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06 February 2022, Volume 37 Issue 2 Previous Issue    Next Issue

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Protocol for the development of guideline for the management of foreign bodies in the digestive tract of children in China（patients and public version，2022） LIU Hui, WANG Hua, LIU Yun-lan, et al 2022, 37(2): 81-87.  DOI: 10.19538/j.ek2022020601 Abstract ( )   To further enhance patient and publics awareness of foreign bodies in the digestive tract of children and to increase information sharing and communication between doctors and patients，Alliance of Patients and Public Guidelines，Pediatric Collaborative Group of Chinese Society of Digestive Endoscopology，Pediatric Digestive Endoscopy Committee of Chinese Endoscopist Association，National Childrens Regional Medical Center （Northwest） and the Affiliated Childrens Hospital of Xi’an Jiaotong University have taken the lead in initiating the development of Guideline for the Management of foreign bodies in the digestive tract of children in China （patients and public version，2022）.This article describes in detail the establishment of guideline development working group，the collection and selection of clinical questions，the evidence retrieval and screening，the formation of recommendations，the external review of the guideline，the publication of the guideline，and the dissemination and implementation of the guideline.The aim is to provide clear ideas and technical guidance for the development of this patients and public guideline，improve the transparency of its development，and provide reference for the development of other patients and public guidelines.

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Paying attention to severe pneumonia & viewing on the development of integrating pediatric pulmonary and critical care medicine FU Hong-min, LU Quan 2022, 37(2): 88-91.  DOI: 10.19538/j.ek2022020602 Abstract ( )   Severe pneumonia is still a main cause of death in children.Playing attention to and better managing severe pneumonia will help reduce fatality of children with pneumonia，realize Childrens Development Program in China（2021-2030），and achieve the goal of “Ending Preventable Child Deaths from Pneumonia by 2025” proposed by World Health Organization.For this reason，some problems in severe pneumonia of children should be paid attention to，such as over-diagnosis of severe pneumonia in practice，establishment of the illness assessing systems of pneumonia and its clinical application，fostering the use of relevant indicators to evaluate pulmonary oxygenation function，and mastering different respiratory support technologies.At the moment，the adult respiratory department at home and abroad has been renamed as the Department of Pulmonary and Critical Care Medicine（PCCM），developing the integrated model of respiratory and critical care medicine.The consensus should be gained on whether the pediatric PCCM should be developed，whether it is feasible and what its prospect is，in order to facilitate its development in practice.

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Research and application progress in inflammatory biomarkers of severe pneumonia in children ZOU Ying-xue, ZHANG Xu-ran 2022, 37(2): 92-96.  DOI: 10.19538/j.ek2022020603 Abstract ( )   Community-acquired pneumonia （CAP） is the main cause of death in children.It is very important to explore the application value of biomarkers commonly used in clinic to evaluate the severity of pneumonia and to assist clinical decision-making.Understanding the role of common biomarkers in the diagnosis and treatment of severe pneumonia in children and the application prospect of new biomarkers can help clinicians understand the evaluation indexes of severe pneumonia in children other than microbiology Price index.It is known that CRP，IL-6 and PCT in biomarkers have certain value in predicting the severity of CAP in children，but the change of single index is not enough to accurately predict the severity of CAP.They should be applied in combination in clinic，and CAP should be comprehensively evaluated based on clinical manifestations.

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Application progress of molecular biological detection technology for pathogen of pneumonia in children LI Feng, FU Hong-min 2022, 37(2): 96-99.  DOI: 10.19538/j.ek2022020604 Abstract ( )   Pneumonia is a common respiratory infectious disease and an important cause of death in children.Choosing efficient and accurate detection method to rapidly identify the pathogen is pivotal in diagnosis and treatment of pneumonia.In recent years，molecular biology technology has achieved rapid development，and many new technologies have been gradually applied in clinical practice，such as real-time fluorescent quantitative PCR，biochips，next-generation sequencing，nucleic acid isothermal amplification technology，etc.，which greatly improves the detection efficiency of pneumonia pathogens.This article briefly introduces the advantages and disadvantages of the above technologies.

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Individualized antiinfectious therapeutic strategies of vancomycin in children with community-acquired methicillin-resistant Staphylococcus aureus pneumonia YU Fei-fei, LUO Zheng-xiu 2022, 37(2): 99-103.  DOI: 10.19538/j.ek2022020605 Abstract ( )   Reports have shown that there has been increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus（CA-MRSA） pneumonia. The factors such as CA-MRSA strain gene mutation，MIC drift，and antimicrobial resistance have increased the challenge for pediatricians in empirical treatment of CA-MRSA infections.Vancomycin is the first-line antibiotic for MRSA infection，which has the characteristics of narrow therapeutic window and nephrotoxicity.Based on individualized pharmacokinetics and pharmacodynamics （PK/PD） and therapeutic drug concentration monitoring （TDM），and under different pathophysiological state of the children，individualized treatment with vancomycin for the patients with CA-MRSA pneumonia can increase the safety and effectiveness，and reduce the prodution of drug-resistant bacteria.

