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06 February 2020, Volume 35 Issue 2 Previous Issue    Next Issue

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Suggestions on the prescription review of aerosol inhalation drugs commonly used in children National Children’s Medical Center（Beijing），Editorial Committee of Chinese Journal of Practical Pediatrics 2020, 35(2): 81-87.  DOI: 10.19538/j.ek2020020601 Abstract ( )

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Expert consensus on the clinical application of Tongqiao Rhinitis Granules in the treatment of children with rhinitis and rhinosinusitis Otolaryngology Professional Committee，Pediatrician Branch，Chinese Medical Doctor Association 2020, 35(2): 88-92.  DOI: 10.19538/j.ek2020020602 Abstract ( )

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Evolution of the definition and diagnostic criteria of bronchopulmonary dysplasia， its current advances and thoughts for future ZHU Jian-xing 2020, 35(2): 93-97.  DOI: 10.19538/j.ek2020020603 Abstract ( )   Bronchopulmonary dysplasia（BPD）is a common complication among the infants with very low birth weight （VLBW） and extreme low birth weight（ELBW） causing higher related morbidity and mortality. The renewed and suggested different definitions and diagnostic criteria have been contentiously put forward bring into the variances in clinical diagnosis for cases and epidemiological data. For a correct direction， many researches and controversies which promote the advancement in both clinical intervention and basic research have been appeared for near a decade. In 2018 and 2019 the NICHD consensus and An Evidence-Based Approach put forward by Jensen and so on containing renewed definitions and diagnostic criteria were published. It should be believed the new ones will be beneficial to the complement and right direction of clinical diagnosis.

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Application of lung ultrasound in diagnosis of bronchopulmonary dysplasia in premature infants LIU Jing， QIU Ru-xin，GAO Yue-qiao 2020, 35(2): 97-100.  DOI: 10.19538/j.ek2020020604 Abstract ( )   Bronchopulmonary dysplasia（BPD） is a common severe respiratory problem in premature infants， and imaging information has important reference value for its diagnosis. Recently， ultrasound has been successfully used in the diagnosis and differential diagnosis of neonatal lung disease， and is valuable in predicting the occurrence and diagnosis of BPD. The ultrasonic imaging characteristics of BPD mainly include pleural line abnormalities， air cystograms and alveolar-interstitial syndrome， etc.， which is very important for the pediatricians.

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Glucocorticoid for prevention and treatment of bronchopulmonary dysplasia：Application and confusion YANG Xiao-yan，MU De-zhi 2020, 35(2): 100-104.  DOI: 10.19538/j.ek2020020605 Abstract ( )   Bronchopulmonary dysplasia（BPD） is a common complication in preterm infants. Corticosteroid is one of the choices for both the prevention and the treatment for BPD. However，short or long-term adverse outcomes were reported in different studies. Hence，there is no recommendation for the "best" medication strategy of corticosteroid. Current evidence shows that low-dose and short course of systemic corticosteroid shows effects in the prevention and/or the treatment of BPD in late postnatal periods（＞7 days）. Meanwhile，early（≤7 days） postnatal hydrocortisone therapy could reduce the incidence of BPD. Long-term neurodevelopment outcomes should be taken into concern before the conclusion is made. Besides，early inhaled or intratracheal instilled glucocorticoids（co-administrated with pulmonary surfactant） could be another choice. Further research is needed to confirm the advantages and disadvantages of this medication program. It is important to have carefully disigned multicenter randomized controlled trials in order to establish the best way of administration and clarify the dosage form，the drug and the timing for glucocorticoids.

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Nutritional problems of bronchopulmonary dysplasia in premature infants DING Guo-fang 2020, 35(2): 104-107.  DOI: 10.19538/j.ek2020020606 Abstract ( )   Bronchopulmonary dysplasia（BPD） is one of the common complications in very low birth weight infants and extra-low birth weight infants. BPD not only leads to respiratory dysfunction，but also affects the development of nervous system. Although the pathogenesis of BPD is relatively complex and there are many influencing factors，more and more attention has been paid to the nutritional problems in the early stage of birth in the process of the formation of BPD. In this paper，the role of nutrition in lung development and the dependence of BPD on nutrition in the early stage of birth and the nutritional management and nutrition suggestions of BPD high risk population in the early stage of birth and after discharge from hospital were discussed.

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Aspiration and microaspiration：An assignable problem in the prevention and treatment of BPD in preterm infants SHI Yong-yan，FU Jian-hua 2020, 35(2): 107-111.  DOI: 10.19538/j.ek2020020607 Abstract ( )   Gastroesophageal reflux（GER） is a common clinical manifestation of preterm infants. Aspiration and microaspiration caused by GER can induce or aggravate the lung injury of bronchopulmonary dysplasia（BPD） by inducing airway and larynx spasm, airway obstruction and lung inflammation. Therefore，aspiration and microaspiration should be avoided by all means. If necessary，appropriate interventions can be taken to facilitate the prevention and treatment of BPD.

