Nutritional assessment serves as the foundation for nutritional interventions.To standardize the pediatric nutritional assessment process，Pediatric Nutrition Professional Committee of the China Healthy Birth Science Association led the development of this consensus，systematically standardizing the techniques for assessing children’s nutritional needs.Building on existing evidence based medical data，epidemiological findings，and international guidelines，this consensus integrates traditional/classical nutritional assessment，individualized/precision nutritional assessment，and assessment scales.It incorporates anthropometric measurements，dietary surveys，biochemical markers，body composition analysis，microbiome profiling，genetic polymorphisms，and emerging technologies like artificial intelligence to formulate recommendations for pediatric nutritional needs assessment.This consensus provides a reference for clinical nutritional assessment and offers guidance for the early identification and precision intervention of pediatric malnutrition，including stunting，micronutrient deficiencies，and overweight/obesity.

Patent ductus arteriosus（PDA）is one of the most common congenital cardiovascular structural abnormalities in preterm infants，and its incidence is significantly negatively correlated with gestational age.Despite the continuous updates of evidence and international guidelines in recent years，there are still differences in PDA assessment criteria，hemodynamic assessment capabilities，selection of treatment timing，and implementation pathways of expectant management among different regions and different levels of hospitals in China.In May 2025，the American Academy of Pediatrics（AAP）released“Patent Ductus Arteriosus in Preterm Infants：A Clinical Report from the American Academy of Pediatrics for Pediatricians”Based on existing research evidence and professional knowledge，this report puts forward clear recommendations for the evaluation and management process of patent ductus arteriosus in preterm infants.This article discusses and supplements this report from the perspective of clinical practice in China，aiming to provide more operational clinical guidance for neonatologists in China.

With rapid advancements in immunology，molecular biology，and targeted drug development，the treatment for pediatric rheumatic and immune diseases has undergone a profound paradigm shift within just a few decades—from the non-specific approach of“broad-spectrum immunosuppression”as a last resort to a thriving era characterized by“precision targeted therapy”targeting specific inflammatory pathways or key molecules.This fundamental shift in therapeutic philosophy not only provides multiple treatment options for affected children but also significantly improves their clinical outcomes and quality of life.

B-cell-targeted biologics have brought transformative advances to the treatment of pediatric rheumatic and immune diseases. Belimumab is currently the only biologic agent approved and covered by national health insurance for childhood systemic lupus erythematosus（SLE）in China. Rituximab has accumulated extensive clinical experience in refractory pediatric SLE，lupus nephritis，ANCA-associated vasculitis，and juvenile dermatomyositis. The use of telitacicept in pediatric patients represents off-label use. Obinutuzumab，a novel type Ⅱ anti-CD20 monoclonal antibody，has demonstrated significant efficacy in the trial in adult SLE，while the pediatric trial is currently underway. This article，integrating guideline recommendations and clinical research，discusses the indication positioning，dosing regimens，tapering and discontinuation strategies，and safety management of the aforementioned agents，aiming to provide a reference for rational clinical use.

With the deepening understanding of the pathogenesis of autoinflammatory diseases，biologics targeting interleukin-1（IL-1）have represented a revolutionary breakthrough in the treatment of pediatric rheumatic and immune disorders.IL-1 inhibitors significantly improve the outcomes of children with conditions such as systemic juvenile idiopathic arthritis，macrophage activation syndrome，and various autoinflammatory diseases by precisely blocking key inflammatory pathways.This article，based on the latest evidence and clinical experience，provides a concise overview of the mechanisms of action，current clinical applications，individualized treatment strategies，and future development directions of IL-1 inhibitors.

