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06 July 2016, Volume 31 Issue 7 Previous Issue    Next Issue

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Interpretation of 2015 NASPGHAN/ESPGHAN Clinical Practice Guidelines for the Management of Gastroesophageal Reflux and Gastroesophageal Reflux Disease：Birth to 1 Year of Age WU Lan，WANG Zhao-xia 2016, 31(7): 481-484.  DOI: 10.7504/ek2016070601 Abstract ( )   Gastroesophageal reflux（GER） is defined as gastric contents passing into the esophagu， which is a normal physiologic process；however，gastroesophageal reflux disease（GERD） causes troublesome symptoms or complications. More than two thirds of healthy infants experience GER symptoms. Comprehensive GER/GERD clinical guidelines for birth to 1 year of age have been jointly updated by the North American Society for Pediatric Gastroenterology，Hepatology，and Nutrition（NASPGHAN） and the European Society for Pediatric Gastroenterology，Hepatology，and Nutrition（ESPGHAN） and endorsed by the American Academy of Pediatrics（AAP）. Conservative measures are indicated as firstline treatment in uncomplicated GER and GERD. Differentiating between infants who require conservative treatment and those requiring gastroenterology referral is crucial for best practice.

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Interpretation of 2015 Use of Biosimilars in Paediatric Inflammatory Bowel Disease：A Position Statement of the ESPGHAN Paediatric IBD Porto Group PI Zhuang，WANG Zhao-xia 2016, 31(7): 485-489.  DOI: 10.7504/ek2016070602 Abstract ( )   Because the patents for biopharmaceutical monoclonal antibodies have or soon will expire，biosimilars are coming to the market widely. It will most likely lead to decreased drug costs and easier access to the expensive agents. Because of the limited available clinical data from adults with rheumatologic diseases and children with inflammatory bowel disease（IBD），use of biosimilars should be done with caution and needs some considerations. Postmarketing surveillance programs for efficacy，safety and immunogenicity should become mandatory in children with IBD using biosimilars，as with all biological drugs.

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Paying attention to the diagnosis and treatment of Helicobacter pylori infection in children GENG Lan-lan， GONG Si-tang 2016, 31(7): 490-493.  DOI: 10.7504/ek2016070603 Abstract ( )   Helicobacter pylori（Hp） is a major factor in the pathogenesis of chronic active gastritis， digestive ulcer，gastric mucosa associated lymphoid tissue（MALT） lymphoma and gastric cancer. Adult Hp infection is acquired mostly in children， and the infection rate rises with the increasing of age.  Once infected， it’s quite unlikely to be eradicated. So it’s important to prevent and treat Hp infection in children. In recent years， great progress has been made in the diagnosis， treatment and prevention of Hp infection.

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Objective evaluation and correct understanding of the beneficial effects of Helicobacter pylori infection CHEN Jie 2016, 31(7): 494-496.  DOI: 10.7504/ek2016070604 Abstract ( )   About Helicobacter pylori（Hp） infection，there is the view that Hp direct interference metabolism or indirect chronic inflammation may be associated with many diseases，and some even suggest that some of the protein composition of Hp or Hp be as a treatment for some diseases，such as asthma and obesity. However， based on the studies on the data about gastroesophageal reflux disease and abnormal immune disease，such as asthma，food allergies，inflammatory bowel disease（IBD） and obesity，there is no evidence showing that Hp is good for the human body. Therefore，for Hp infection- related diseases，pediatricians should give active treatment and strengthen research in order to cope with the rising Hp resistance and treatment failure rate.

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Epidemiology and dynamic change of Helicobacter pylori infection in Chinese children DING Zhao-lu 2016, 31(7): 497-499.  DOI: 10.7504/ek2016070605 Abstract ( )   The occurrence of Helicobacter pylori（H.pylori） infection is significantly higher in developing countries when compared to developed nations. It is one of the most common chronic bacterial infections in China and significant geographic differences among regions are likely to present. The rates of H.pylori infection and related diseases have been declining yearly in both developed and rapidly developing countries. A prospective，multicenter study performed recently in China indicates that H.pylori infection rate among Chinese asymptomatic children increases with age and is high after the age of ten. There is no overall regional difference among different cities. H.pylori infection rate in children has declined in Beijing in recent 20 years since 1991，which indicates that improvement in socioeconomic conditions might have helped to reduce the infection rate in children.