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Home oxygen therapy and management for preterm infants with bronchopulmonary dysplasia HU Li-yuan，ZHOU Wen-hao 2020, 35(2): 111-115.  DOI: 10.19538/j.ek2020020608 Abstract ( )   Preterm infants are more vulnerable to intermittent hypoxia than term infants which results in adverse outcomes，and home oxygen therapy（HOT） is helpful to improve prognosis. Extremely premature infants，small for gestational age，prolonged duration on mechanical ventilation，severe bronchopulmonary dysplasia are major predictors for infants requiring HOT at discharge. Because HOT is not widely administered in China，the following aspects are what pediatrians need to pay attention to，including the clinical significance of performing HOT，how to identify infants at risk of HOT，administration and management of HOT and prognosis of infants.

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Role of hemophilia joint health score（HJHS） in the evaluation of hemophilia joints in preschool children：A clinical data analysis of a multicenter children with severe hemophilia A WANG Yan*，AI Di，LI Xiao-jing，et al 2020, 35(2): 116-119.  DOI: 10.19538/j.ek2020020609 Abstract ( )   Objective　To understand the significance of hemophilia joint health score（HJHS） in the evaluation of joint disease in children with severe hemophilia A（HA） and early detection of early joint dysfunction. Methods　The study was an observational cohort study with the Chinese Hemophilia Individualized Prophylaxis Study（CHIPS） as the background. The basic data of outpatients with hemophilia in Beijing Children’s Hospital，Capital Medical University and Chengdu Women and Children’s Central Hospital between August 2016 and June 2017 were analyzed. Twenty patients with severe HA who had a history of joint bleeding at 4 to 7 years of age were enrolled. Six index joints of the bilateral elbow，knee and ankle were examined by HJHS and ultrasound（US）. The data of joint bleeding of the group in 3 months before the study were collected retrospectively. The above data were analyzed retrospectively. Results　A total of 20 patients with a median age of 4.75（4.00-7.58） were enrolled in the study and HJHS and US examinations were performed on 120 target joint. Among them，26.7%（32/120） of joints had bleeding records and the median number of joint bleeding in 20 patients was 1（0-6） times in 3 months before the study. There was statistical difference between the cases with joint bleeding and those without in the HJHS score （Z＝-2.608，P＝0.009），which showed that HJHS score of the joint with bleeding was higher. There was difference between the HJHS score and the US score（χ2＝24.221，P＜0.001），which showed that the two scores couldn’t substitute for each other. There were 88 joints without bleeding records，22.7%（20/88） of them had abnormal US scores，36.3%（33/88） had abnormal HJHS scores，and 12（17.6%） joints had abnormal HJHS scores but normal US scores. There was a statistically significant difference in joint HJHS scores between these 12 joints and those with bleeding and abnormal HJHS scores and US scores（Z＝-2.513，P＝0.012），with 50%（6/12） being the knee joints and 58.3%（7/12） being swelling. Conclusion　Joint diseases can be found by HJHS examination in pre-school severe hemophilia A children as the complement with US；there is difference between HJHS scores and US scores. Therefore，these children should receive comprehensive evaluation in order to ensure the health of the joints.

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Efficacy and safety of Peptamen Junior in the nutritional support for children with acute lymphoblastic leukemia LI Xin-yu，WENG Wen-jun，WANG Jing-wen，et al 2020, 35(2): 120-125.  DOI: 10.19538/j.ek2020020610 Abstract ( )   Objective　To evaluate the efficacy and safety of Peptamen Junior in nutritional support for acute lymphoblastic leukemia（ALL） children during chemotherapy. Methods　A total of 88 cases of ALL admitted to Department of Pediatrics，Sun Yat-sen Memorial Hospital，Sun Yat-sen University，from June 2015 to December 2017 were involed in the randomized control trial. Volunteers were included and assigned randomly into 2 groups（control group and treatment group）. The treatment group received standard dose of Peptamen Junior for intervention；meanwhile，all of them will accept induction remission chemotherapy. The data on efficiency of nutrition intervention，adverse events，and remission rates were collected and studied. Results　A total of 88 cases were analyzed，including 21 cases（23.86%） with Z-value of average weight for age being -1 SD— -2 SD and 6 cases（6.82%） with Z-value being under -2 SD. At the end of chemotherapy，the incidence of hyponatremia（P＝0.03） and hypocalcemia（P＝0.047） in the treatment group was significantly lower than that in the control group，while the serum protein level was higher（P＝0.046）. There was no difference in the incidence of acute pancreatitis or coagulation disorders between two groups. The average amount of albumin transfusion was 21.57（16.02，27.10） g in the treatment group and 34.59（26.33，42.86） g in the control group（P＝0.011）. The weight of children in the treatment group was stable，while that of the control group was decreasing. Conclusion　Peptamen Junior is safe in ALL induction remission chemotherapy. Peptamen Junior maintains the weight stability of children，alleviates hypoalbuminemia and hypoalbuminemia，and decreases the albumin infusion amount and the occurrence of electrolyte disorders.

