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06 March 2019, Volume 34 Issue 3 Previous Issue    Next Issue

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Clinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis Otolaryngology Professional Committee，Pediatrician Branch，Chinese Medical Doctor Association 2019, 34(3): 169-175.  DOI: 10.19538/j.ek2019030601 Abstract ( )

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Expert consensus on immunization in children with special health state（Ⅻ） ：Infectious diseases and immunization Center for Disease Control and Prevention in Hangzhou，Center for Disease Control and Prevention in Suzhou，Center for Disease Control and Prevention in Shanghai，et al 2019, 34(3): 176-177.  DOI: 10.19538/j.ek2019030602 Abstract ( )

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Expert consensus on immunization in children with special health state（ⅩⅢ）：Perianal abscess and immunization Center for Disease Control and Prevention in Hangzhou，Center for Disease Control and Prevention in Suzhou，Center for Disease Control and Prevention in Shanghai，et al 2019, 34(3): 177-178.  DOI: 10.19538/j.ek2019030603 Abstract ( )

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Expert consensus on immunization in children with special health state（ⅩⅣ） ：IgA vasculitis and immunization Center for Disease Control and Prevention in Shanghai，Center for Disease Control and Prevention in Hangzhou，Center for Disease Control and Prevention in Suzhou，et al 2019, 34(3): 178-180.  DOI: 10.19538/j.ek2019030604 Abstract ( )

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Expert consensus on immunization in children with special health state（ⅩⅤ） ：Autoimmune disease and immunization Center for Disease Control and Prevention in Shanghai，Center for Disease Control and Prevention in Hangzhou，Center for Disease Control and Prevention in Suzhou，et al 2019, 34(3): 180-181.  DOI: 10.19538/j.ek2019030605 Abstract ( )

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Interpretation of the pathogenesis part of Clinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis ZHANG Jian-ji*，SHI Lei 2019, 34(3): 182-187.  DOI: 10.19538/j.ek2019030606 Abstract ( )   Allergic rhinitis（AR） in children is non-infectious chronic inflammatory disease in the nasal mucosa which was largely determined by IgE when the body is exposed to allergens. It was believed that Th1/Th2 immune imbalance is the main pathogenesis of AR；however，more and more studies put emphasis on the integrality of individual immune system of the disease. Systematic discussion on the pathogenesis of natural immunity and acquired immunity in allergic rhinitis may provide useful AR treatments in the future.

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Interpretation of the diagnostic part of Clinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis SHEN Ling，YANG Zhong-jie，LIN Zong-tong，et al 2019, 34(3): 188-191.  DOI: 10.19538/j.ek2019030607 Abstract ( )   Allergic rhinitis is a common and difficult chronic nasal disease in children，which may affect the quality of life of children，and even cause complications such as sinusitis，secretory otitis media，sleep apnean syndrome and so on. This article explains the diagnostic part in theClinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis developed by Otolaryngology Professional Committee，Pediatrician Branch，Chinese Medical Doctor Association. Child allergic rhinitis should be diagnosed according to family history，allergic disease history，clinical manifestation and the consistent allergen detection.Infants can be diagnosed only according to family history，allergic disease history and clinical manifestations.

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Interpretation of the treatment part of Clinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis WANG Zhi-nan 2019, 34(3): 192-196.  DOI: 10.19538/j.ek2019030608 Abstract ( )   Otolaryngology Professional Committee，Pediatrician Branch，Chinese Medical Doctor Association has published Clinical Practice Guideline：Diagnosis and Treatment in Children with Allergic Rhinitis. The article is an interpretationof the diagnosis and treatment of patients with AR. The diagnosis of child AR should be based on family history，typial allergic history，clinical manifestations and the consistent allergen detection. Its management should combine prevention and treatment. The treatment principles of AR include environmental controls，drug therapy，immunotherapy and patient education.

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Epidemiology of allergic rhinitis in children 2019, 34(3): 197-199.  DOI: 10.19538/j.ek2019030609 Abstract ( )   Allergic rhinitis is one of the most common chronic disease in children. According to the global epidemiological investigation，the incidence of allergic rhinitis in children is different among different ages and different regions，and the prevalence of allergic rhinitis shows slow increase trends all over the world. In addition，the distribution of allergens in different areas is different. In Europe，America and Xinjiang， plants species are the main allergens，while mites are the main allergens in other areas of China.

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Specific immunotherapy for allergic rhinitis in children KOU Wei，WEI Ping，ZHANG Cheng，et al 2019, 34(3): 200-205.  DOI: 10.19538/j.ek2019030610 Abstract ( )   At present，allergen-specific immunotherapy （AIT） is the only treatment method that can change the natural course of allergic rhinitis in children. While achieving good clinical efficacy，it reduces the dosage of drugs for AR children，improves the quality of life，prevents AR progression to asthma，and reduces new allergens. New methods and techniques for AIT are designed to shorten the time to reach immune tolerance，improve the compliance of children，enhance the safety of treatment，and reduce the treatment burden as much as possible. Here，we review the clinical progress of AIT in AR children.