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Diagnostic methods of Helicobacter pylori infection in children and their clinical application LI Zhong-yue 2016, 31(7): 500-504.  DOI: 10.7504/ek2016070606 Abstract ( )   There are various diagnostic methods for Helicobacter pylori （Hp） infection， which can be divided into invasive and non-invasive diagnostic methods. There should be differences in the detection of Hp infection in different clinical status. Although the nested PCR is the closest gold standard method for detection of Hp infection in children， at present the diagnosis of Hp infection still is lack of absolute gold standard. To develop a more reliable and convenient diagnostic method for different clinical purpose， for specific population or for genetic characteristics is the future development direction.

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Standardized treatment for Helicobacter pylori infection in children HUANG Ying，ZHOU Ying 2016, 31(7): 505-509.  DOI: 10.7504/ek2016070607 Abstract ( )   It is well known that a successful eradication of H.pylori dramatically reduces the rate of recurrence of gastritis and peptic ulcers in affected children. The recommended first-line eradication therapy for H.pylori infection has been triple therapy consisting of a proton pump inhibitor and two antibiotics. However，the eradication rate has declined in recent years，due to an increased bacterial resistance to antibiotics or decreased compliance with the patients. The treatment of H.pylori infection in children should be personalized.

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Problems in the treatment of Helicobacter pylori infection in children and the eradication measures for high-resistant Helicobacter pylori GUO Jing，XU Xi-wei 2016, 31(7): 509-512.  DOI: 10.7504/ek2016070608 Abstract ( )   The infection rate of Helicobacter pylori is increasing year by year，while the eradication rate is declining. The paper explains the difficult problems in the treatment of Helicobacter pylori infection from strain，host and environment. Through combination of recent research advances and clinical experiences，the authors provide some solutions to the above problems in order to increase the eradication rate and reduce recurrence.

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Research progress of Helicobacter pylori infection in children with extradigestive diseases YIN Guo-feng， JIANG Mi-zu 2016, 31(7): 512-516.  DOI: 10.7504/ek2016070609 Abstract ( )   Helicobacter pylori（Hp） infection is one of the most common infections in human. Hp can not only directly colonize to the stomach of the host，causing gastrointestinal tract diseases，but also induce extradigestive disorders by generating a series of hormone and immune molecules，cytokines and chemokines. In the article，the relationship between Hp infection and extradigestive diseases in children is reviewed in order to improve people’s attention on the relationship，and provide more theoretical basis for the indication of anti-Hp treatment.

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Transmission，risk factors and prevention of Helicobacter pylori infection in childhood WU Bin，HUANG Huan-Huan 2016, 31(7): 517-520.  DOI: 10.7504/ek2016070610 Abstract ( )   Helicobacter pylori（Hp） is responsible for one of frequent chronic bacterial infections worldwide and most likely spread from person to person through fecal-oral or oral-oral routes. Children are at high risk of Hp infection. Hp infection in childhood is clustered in the family members，and associated closely with social economic status，personal hygiene and the feeding way. To promote health education，advocate breastfeeding，improve basic sanitation and family health behavior，pay attention to hand hygiene and correct poor diet living habits would be critical to reducing the incidence rates of Hp infection in childhood.

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Helicobacter pylori infection and gastrointestinal microbiota in children SHU Sai-nan，HUANG Zhi-hua 2016, 31(7): 521-523.  DOI: 10.7504/ek2016070611 Abstract ( )   Helicobacter pylori（Hp） infection is most frequently acquired during childhood and spontaneous clearance is rare. Hp infection can change the gut microbiota and cause the disease. In recent years，the Hp eradication rate through  traditional triple therapy is decreased due to the development of Hp resistant strain. Probiotic therapy can inhibit the activity of Hp and reduce the side effects of drugs，which is a promising way to prevent and control the Hp infection.