Janus kinase inhibitors provide a new therapeutic option distinct from conventional immunosuppressants and single target biologics for pediatric rheumatic and immune diseases by modulating multiple cytokine signals through the JAK-STAT pathway. Currently，there have been clear evidence of randomized controlled trials for tofacitinib and baricitinib in non-systemic juvenile idiopathic arthritis，while evidence for upadacitinib in polyarticular juvenile idiopathic arthritis is accumulating. In juvenile dermatomyositis，JAK inhibitors may be considered as individualized targeted therapeutic options for patients with refractory disease or specific phenotypes，particularly for children with prominent cutaneous involvement，marked type I interferon activation，or concomitant interstitial lung disease. In childhood onset systemic lupus erythematosus，their use remains mainly confined to refractory，relapsing，steroid-dependent or specific hyperinflammatory phenotypes. Besides，JAK inhibitors can also be used in type I interferonopathies and macrophage activation syndrome secondary to rheumatic and immune diseases.Clinical application of JAK inhibitors should be guided by stratified decision-making based on disease phenotype，inflammatory pathways，previous treatment response and individual risk profiles. In the future，their use in child patients should focus on monitoring of blood drug concentration and precise adjustment of individualized dose.

Tumor necrosis factor inhibitors（TNFi）are an important class of biological agents for the management of pediatric rheumatic and immune diseases.TNF-α is a key inflammatory cytokine overexpressed in various autoimmune conditions. TNFi play their therapeutic roles by specifically blocking the biological activity of TNF-α.Two main categories are used clinically：receptor fusion proteins（etanercept）and monoclonal antibodies（infliximab and adalimumab）.Approved adult indications of TNFi include rheumatoid arthritis and ankylosing spondylitis；approved pediatric indications include polyarticular juvenile idiopathic arthritis and non-infectious uveitis.In addition，TNFi have also shown clinical utility in refractory rheumatic diseases such as adenosine deaminase 2 deficiency and Behçet’s disease.The overall safety profile is favorable in children.Screening for latent tuberculosis and hepatitis B before treatment initiation，along with regular monitoring of efficacy and adverse events，is recommended. 

Interleukin-17 inhibitors，as a novel class of biologic disease-modifying anti-rheumatic drugs，have been increasingly used in the treatment of rheumatic and immune-mediated diseases in recent years.Using secukinumab and ixekizumab as representative examples，this article reviews their clinical applications and the latest evidence-based medical evidence in rheumatic and immune- mediated diseases such as two subtypes of juvenile idiopathic arthritis（juvenile psoriatic arthritis and enthesitis-related arthritis），refractory Behçet’s disease，and certain inflammatory diseases，aiming to promote their standardized use in children.

Pediatric rheumatic diseases are characterized by autoimmunity and tissue injury，and dysregulation of the cytokine network constitutes their core pathogenesis.Among relevant pathways，the IL-12/IL-23 pathway acts as a pivotal mediator in immune inflammatory responses by regulating the differentiation of Th1 and Th17 cells.This article systematically reviews clinical research evidence and indications of IL-12/IL-23 pathway inhibitors for pediatric disorders including psoriatic arthritis，enthesitis-related arthritis and inflammatory bowel disease.It focuses on medication initiation timing，dose tapering and discontinuation regimens，drug administration for special populations，and drug safety concerns. In addition，it prospects the developmental trends of precision medicine in this field，providing references for standardized clinical application of IL-12/IL-23 targeted therapies in pediatric rheumatic immune diseases.

IL-6 inhibitors offer targeted therapeutic options for pediatric rheumatic and autoimmune disorders.Currently available IL-6 inhibitors include tocilizumab，sarilumab，and satralizumab targeting IL-6 receptor，siltuximab and olokizumab targeting IL-6，and selective trans-signaling inhibitor olamkicept.In the field of pediatric rheumatic and autoimmune diseases，tocilizumab is the only IL-6 inhibitor approved in China for the treatment of systemic juvenile idiopathic arthritis and is commercially available. Preliminary evidence supports its off-label use in conditions such as polyarticular juvenile idiopathic arthritis，Takayasu arteritis，scleroderma，juvenile idiopathic arthritis-associated uveitis，and dermatomyositis.Routine screening for tuberculosis is required prior to initiation of IL-6 inhibitor therapy，with regular monitoring of complete blood count，hepatic and renal function，lipid levels，and inflammatory markers during treatment.In the future，high quality randomized controlled trials are needed to clarify expanded indications，tapering and discontinuation strategies，and long-term safety.