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Clinical application of H1 antihistamines in children with allergic rhinitis ZHANG Yun-fei， XU Zheng-min 2019, 34(3): 205-208.  DOI: 10.19538/j.ek2019030611 Abstract ( )   The incidence of allergic rhinitis in children increases year by year，and H1 antihistamines play a role in the control of allergic diseases by blocking the binding of histamine and H1 receptor. The second-generation H1 antihistamines have more stable binding，better specificity，lower central inhibitory effect and longer action time，and can effectively improve the symptoms of the nose and eyes，which is the first-line drug for the treatment of allergic rhinitis in children. At present，there aren’t objective testing methods to evaluate the effectiveness and safety of antihistamines. Therefore，the dosage for children should be adjusted according to body weight，appropriate dosage forms should be selected，age limit should be paid attention to，dosage varieties should be individualized as far as possible，and reasonable course of treatment should be applied.

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Analysis of allergen screening results in 2413 children with allergic rhinitis in Children’s  Hospital of Fudan University LI Qi，ZHANG Yun-fei，XU Zheng-min 2019, 34(3): 209-211.  DOI: 10.19538/j.ek2019030612 Abstract ( )   Objective　To analyse the allergens in children with allergic rhinitis and provide evidence for the prevention and treatment of allergic rhinitis in children. Methods　Allergens were detected in 2413 children with allergic rhinitis by immunoblotting from January 2013 to July 2018 in Department of Otolaryngology  Head and Neck Surgery，Children’s Hospital of Fudan University. Results　The first four inhaled allergens were house dust mites，mixed mold，dog hair and house dust，each accounting for 49.52%，23.62%，17.99%，and 15.54%. The first four food-borne allergens were milk，eggs，cashews，and crabs，each accounting for 46.54%，22.92%，19.10%，and 9.45%. Most patients with allergic rhinitis（46.33%） have both inhaled and ingestive allergies.There was a statistically significant difference in the positive rate of allergens between male and female children（P＜0.05）. With age increasing，the positive rate of inhaled allergens in children gradually increased，and the positive rate of ingestive allergens gradually decreased. Conclusion　The inhaled allergens in Shanghai are mainly dust mites and mixed molds. The food-borne allergens are mainly milk and eggs. The detection of allergens can help to understand the allergic state of children.

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Observation of tigecycline treatment for children with severe infection LIN Shu-peng*，ZHANG Chen-mei，YE Sheng 2019, 34(3): 212-217.  DOI: 10.19538/j.ek2019030613 Abstract ( )   Objective　To evaluate the efficacy and safety of tigecycline therapy in children with severe infection. Methods　We conducted a restrospective chart review of 114 children with severe infection in a tertiary hospital from May 1，2012 to April 30，2017. Inclusion criteria: receiving tigecycline administration for at least 2 days（4 doses）. Clinical data and laboratory results were recorded before and after the therapy. Results　Totally 114 children were enrolled，including 47 patients diagnosed with Acinetobacter baumanmii infection，with 52 Acinetobacter baumanmii strains. The in-hospital mortality was 23.4%. Median duration of tigecycline treatment was 13 days（2.5-13.5 days）. Median duration of antibiotics prior to tigecycline treatment was 9 days（2-27 days）. The total clinical improvement rate was 47.3%，and the etiological eradication rate was 38.9%. After treatment 24 cases got clinically improved in 47 patients and 26 strains were eradicated. No serious adverse effect was reported. Conclusion　The efficacy and safety of tigecycline should not be overvalued. Additional data from randomized controlled trials are required to assess the administration of tigecycline.