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Severe H5N6 avian influenza pneumonia：First child case in China YAO Zhen-ya*， LU Xiu-lan， LUO Ru-ping， XIAO Zheng-hui 2016, 31(7): 524-527.  DOI: 10.7504/ek2016070612 Abstract ( )   Objective    To summarize and analyze the clinical characteristics， diagnostic and therapeutic measures for the first child case of severe H5N6 avian influenza pneumonia in China. Methods    The clinical data of the first case of severe H5N6 avian influenza infection in China admitted in April 13， 2016 in Department of Emergency Center， Hunan Children’s Hospital were analyzed and summarized. Results    The case was an 11 years old girl， acute onset， was similar with early symptoms of common respiratory infection including high fever， fatigue， vomiting， but catarrhal symptoms was not obvious. Since fever of unknown origin， obvious weakness， vomiting and other suspected influenza symptoms，clinicians speculated “flu” or “bird flu” possibility considering her history of exposure to her mother died of unknown illness. The girl was admitted to the Department of Infectious Isolation Ward and received oral oseltamivir treatment. On the 8th day of the course， the condition was aggravated， which showed large areas of dense shadow on chest X-ray film.The girl was diagnosed as acute respiratory distress syndrome（ARDS）， and was transferred to the Intensive Care Unit for isolation and treatment. Based on the reports of Hunan CDC and National CDC， the girl was confirmed to be a case of avian influenza A H5N6 virus infection case. The treatment started with oseltamivir and then peramivir antivirus treatmnet， nCPAP ventilation， synchronous glucocorticoid treatment， and the gradual weaning of noninvasive ventilator. The girl recovered and was tolerance without oxygen therapy， then discharged from hospital. Conclusion    It is very important for clinicians to pay more attention to epidemiological history. Timely detection， early diagnosis are crucial to the treatment of avian influenza virus pneumonia and the effective treatment can get better prognosis.

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Hypereosinophilic syndrome in children：A clinical analysis of 13 patients ZHOU Jin，WANG Guo-li，FU Li-bing，JIANG Jin，XU Xi-wei 2016, 31(7): 528-532.  DOI: 10.7504/ek2016070613 Abstract ( )   Objective    To investigate the clinical characteristics and treatment of hypereosinophilic syndrome（HES） in children. Methods    The clinical manifestations， laboratory examinations，gastroscopy and imaging features，pathological results and therapy experience in 13 HES children admitted in Beijing Children’s Hospital，Capital Medical University from January 2009 to February 2016 and related literatures were analyzed retrospectively. Results    Of the 13 patients evaluated， 7 were male（54%） and 6 were female（46%）. The median age at diagnosis was 9.6 years old（ranging 3 to 14 years old）. The median course of disease was 23 months（ranging 1 to 72 months）. The peripheral eosionophil counts ranged （4.5—29.2）×109/L（mean 13.5×109/L）. Gastrointestinal tract was the most commonly involved organ， and was reported in 92%（12/13） of patients. It was followed in frequency by urinary system（84%），pulmonary（53%），cardiac（23%），and skin（8%） and liver（8%）. A total of 2 sites were involved in 6 patients，3 sites were involved in 5 patients and 4 sites were involved in 2 patients. Treatment of oral prednisone therapy was given and follow-up of 10 patients had no clinical symptoms（2 patients had stopped prednisone）. But eosionophil counts still increased to varying degrees. Three patients were lost to follow-up. Conclusion    HES in children is more common in school age and adolescent children. Gastrointestinal tract，urinary system and pulmonary involvement are more common. Glucocorticoid treatment is effective，which requires to be maintained in small dose in the long term.

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Effect of ketogenic diet in patients with Dravet syndrome ZHANG Jing，ZHANG Yue-hua，TIAN Xiao-juan，JI Tao-yun，ZHANG Yao，XU Xiao-jing，YANG Xiao-ling，WU Xi-ru 2016, 31(7): 533-536.  DOI: 10.7504/ek2016070614 Abstract ( )   Objective    To evaluate the effect of ketogenic diet（KD） in patients with Dravet syndrome（DS）. Methods    The seizures，electroencephalogram（EEG） and cognitive function of 46 DS patients receiving treatment of KD from January 2007 to November 2015 in Department of Pediatrics were analyzed retrospectively. Modified Johns Hopkins protocol  was used to initiate KD，and urinary ketone bodies were daily monitored in the patients to maintain the state of ketosis. The effect was evaluated by Engel outcome scale. The EEG， cognition，language，and motor function of the patients were assessed. Results    Totally 46 DS patients（25 boys，21 girls） received treatment of KD more than 12 weeks，and among them 29（63.0%） patients were maintained on the diet more than 24 weeks，16（34.8%） patients more than 48 weeks. Nine patients were seizure free. The seizures in 25 patients were reduced over 50%，and the KD effect was observed within 2 weeks in them.At the end of 12 weeks of treatment with KD，46 patients achieved Ⅰ， Ⅱ， Ⅲ， Ⅳ grade effect，accounting for 19.6%（9/46 cases），13.0%（6/46 cases），21.7%（10/46 cases），and 45.7%（21/46 cases） respectively according to Engel scale. The background rhythm of EEG showed obvious improvement in 6 patients，and interictal seizure discharge frequency decreased significantly. Cognitive function of 15 patients was improved. Language was enhanced in 8 patients. Motor function was improved in 8 patients. The main adverse reactions of KD in the treatment process were mainly gastrointestinal symptoms and metabolic disorders. Conclusion    KD treatment in Dravet syndrome has many advantages，such as fast acting， being effective in more than half of the DS patients and tolerable adverse reactions. Drug resistant DS patients are suggested to receive KD treatment.