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Clinical manifestations of severe community-acquired pneumonia caused by different pathogenic infections YIN Bing-ru, DONG Xiao-yan 2022, 37(2): 104-110.  DOI: 10.19538/j.ek2022020606 Abstract ( )   Pneumonia is the leading cause of death in children under 5 years of age.The majority of pneumonia in children is community-acquired pneumonia（CAP）.Severe pneumonia in CAP is an important cause of death and affecting life quality in children.Domestic guidelines and norms all propose to assess the severity of childrens CAP based on age，clinical manifestations and images.We can turn empirical treatment into target treatment as soon as possible，when the pathogens are confirmed.Then the prognosis of the patients can be improved.This article will explain the clinical manifestations of severe pneumonia in children with different pathogens from the perspective of etiology，in order to deepen our understanding of severe pneumonia in children，so that early detection and treatment can be achieved，and the incidence and mortality of CAP in children can be reduced.

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Deficiency of noninvasive ventilation and timing of endotracheal intubation in children FU Yue-qiang, XU Feng 2022, 37(2): 110-113.  DOI: 10.19538/j.ek2022020607 Abstract ( )   In recent years，noninvasive ventilation has developed rapidly in the field of respiratory support in children.Noninvasive ventilation does not need endotracheal intubation.It is easy to operate and has satisfactory curative effect on some serious respiratory diseases.However，noninvasive ventilation cannot replace invasive ventilation completely. In some cases，noninvasive ventilation has a high failure rate，and the delay of endotracheal intubation can lead to the deterioration of the disease and increase the mortality of children.Pediatricians need to evaluate whether the patient is suitable for NIV treatment.For children treated with NIV，close monitoring is needed to observe the changes in physiological indexes and monitoring data，and the timing of endotracheal intubation must be suitable，so as to avoid the delay of IMV treatment.

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Promoting application of scoring system in pediatric severe pneumonia SONG Wen-liang, XU Wei 2022, 37(2): 113-118.  DOI: 10.19538/j.ek2022020608 Abstract ( )   Pneumonia is the leading cause of death in children under five worldwide.Early diagnosis and accurate assessment of severe pneumonia in children are very important for treatment and prognosis.At present，the diagnostic criteria for severe pneumonia in children are not completely consistent，so it is necessary to use a scoring system or scale to evaluate the severity of pneumonia，so as to guide clinical treatment and evaluate the prognosis.Up to now，the modified PIRO scale is the most widely used and may be suitable for children with severe pneumonia.

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Significance and clinical application of metabolism-related indexes indicating oxygen supply/hypoxia YE Bei, ZHANG Yuan-yuan, FU Hong-min 2022, 37(2): 118-120.  DOI: 10.19538/j.ek2022020609 Abstract ( )   Oxygen is an important substance necessary to sustain life activities.Many diseases would cause imbalance in oxygen supply and demand，thereby leading to tissue and organ damage.It is very important for clinicians to use those indexs reflecting oxygen supply/hypoxia to judge whether the body has hypoxia and its degree in the early stage of illness，which will be beneficial to directing treatment and improving outcome.This paper introduces the indicators related to oxygen supply，lung oxygenation function and tissue oxygen metabolism.

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Role of flexible bronchoscope in the diagnosis and treatment of severe pneumonia in children WANG Jin-hua, YANG Jia-wu, AI Tao 2022, 37(2): 121-123.  DOI: 10.19538/j.ek2022020610 Abstract ( )   Severe pneumonia has an increasing trend in clinic.It is often difficult to obtain satisfactory curative effect only by routine medical treatment.Flexible bronchoscope （FB） technology has developed rapidly in pediatrics in recent years.FB can show the morphological characteristics of bronchus and obtain deep lung secretions or tissue samples for pathogenic detection，which plays an important role in the pathogenic and etiological diagnosis of severe pneumonia.FB can also clear the airway by means of lavage，clamp operation，freezing，local administration and so on，which plays an important promoting role in controling infection，shortening the course of disease and preventing recurrence.