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Influence of delivering methods of drug on bronchodilation test with tidal lung function WANG Hui-min*，LIU Chuan-he，ZHU Ye-xuan，et al 2019, 34(3): 218-222.  DOI: 10.19538/j.ek2019030614 Abstract ( )   Objective　To investigate the factors influencing the improvement of tidal lung function bronchodilation test，and to provide evidence for the diagnosis of infant asthma. Methods　Totally 71 infant patients diagnosed with asthma were included from clinic of Children’s Hospital of Capital Institute of Pediatrics and alternativley assigned into two groups，who respectively received bronchodilator via pMDI（pMDI group）or nebulization（nebulization group），and bronchodilation test was performed. The effects of drug delivering methods on the bronchodilation test was compared，and the main observation indexes were respiratory rate（RR），VT/kg，inspiratory time（Ti），expiratory time（Te），Ti/Te，time to peak tidal expiratory flow as a proportion of expiratory time（TPTEF/TE），volume to peak expiratory flow as a proportion of exhaled volume（VPEF/VE） and peak tidal expiratory flow（PTEF）. Further analysis was carried within each group. Results　Twenty patients received bronchodilator via pMDI，and fifty-one patients received bronchodilator via nebulization. After drug delivery，the RR of the children in the pMDI group decreased significantly（P＝0.003），and the Ti increased significantly（P＝0.011）. The VT/kg，Ti，Ti/Te，TPTEF/TE and VPEF/VE increased significantly in nebulization group（all P＜0.05）. In the nebulization group，the improvement rate of TPTEF/TE and VPEF/VE were significantly higher than that of pMDI group（all P＜0.05）. In the pMDI group，the Te，Ti/Te，TPTEF/TE and VPEF/VE significantly improved in patients with severe airway obstruction（all P＜0.05）. The above parameters also improved after bronchodilation test in nebulization group. Compared in difference age groups，TPTEF/TE and VPEF/VE in children over 2 years improved more significantly than those in children under 1 year（all P＜0.05）. Conclusion　The effects of nebulization are better than pMDI in tidal lung function bronchodilation test. The improvement rate of tidal lung function is related to the degree of airway obstruction and the age of patients.

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Retrospective analysis of 617 cases of accidental injury in critically ill children ZHAN Yi-shan，ZHU You-rong 2019, 34(3): 223-226.  DOI: 10.19538/j.ek2019030615 Abstract ( )   Objective　By analyzing the cases of accidental injuries among critically ill children in our hospital in recent years，we put forward feasible preventive measures to effectively reduce the occurrence of accidental injuries. Methods　A retrospective analysis was performed on the clinical data of children who were admitted to the PICU in our hospital from May 1，2015 to April 30，2018；the types of children with accidental injuries were analyzed，and the male-to-female ratio of the results was analyzed. Seasonal characteristics，age，and the proportion of deaths were analyzed. Results 　It was found that the top three causes of accidents in critically ill children were falling injuries（246，39.87%），traffic accidents（156，25.28%），and poisoning（57，9.23%）. The incidence of accidental injuries for boys was significantly greater than that for girls；there were 375 boys and 242 girls，the ratio being 1.55∶1；severe accident injuries peaked in early childhood（1～4 years old）；there was no significant difference between urban and rural areas. Conclusion　The accidental injuries in critically ill children have undergone tremendous changes. We should adopt preventive measures to reduce accidental injuries.

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Diagnosis and treatment of necrotizing pneumonia in 32 children with flexible bronchoscopy YANG Wei-na，LIU Jun-hui，KE Ling-si，et al 2019, 34(3): 227-229.  DOI: 10.19538/j.ek2019030616 Abstract ( )   Objective　To evaluate the diagnostic and therapeutic value of flexible bronchoscopy in children with necrotizing pneumonia. Methods　Clinical data of children diagnosed with necrotizing pneumonia in the Department of Pediatrics of the First Hospital of Jilin University from December 2016 to December 2017 were collected. The general clinical manifestations，laboratory examination results，chest X-ray or lung CT，flexible bronchoscope and other examinations of all the children were analyzed retrospectively. Based on the characteristics，diagnosis，treatment and prognosis，the advantages of flexible bronchoscopy in this disease were analyzed. Results　All the 32 cases were diagnosed as necrotizing pneumonia by imaging examination，with an average diagnosis time of 14.1 d. All 32 cases of children with necrotizing pneumonia received flexible bronchoscopy and alveolar lavage. The alveolar lavage in 32 cases presented turbidity mitota-like changes，which had high sensitivity in the diagnosis of necrotizing pneumonia. The average time for mitota-like changes in alveolar lavage was 6.7 days. Conclusion　Flexible bronchoscopy is an important method in the diagnosis and treatment of necrotizing pneumonia，and the change of alveolar lavage fluid is a sensitive index for early prediction of necrotizing pneumonia.

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Etiological analysis of 491children with pertussis-like syndrome XIE Jin-hong，PENG Dong-hong 2019, 34(3): 230-234.  DOI: 10.19538/j.ek2019030617 Abstract ( )

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One case of congenital adrenal dysplasia caused by new mutation of NROB1 gene and literature review WANG Hui-zhen，WU Sheng-nan，YANG Hai-hua，et al 2019, 34(3): 235-238.  DOI: 10.19538/j.ek2019030618 Abstract ( )

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Clinical research progress of invasive fungal infection in pediatric intensive care unit LIU Bo，WANG Li-jie 2019, 34(3): 239-243.  DOI: 10.19538/j.ek2019030619 Abstract ( )

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Research progress on the relationship between bronchopulmonary dysplasia and childhood asthma ZHAI Bo-ya，CHEN Xiao-qing 2019, 34(3): 244-248.  DOI: 10.19538/j.ek2019030620 Abstract ( )