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Live capsules/powder combining Bifidobacterium，Lactobacillus and Enterococcus for the treatment of infantile rotavirus enteritis：A meta-analysis LI Hao*，YANG Yong-zhi，WU Qing-bin，HUANG Zhi-hua，ZHENG Yue-jie，QIN Huan-long 2016, 31(7): 537-541.  DOI: 10.7504/ek2016070615 Abstract ( )   Objective    To evaluate the clinical therapeutic effect of live capsules/powder combining Bifidobacterium，Lactobacillus and Enterococcus in treating infantile rotavirus enteritis by meta-analysis. Methods     Such databases as China Knowledge Resource Integrated Database， Wanfang Database， Vip Database， Pubmed， Embase and Web of Science were searched from establishing database to December 2015 to collect all randomized controlled trials （RCT） and prospective non-randomized controlled trials（non-RCT） on live capsules/powder combining Bifidobacterium， Lactobacillus and Enterococcus in treating infantile rotavirus enteritis. The studies were selected according to the inclusion and exclusion criteria. The data were extracted， the methodological quality of the included studies was assessed， and the meta-analysis was performed with RevMan 5.2 in February 5，2016. Results    A total of 23 prospective non-RCTs involving 3388 patients from 21 studies were included， including 1804 patients from treatment group（live capsules/powder combining Bifidobacterium，Lactobacillus and Enterococcus plus conventional treatment） and 1584 patients from control group（conventional treatment）. The total effective rate of the treatment group was superior to that of the control group（OR＝4.59， 95%CI 3.69～5.70， P＜0.01）； the diarrhea relieving time of the treatment group was shorter than that of the control group（MD＝-1.39， 95%CI -2.24 — -0.53， P＝0.001）； the total treatment time of the treatment group was shorter than that of the control group（MD＝-1.32， 95%CI -2.19 — -0.45，P＝0.003）. Conclusion    Live capsules/powder combining Bifidobacterium，Lactobacillus and Enterococcus combined with conventional drugs can improve the total therapeutic effect on infantile rotavirus enteritis and shorten the diarrhea relieving time and total treatment time.

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Anti-N-methyl-D-aspartate receptor encephalitis secondary to herpes simplex virus encephalitis in children：A clinical analysis of 16 cases WANG Xiao-hui，ZHANG Wei-hua，FANG Fang，et al 2016, 31(7): 542-544.  DOI: 10.7504/ek2016070616 Abstract ( )

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Nutrition support treatment for critically ill children ZHENG Jian-bin，GONG Si-tang，TAO Jian-ping，et a 2016, 31(7): 545-548.  DOI: 10.7504/ek2016070617 Abstract ( )

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Thirty days after birth，skin and scleral turning yellow for 4 weeks LIU Bo，LI Jun，LI Zhong-yue 2016, 31(7): 549-552.  DOI: 10.7504/ek2016070618 Abstract ( )

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Intermittent abdominal pain complicated with acid reflux for more than 1 year LI Dong-dan，QIN Xiu-min，WANG Guo-li，et al 2016, 31(7): 553-557.  DOI: 10.7504/ek2016070619 Abstract ( )

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Pertussis in the newborn：A report of 1 case CHEN Yi-yu，WEI Hong 2016, 31(7): 558-560.  DOI: 10.7504/ek2016070620 Abstract ( )