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Application of holistic integrative medicine in treatment of severe pneumonia in children WEN Shun-hang, ZHANG Hai-lin 2022, 37(2): 123-126.  DOI: 10.19538/j.ek2022020611 Abstract ( )   The comprehensive treatment is applicated for severe pneumonia in children，and the treatment of severe pneumonia in children needs the concept of holistic integrative medicine and dialectical thinking.To assess the severity of pneumonia，the respiration，circulation，brain function and homeostasis should be evaluated firstly.Based the clinical features and laboratory indicators for predicting the pathogens，which may mean more targeted treatments.Attention should be paid to the improvement of ventilation and hypoxia，the maintenance of water-electrolyte balance，the reassessment after treatment and the rational application of traditional Chinese medicine.

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Severe pneumonia and pulmonary infraction LI Shu, CHEN Li-na 2022, 37(2): 126-128.  DOI: 10.19538/j.ek2022020612 Abstract ( )   Pulmonary infarction，which usually results from pulmonary thromboembolism，is an infrequent complication of childhood severe pneumonia.It often affects lower lobes of the lung and is arranged along the visceral pleura.The diagnosis of pulmonary infarction depends on contrast enhanced chest tomography.Studies on severe pneumonia with pulmonary infarction in children are scarce，and there is a lack of data about the etiology，epidemiology and clinical features of this disease.Reports based on adults reveal that the manifestations，treatment and prognosis of pulmonary infarction are similar to those of pulmonary thromboembolism.Pediatricians should improve recognition of this disease and accumulate experiences on diagnosis and treatment by real world studies.

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Risk factors for eosinophilia in low-birth-weight infants in NICU SUN Jin-bo, HAN Tong-yan, TONG Xiao-mei, et al 2022, 37(2): 129-134.  DOI: 10.19538/j.ek2022020613 Abstract ( )   Objective 　To analyze the factors influencing eosinophilia in low birth weight infants in NICU.Methods　The clinical data of 496 cases of low-birth-weight infant in NICU of Peking University Third Hospital from January 1，2019 to March 31，2020 were analyzed retrospectively. A total of 196 cases were excluded for various reasons.Three hundreds of cases were divide into eosinophilia group （150 cases） and control group （150 cases） according to whether eosinophilia was present or not.The data were identified by univariate analysis，and followed by unconditional logistic regression analysis of factors influencing eosinophilia in low-birth-weight infants.Results　（1） Eosinophils in both groups peaked in the third week after birth and then gradually declined，but a longer duration of eosinophilia was shown in the eosinophilia group.（2） The case number of mothers with gestational hypertension，premature rupture of membranes，postnatal food allergy，infection，anemia，blood transfusion，BPD，leukocytosis and thrombocytosis in both groups was respectively 59 （39.3%） vs.33 （22.0%），47（31.3%） vs.31（20.7%），10（6.7%）vs.1（0.7%），54（36.0%）vs.15（10.0%），133（88.7%） vs.88（58.7%），67（44.7%） vs.26（17.3%），75（50.0%） vs.23（15.3%），61（40.6%） vs.43（28.7%），and 54（36.0%） vs.32（21.3%），the difference being statistically significant（χ2=10.598，4.435，7.644，28.628，34.796，26.196，40.978，11.092，7.890；P=0.001，0.035，0.006，0.000，0.000，0.000，0.000，0.001，0.005）.In the two groups. the gestational age at birth was 30.00 and 31.43 weeks and the birth weight was 1280.0g and 1550.0g，respectively，and the difference was statistically significant（Z=-4.933，-6.220，χ2=0.000，0.000）.（3） Unconditional logistic regression analysis showed that mothers gestational hypertension，postnatal infection of infants，BPD，food allergy，anemia and thrombocytosis were influencing factors of eosinophilia in low-birth-weight infants（OR=2.190，2.442，3.441，9.241，2.757，2.190；95%CI=1.202-3.989，1.199-4.891，1.841-6.433，1.095-78.018，1.395-5.447，1.202-3.989）.Conclusion　Mothers’ gestational hypertension，postnatal infection of infants，BPD，food allergy，anemia and thrombocytosis are influencing factors of eosinophilia in low-birth-weight infants.

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Clinical characteristics and gene analysis of hepatolenticular degeneration in children: A report of 70 cases ZHANG Tian-he, MAO Zhi-qin 2022, 37(2): 135-139.  DOI: 10.19538/j.ek2022020614 Abstract ( )   Objective　To investigate the clinical characteristics and gene analysis of hepatolenticular degeneration （WD） in children.Methods　The clinical data of 70 WD children were analyzed retrospectively，who were treated in sheng jing Hospital of China Medical University from Jan.2011 to Jun.2021.Results　Among the 70 cases，there were 41 males and 29 females.The median age at diagnosis was 6 years old.The first symptoms were abnormal liver function found during physical examination.Among the different clinical phenotypes，the onset age of livertype children was small and their transaminase level was high.Neurotype children showed a high positive rate of eye K-F ring，microscopic hematuria，on diffuse liver injury and cirrhosis abdominal ultrasound，typical head MRI changes，and high urine copper level at 24 hours，the differences being statistically significant（P＜0.05）.ATP7B gene sequencing was performed in 41 children，and a total of 31 different types of mutation were found.The most common allelic mutation was p.R778L，and the allele frequency was 44.87%.The level of culoplasmin in children with p.R778L mutation was significantly reduced；there were 3 cases of fulrninant liver failure，and the allelic genes had LOF mutation，the difference being statistically significant（P＜0.05）.Conclusion　The onset of WD in children is mostly liver lesions；there are no clinical symptoms in the early stage of the disease，and only abnormal liver function can be found on physical examination.ATP7B gene test is helpful for early clinical diagnosis and prognosis evaluation of children highly suspected with WD.