Complement inhibitors offer new possibilities for intervention from the beginning in severe pediatric rheumatic diseases；however，in China，no approved indications for such drugs in treating pediatric rheumatic diseases exist yet，and clinicians can only rely on eculizumab for clinical use. This article focuses on practical clinical applications，drawing on existing evidence and expert consensus to systematically elaborate on the target of action of various complement inhibitors and their current approval status in pediatrics. It particularly analyzes the proper identification of indications，optimal initiation timing，and safety management strategies for conditions such as anti-neutrophil cytoplasmic antibody-associated vasculitis，systemic lupus erythematosus（especially lupus nephritis and lupus-associated thrombotic microangiopathy），and catastrophic antiphospholipid syndrome. The article also shares in detail the procedures for confirming vaccination history，antibiotic prophylaxis，alternative approaches for therapeutic drug monitoring，and strategies for discontinuation and dose reduction. Additionally，it emphasizes that lupus nephritis/systemic lupus erythematosus-related thrombotic microangiopathy is a secondary condition；once the underlying disease is under control，active consideration should be given to discontinuing the medication，rather than maintaining it lifelong as is often seen in atypical hemolytic uremic syndrome.

Interleukin-5（IL-5）represents a key therapeutic target in the treatment of eosinophilic disorders.In recent years，the clinical use of IL-5 antagonists in pediatric populations has been increasing，with accumulating evidence of benefit across a range of conditions and an overall favorable safety profile.This review summarizes the use of IL-5 antagonists in children based on recent literature，aiming to provide references for clinical decision-making in pediatric practice.

The interferon-γ（IFN-γ）pathway plays an important role in hyperinflammatory response associated with pediatric rheumatic and immune diseases，particularly in macrophage activation syndrome（MAS）complicating systemic juvenile idiopathic arthritis.IFN-γ contributes to MAS progression by enhancing antigen presentation，promoting Th1 polarization，activating macrophages，and inducing chemokine release.Emapalumab，the first approved monoclonal antibody targeting IFN- γ，has been used for primary hemophagocytic lymphohistiocytosis and has shown therapeutic potential in Still’s disease-associated MAS by reducing CXCL9 levels，promoting clinical remission，and reducing glucocorticoid use.Current researches also suggest its possible therapeutic value in systemic lupus erythematosus-associated MAS，although current evidence remains limited.Attention should be paid to infection screening，vaccination management，drug interactions，and standardized off-label use in clinical application of IFN-γ.

Pediatric rheumatic diseases comprise a group of immune dysregulation–mediated disorders that may involve multiple systems and organs，including juvenile idiopathic arthritis（JIA），childhood-onset systemic lupus erythematosus（cSLE），juvenile dermatomyositis（JDM），systemic sclerosis（SSc），Sjögren’s syndrome（SS），and vasculities.Aberrant B-cell activation，autoantibody production，and dysregulated humoral immunity play pivotal roles in the occurrence and progression of various pediatric rheumatic diseases，thereby providing theoretical evidence for B-cell–targeted therapies.In recent years，chimeric antigen receptor T-cell（CAR-T）therapy has attracted increasing attention in the treatment of autoimmune diseases.In particular，CAR-T therapies targeting B-cell–associated molecules，such as CD19 and B-cell maturation antigen（BCMA），offer a novel therapeutic strategy for severe，refractory，or relapsing pediatric rheumatic diseases in children through eliminating aberrantly activated or pathogenic B cells，reducing autoantibody production，and facilitating the restoration of immune homeostasis. Nevertheless，the application of CAR-T therapy in pediatric rheumatic and immune-mediated diseases remains at an early stage of clinical investigation.Current evidence is largely derived from case reports，small case series，hospital-exemption programs，and early-phase clinical studies. Randomized controlled trials and long-term follow-up data are still lacking；therefore，the durability of therapeutic responses，risk of relapse，and long-term safety require further validation.

