| Objective: To investigate the etiology,clinical characteristics,influencing factors of complications and short-term prognosis of vomiting in 696 hospitalized children who aren't diagnosed by routine screening.Methods: Choose children hospitalized in the Children's Hospital of Chongqing Medical University from 1 July 2015 to 30 June 2018.Their chief complaint is vomiting,and they aren't diagnosed by routine screening,which included blood routines,stool routines,urine routines,liver and kidney function tests,electrolyte,blood glucose and imaging examinations(chest X-ray,abdominal X-ray and/or abdominal ultrasound).Undiagnosed cases on discharge are excluded.Retrospective analysis of general information and etiology of confirmed cases.And group by etiology,main cause groups have 20 children at least.Analyze each group's clinical manifestations,complications,time of diagnosis,length of stay and condition on discharge.Group by age,there are neonate group,infant group,toddler group,preschool group,school-age group and adolescent group,then analyze their etiology distribution,complications and condition on discharge.Group by course,there are “more than 2 weeks” group and “no more than 2 weeks” group,then analyze their etiology distribution,vomiting frequency,vomitus,complications and condition on discharge.Analyze the influencing factors of complications and short-term prognosis of 696 diagnosed cases.SPSS 22.0 statistical software is used for statistical processing.Results: 1.1489 cases are included at first,793 cases are excluded,and eventually 696 cases are confirmed.There are 441/696 males and 255/696 females.There are 57 single causes of vomiting in 623/696 cases,which is dominated by digestive system diseases(578/623 cases),and non-infectious diseases(530/623)have more cases than infectious diseases(93/623).There are 73/696 cases who have at least 2 kinds of causes,and the causes include 16 main causes and 20 complicated causes,which are compose with digestive system diseases mainly.2.There are 9 main cause groups,who are gastroesophageal reflux(GER)group(91/696 cases),congenital intestinal malrotation group(85/696 cases),congenital intestinal atresia/stenosis group(64/696 cases),congenital hypertrophic pyloric stenosis group(41/696 cases),acute gastritis group(38/696 cases),Hirschsprung's disease group(30/696 cases),cyclic vomiting syndrome(CVS)group(29/696 cases),necrotizing enterocolitis group(24/696 cases)and annular pancreas group(23/696 cases).There are significant differences among groups in age,course,frequency of vomiting,time of diagnosis,length of stay and the incidence rate of vomiting food,vomiting blood,vomiting bile,abdominal distension,stomachache,diarrhea,bloody stool or melena,meconium delay,headache or dizzy,respiratory tract infection complication,electrolyte disturbance complication,dehydration complication and poor short-term prognosis(P<0.05).And there is no significant difference in the incidence rate of acid-base disturbance(P>0.05).CVS has the oldest age(108 months),longest course(750 days),maximum vomiting frequency(15 times each day)and the highest incidence rate of vomiting blood,stomachache and headache(37.93%,62.07%,31.03%).Hirschsprung's disease has the longest time of diagnosis(12 days)and length of stay(operation: 32.5 days.Non-operation: 13 days),also the highest incidence rate of abdominal distension,meconium delay and poor short-term prognosis(86.67%,30.00%,23.33%).Congenital intestinal malrotation has the highest incidence rate of vomiting bile(77.65%).Acute gastritis has the highest incidence rate of diarrhea(15.79%).Necrotizing enterocolitis has the highest incidence rate of bloody stool or melena(8.82%).GER has the highest incidence rate of respiratory tract infection complication(92.3%).Congenital intestinal atresia/stenosis has the highest incidence rate of electrolyte disturbance complication(43.75%).Annular pancreas has the highest incidence rate of dehydration complication(17.39%).3.There are 399/696 neonates,126/696 non-neonatal infants,67/696 toddlers,33/696 preschool children,57/696 school-age children and 14/696 adolescents.The causes of the top three in different age groups are different.And there are no significant differences in the incidence rate of comorbidities and poor short-term prognosis among different age groups(P>0.05).There is significant difference in the incidence rate of complications among different age groups(P<0.05).The neonate group has the highest incidence rate of complications(94.72%),followed by the infant group(81.89%),and the school-age group has the lowest incidence rate of complications(52.63%).The neonate group is most likely to be complicated with respiratory tract infection,electrolyte disturbance and acid-base balance disorder,while infant group and toddler group are most likely to be complicated with dehydration.4.“no more than 2 weeks” group has 513/696 cases,which have 449/513 cases with single cause and 64/513 cases with comorbidities.“more than 2 weeks” group has 183/696 cases,which have 174/183 cases with single cause and 9/183 cases with comorbidities.Compared with “more than 2 weeks” group,“no more than 2 weeks” group have the higher incidence rate of comorbidity,vomiting bile,vomiting stool and complication(12.48% vs 4.92%,46.98% vs 34.43%,4.29% vs 1.09% and 89.67% vs 73.77%),and the lower incidence rate of vomiting food(90.25% vs 99.45%).All the differences are statistically significant(P<0.05).And there are no significant differences in vomiting frequency and the incidence rate of vomiting blood and poor short-term prognosis between different course groups(P>0.05).5.Age at neonatal is a risk factor for respiratory infection complication(P<0.05),and gender,course,frequency of vomiting,preterm birth,low birth weight and GER are not significant influencing factors of respiratory infection complication(P>0.05).Age at school age is a protective factor for electrolyte disturbance complication(P<0.05),digestive system malformation is a risk factor for electrolyte disturbance complication(P<0.05),and gender,course,frequency of vomiting,preterm birth and low birth weight are not significant influencing factors of electrolyte disturbance complication(P>0.05).Digestive system malformation,age at infancy and toddler stage are risk factors for dehydration complication(P<0.05).The risk of dehydration increases by 15.3% for 1time/d increase in vomiting frequency(P=0.001).Gender,course,preterm birth and low birth weight are not significant influencing factors of dehydration complication(P>0.05).Age at neonatal is a risk factor for acid-base disturbance complication(P<0.05),and gender,course,frequency of vomiting,preterm birth,low birth weight and digestive system malformation are not significant influencing factors of acid-base disturbance complication(P>0.05).The course which is more than 2 weeks is a protective factor for severe complications(P<0.05),digestive system malformation and NEC are risk factors for severe complications(P<0.05),and gender,age,frequency of vomiting,preterm birth and low birth weight are not significant influencing factors of severe complications(P>0.05).Digestive system malformation and severe complications are risk factors for poor short-term prognosis(P<0.05),and gender,age,course,preterm birth,low birth weight and are comorbidities not significant influencing factors of short-term prognosis(P>0.05).Conclusion: The etiology of vomiting in children is various and complex.The main etiologies of vomiting not diagnosed by routine screening are digestive system diseases.The clinical manifestations,complications,time of diagnosis,length of stay and short-term prognosis of different causes are different.Common causes vary by age groups,neonates are most likely to be suffer from vomiting and complications,especially the respiratory infections,electrolyte and acid-base disturbance complications.Vomiting with no more than 2 weeks course in children are more likely to meet the situations include vomiting bile,vomiting stool,occurring comorbidities and complications.Age is an influencing factor for respiratory infections,dehydration,electrolyte and acid-base disturbance complications.Vomiting frequency is an influencing factor for dehydration complication.Course and NEC are influencing factors for severe complications.Digestive system malformation is an influencing factor for dehydration,electrolyte disturbance and severe complications.Digestive system malformation and severe complications are influencing factors for poor short-term prognosis. |
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