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Econimic study on the diagnosis and treatment of the patients with genetic diseases LI Yan-yan, CHEN Zhe-hui, KANG Lu-lu, et al 2022, 37(2): 140-145.  DOI: 10.19538/j.ek2022020615 Abstract ( )   Objective　To conduct a preliminary investigation in the course of seeking medical care，and analyze the economic burden and cost of the patients with rare genetic diseases.Methods　The data of 372 cases of rare genetic diseases were collected from the Out-patient Department of Pediatrics of Peking University First Hospital from April to December 2019 and the data were analyzed.Results　A total of 372 cases of 93 genetic diseases were involved in the study There were.There were 226 cases of inherited metabolic disorders.The patients came from 32 provinces or cities.The onset age ranged from 2 days to 27 years old and they were aged one month to 30 years when investigated.Before the patients got definite diagnosis，61% of them spent 1 to 26 years receiving treatment and visited 3 to 6 hospitals.The patients had various presentations：58% of them had acute onset，and many patients had convulsions or acute encephalopathy as the first symptoms.Some patients showed chronic diseases，such as psychomotor retardation or retrogression；57% of the patients visited hospitals right after the disease onset，whereas only 4.3% of them got the correct initial diagnosis，and the cost was less than 10，000 yuan.Patients spent different amount of money on non-appropriate treatment before they got the correct diagnosis.About 4.3% of them spent less than 10，000 yuan；40.9% of the patients spent 10，000 to 90，000 yuan；23.9% of the patients spent 100，000 to 190 000 yuan；22.9% of the patients spent 200 000 to 490.000 yuan；8.9% of the patients spent more than 500，000 yuan.About 70.0% of patients were diagnosed with various diseases，such as cerebral palsy，intellectual and motor retardation，epilepsy，kidney failure，neonatal hemolysis，hypoxic ischemic encephalopathy，anemia，autism and psychosis before they had the correct diagnosis.Most patients got non-appropriate rehabilitating therapy；34.4% of patients had received non-appropriate physical or medical treatment，which cost them more than 100，000 yuan.Conclusion　Most of the genetic diseases present with non-specific symptoms and are with high mortality and disability.Early definite diagnosis and timely precise treatment is the keys to improving prognosis and saving the medical resources.Public medical education，newborn screening and high－risk screening are important to improve the ability of identifying，diagnosing，treating and preventing genetic diseases.

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Follow-up study of interventional closure for atrial septal defect in children under 2 years old SUN Hong-xiao, PAN Si-lin, LI Guo-ju, et al 2022, 37(2): 146-150.  DOI: 10.19538/j.ek2022020616 Abstract ( )   Objective　To summarize the complications and postoperative recovery of children under 2 years old after interventional closure for atrial septal defect.Methods　The clinical data of 235 children who underwent interventional closure for atrial septal defect in Heart Center of Women and Childrens Hospital，Qingdao University from July 2009 to June 2019 were retrospectively analyzed，and they were divided into experimental group（age＜2 years，95 cases）and control group（age≥2 years，140 cases）.The inpatient medical records and follow-up data of the two groups were analyzed and compared.Results　There was no significant difference in the basic clinical data between the two groups（P＞0.05），and the related preoperative laboratory examination was normal，with no significant difference（P＞0.05）.There was no significant difference in the incidence of postoperative complications between the two groups（P＞0.05），and no significant difference in postoperative cardiac function or recovery of complications was found（P＞0.05）.Conclusion　Interventional closure for atrial septal defect in children less than 2 years old is safe and effective.

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Advances in diagnosis and treatment of Takayasu arteritis in children YANG Chang-rong, QIN Xia, JIANG Min 2022, 37(2): 151-156.  DOI: 10.19538/j.ek2022020617 Abstract ( )

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One case report of hereditary pancreatitis in children WANG Chun-hui, GAO Zhi-bo, LAN Li, et al 2022, 37(2): 157-160.  DOI: 10.19538/j.ek2022020618 Abstract ( )