Objective　To investigate the treatment and clinical outcomes of children with congenital hypothyroidism（CH） complicated by thyroid enlargement，diagnosed through neonatal screening in Beijing，and to provide a scientific basis for standardizing clinical management. Methods　A retrospective study was conducted on children with CH and thyroid enlargement who were born in Beijing between January 2015 and December 2024，screened and diagnosed by the Beijing Newborn Screening Center，and received treatment.Their clinical characteristics，treatment regimens，and clinical outcomes were analyzed. Results　From January 2015 to December 2024，a total of 1 837 776 newborns were screened in Beijing；1 445 were diagnosed with CH，among whom 610 cases had thyroid enlargement. After excluding the ineligible cases，338 children with CH and thyroid enlargement were included，comprising 246 in the transient CH（TCH） group and 92 in the permanent CH（PCH） group. Significant differences were observed between the two groups in gestational age at birth，type of thyroid morphological changes，TSH levels at initial screening，FT4 levels at diagnosis，and L-T4 dosage at 12 and 24 months of age（P<0 .05）. ROC curve analysis showed that the combination of L-T4 dosage at 12 months of age and the change in dosage from age 1 to 2 had good predictive performance for TCH. Conclusion　The incidence of CH in Beijing is 78.6 per 100，000，and the incidence of CH with thyroid enlargement is 33.2 per 100，000，in which TCH accounts for a relatively high proportion.Gestational age at birth，L-T4 dosage at 24 months of age，and the change in L-T4 dosage from age 1 to 2 are independent influencing factors for TCH.

Objective　To investigate the etiological composition and clinical features of primary adrenal insufficiency（PAI） in 42 children diagnosed in different age groups. Methods　Clinical data and genetic test results of 42 children hospitalized for PAI at Hebei Children’s Hospital between January 2018 and December 2024 were retrospectively collected. The patients were divided into two groups based on the age at definitive diagnosis：a 0~3-month group and a >3-month group. The etiological composition and clinical features were compared between the two groups. Results　A total of 42 children with PAI were included（26 males，16 females）. The age at presentation ranged from 30 hours to 12 years and 6 months，with a median age of 2 years and 8 months. The 0~3-month group comprised 15 children，and the >3-month group comprised 27 children. There were 26 cases presenting with 21-hydroxylase deficiency（21-OHD），which was the most common etiology. In the 0~3-month group，the salt-wasting form of 21-OHD was predominant（10/15，66.7%）. In the >3-month group，the simple virilizing form of 21-OHD was more common（10/27，37.0%）. The most common clinical manifestations in the 42 cases were hyperpigmentation，abnormal external genitalia，and electrolyte imbalances. Electrolyte imbalances（12/15，80.0%） and anemia（8/15，53.3%）were significantly more frequent in the 0~3-month group compared to the >3-month group（P<0 .05）. There were no deaths in the 42 cases of PAI. Hormone replacement and symptomatic treatment led to significant improvement in 30 out of 42 patients（71 .4%）. Conclusion　The etiological composition of PAI in children differs according to the age at diagnosis，with significantly different clinical manifestations. The salt-wasting form of 21-OHD is most common in infants diagnosed within 0~3 months，demonstrating a high genotype-phenotype correlation，and these patients are more prone to electrolyte imbalances，anemia. In children diagnosed after 3 months，the simple virilizing form of 21-OHD is frequent，and rare causes like X-linked adrenoleukodystrophy and X-linked adrenal hypoplasia congenita are notable；phenotypes are diverse in this group.

Kawasaki disease（KD）is recognized as the leading cause of acquired heart disease in children in developed countries，with coronary artery damage being its most frequent and most severe complication. Early diagnosis and evaluation of coronary artery damage in children with Kawasaki disease are of critical importance for both treatment and prognosis. This article reviews the research progress in imaging diagnostic techniques for coronary artery lesions in Kawasaki disease. It summarizes the strengths and limitations of various imaging modalities，including echocardiography，cardiovascular magnetic resonance imaging（CMR），CT coronary angiography（CTCA），optical coherence tomography（OCT），and intravascular ultrasound（IVUS），and discusses the application indications and timing recommended by the latest guidelines in China and around the world，which provides references for future clinical diagnosis，treatment and follow-up.