of adults. Timely intervention is essential to save the child's life. Especially for a rare case of bilateral spontaneous pneumothorax in newborns like Xiaobao, any one link that goes wrong can be life-threatening.
When the child's condition suddenly changed suddenly, the Red House neonatal team screened and performed chest puncture drainage for the first time, which won a valuable "first stick" for timely treatment.
Image source: Courtesy of the interviewee
"The child's unexplained spontaneous bilateral pneumothorax needs to relieve the child's pain, reduce crying, and prevent further exacerbation of the pneumothorax. At the same time, invite pediatric surgeons to assist in diagnosis and treatment, and when the vital signs are stable, they will be referred to a pediatric specialist hospital! ”
Urgently dispense drugs, check infusions, improve examinations, write treatment records, communicate with patients' families, contact consultation and referral... They started racing for time and speed!
After learning of the condition, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine immediately arranged for a professional team to arrive at the scene, and the 120 Center urgently deployed an emergency transport vehicle, and soon Xiaobao was safely transferred to the intensive care unit of Xinhua Hospital.
Recently, the hospital has sent good news: Xiaobao has successfully extubated and withdrawn, his vital signs are stable, and his recovery is good!
Love relay, so that the treatment of children with hemodialysis does not fall once
In the special epidemic period, in the face of critical newborns, although all medical staff are not in the same hospital and not in the same battlefield, everyone's goal is the same, that is, to work together to win valuable time for children!
It is reported that since the outbreak of the epidemic, most medical workers have been stationed in the hospital for many consecutive days to build a solid safety barrier for the lives of newborns. Since the end of March, nearly 700 newborns have arrived safely. While the Red House Hospital is busy saving new lives, the medical staff of the Children's Hospital affiliated to Fudan University (National Children's Medical Center) also guard the "lifeline" of children with chronic diseases.
"Dr. Zhang, Dr. Zhang, I have done a good job of hemodialysis, and my weight is now 26.6 kilograms." Rui Rui (pseudonym), a 14-year-old boy with uremia, loudly reported his weight on WeChat to Zhang Zhiqing, attending physician of the Nephrology Blood Purification Center of the Children's Hospital of Fudan University. He originally had to go to the hospital three or four times a week for hemodialysis, and he was as lucky as other children with hemodialysis, and did not leave a dialysis because of the closure of the epidemic.
In mid-to-late March, according to the requirements of epidemic prevention and control, the inpatient building of the Children's Hospital Affiliated to Fudan University was temporarily closed. What about the blood purification centers that receive children with chronic hemodialysis every day for treatment in the inpatient building, who live in Minhang, Jing'an, Jinshan, Putuo and Pudong? If they cannot dialysis on time, they can always be life-threatening due to excessive fluid load, hyperkalemia, toxin accumulation, etc.
Hemodialysis is their "lifeline"! Xu Hong, secretary of the Party Committee of the Children's Hospital affiliated to Fudan University, instructed Shen Qian, director of the Department of Nephrology, to say: "We are the dialysis center designated by these children, and we have the responsibility to arrange where they continue to be treated!" A relay of love for children with hemodialysis was quickly launched.
Because the children's hemodialysis equipment is different from that of adults, Shen Qian has urgently contacted a number of hospitals to receive hemodialysis children to go to treatment. Rui Rui was coordinated to go to Shanghai Children's Hospital for hemodialysis, and on March 24, when Rui Rui was preparing to go to hemodialysis, the community where he lived suddenly encountered a blockade and could not go on time. What to do? Rui Rui's father urgently asked the department for help. Considering that Rui Rui's family lives in Pudong, the department urgently contacted Renji Hospital for coordination, and after many efforts, on March 25, Rui Rui finally received hemodialysis at Renji Hospital.
At noon on the 25th, Rui Rui's father sent a WeChat message to Zhang Zhiqing to express his gratitude: "Dr. Zhang, through your efforts, the child has been bloody, and he is very grateful in his heart, and thank you for your concern and help to Rui Rui in the past few days." ”
Image source: Courtesy of the interviewee
Prior to kidney transplantation, home peritoneal dialysis and hemodialysis are currently the two main renal replacement treatments for uremia in children. About 90% of the children with uremia dialysis followed up by the Department of Nephrology of the Children's Hospital of Fudan University underwent home automatic peritoneal dialysis. "10% of children choose hemodialysis treatment due to illness or social factors, and we must ensure that all children with hemodialysis receive treatment on time." Shen Qian introduced that in order to reduce the unpredictable factors caused by the epidemic as much as possible and ensure that the treatment of children with hemodialysis is not interrupted, after the inpatient building is unsealed, all children with hemodialysis are admitted to the hospital in turn for management, so that "no one can be less"!
On 27 March, Rui Rui returned to the pediatric hospital and was hospitalized like other children with hemodialysis. They never expected that it was this decisive decision of the treatment team of the pediatric hospital that made their treatment during the epidemic closure period avoid all kinds of rushing difficulties, and hemodialysis did not fall once!
During special periods, their chronic disease management goes beyond treatment itself
What about children with uremia and other children with chronic kidney disease except for children with hemodialysis?
Chronic kidney disease is the silent "killer". Chronic kidney disease mortality has increased by 41.5% since 1990, with chronic kidney disease becoming the 12th leading cause of death worldwide in 2017 and expected to be the 5th leading cause of death in 2040. Currently, there are about 850 million people with chronic kidney disease worldwide, and about 1 in 10 adults have chronic kidney disease. The incidence of uremia in the pediatric population is about 3-15.5 cases /million, and shows an upward trend year by year, according to the mainland population, about 2000-3000 cases of new uremia per year.
It is understood that during the epidemic period, the treatment team of the Department of Nephrology of the Children's Hospital Affiliated to Fudan University carried out one-person, one-policy and full-time management through various channels according to the different conditions of children with chronic diseases.
In the Internet Hospital of Pediatric Hospital, the WeChat group of peritoneal dialysis patients in pediatric hospitals and the WeChat group of kidney transplant patients, and the intelligent consultation platform of Fudan Pediatric Nephrology Public Account, the management team of children with chronic kidney disease will arrange personnel shifts to provide guidance for the questions of parents of children, and provide professional guidance programs online for children who are in other provinces and cities but need regular follow-up consultations. For children in Shanghai who need regular follow-up visits, the treatment team provides offline specialist outpatient treatment for proper care according to the child's situation. In addition, the nephrology department's 24-hour duty telephone provides emergency counseling and guidance to parents of children all over the country at any time.
There are also several special stranded children in the nephrology ward of the pediatric hospital. Since March, three children with uremia and one child with acute kidney injury in Xinjiang have been stranded in hospitals due to epidemic prevention and control and flight suspensions. In addition to ensuring treatment, the special dietary needs of the children's families have also been met, the hospital on the one hand communicates with the canteen to ensure that sufficient eggs and staple foods are provided every day, on the other hand, it distributes the collected instant noodle cakes and fruits, etc. In addition, when the medical staff of the department change their guards, they have brought vegetables, fruits, milk and other materials from home to these children's families.
During the epidemic period, pediatric hospitals have adopted the "resident model" and "grid management", making every effort to ensure that medical treatment does not fall off the line, and to create a life channel to protect children with chronic diseases.