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Chronic granulomatous disease：A clinical analysis of 8 cases ZHU Ying-ying*，LIU Wei，GUO Ming-fa，et al 2020, 35(2): 126-131.  DOI: 10.19538/j.ek2020020611 Abstract ( )   Objective　To evaluate the clinical features and gene mutations of chronic granulomatous disease（CGD）. Methods　The clinical data of 8 CGD patients diagnosed from January 2015 to June 2018 at Children’s Hospital Affiliated to Zhengzhou University were analyzed retrospectively. A range of evaluation indexes were included，such as clinical manifestation，neutrophil respiratory burst assay，gene sequencing，treatment and prognosis. Results　The average age of disease onset and diagnosis was 17 days and 44 days， respectively， including 7 male and 1 female cases. All patients had fever at early stage， which presented with pneumonia（n＝8）； abnormal reaction after Bacillus Calmette-Gurein（BCG） vaccination occurred in 3 cases；recurrent diarrhea， hemafecia and anal fistula occurred in 1 case；perianal abscess occurred in 1 case； lymphadenitis occurred in 2 cases and pustular eruption in 2 cases. Pathogenic examination showed that there were 4 cases of mycobacterium infecton（50.0%）， including 3 cases of BCG infection and 1 case of Mycobacterium tuberculosis infection；staphylococcus aureus occurred in 1 cases（12.5%）；aspergillus fumigatus occurred in 1 case（12.5%）； aspergillusfumigatus and Candida albicans occurred in 1 case（12.5%）and burkholderia in 1 case（12.5%）. The activation rate of neutrophil respiratory burst assay in all cases was less than 20%. The type of gene mutation in seven cases was identified， including 6 males with X-linked gene mutation and 1 female with NCF2 gene mutation. Three cases died and 5 cases survived. Conclusion　CGD has the characteristics of early onset and high mortality and the pulmonary infection is most common. The abnormal reaction after BCG inoculation displays important implications for the diagnosis of CGD. Neutrophil respiratory burst assay and gene sequencing are helpful for early diagnosis.

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Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum：A report of 10 cases LUO Gang*， LIU Na， LIU Ai， et al 2020, 35(2): 132-136.  DOI: 10.19538/j.ek2020020612 Abstract ( )   Objective　To summarize and evaluate the clinical effect of ultrasound-guided fetal pulmonary valvuloplasty（FPV） in the treatment of intra-uterine pulmonary atresia with intact ventricular septum（PA/IVS）. Methods　From July 2018 to January 2019， 10 PA/IVS fetuses were successfully operated on by FPV in our hospital. The median gestational age was （27+3） weeks［（26+2）～（28+4） weeks］. To summarize and analyze the changes of the morphological and functional parameters， complications and fetal postnatal outcomes. Results　All 10 PA/IVS fetuses were successfully operated on by FPV under general anesthesia. Transient bradycardia was common in operation， and adrenaline or atropine was injected for some fetuses. Case 7 had sustained fetal bradycardia after FPV， and had termination of pregnancy. The remaining 9 fetuses were followed up for 2 weeks. Echocardiography showed that the fetal TV/MV， RV/LV， PV/AV and TID/CC increased from 0.81（0.44-0.88）， 0.56（0.52-0.80）， 0.69（0.58-1.00） and 0.35（0.26-0.43） before operation to 0.92（0.80-1.08）， 0.83（0.68-0.88）， 0.98（0.85-0.1） and 0.45（0.37-0.53）， the difference being statistically significant（P＜0.05）. The median speed of tricuspid regurgitation decreased from 3.9 m/s（3.2-4.6 m/s） before operation to 3.2 m/s（2.6-4.0 m/s）， and the difference was statistically significant（P＜0.05）. Cases 1 and case 5 with severe pulmonary stenosis after birth were treated with percutaneous balloon pulmonary valvuloplasty（PBPV） and PDA stenting. The transpulmonary pressure gradients were 55 mmHg（1 mmHg＝0.133 kPa） and 52 mmHg respectively in cases 2 and case 3 after birth；the arterial catheter was kept open and there was no surgical intervention at the early stage. The other fetuses were followed up regularly， and the related right ventricular indexes did not deteriorate. Conclusion　FPV technology is safe and effective for the fetuses at the early and middle stage of pregnancy. It can significantly relieve the pressure of right ventricle and increase the chance of biventricular circulation after birth，and even early intervention can be avoided. This technology is worth further application.

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Expression and significance of serum T helper 17 cells-related cytokines in pediatric patients with inflammatory bowel disease FANG Ying*，SUN Li-na，HAN Ya-nan，et al 2020, 35(2): 137-141.  DOI: 10.19538/j.ek2020020613 Abstract ( )   Objective　To investigate the expression levels and significance of serum Th17-related cytokines in pediatric patients with inflammatory bowel disease（IBD）. Methods　Serum from 40 children with IBD and 21 pediatric controls without inflammatory diseases admitted between April 2017 and May 2019 to the Affiliated Children’s Hospital of Xi’an Jiaotong University were collected. Serum levels of IL-17A，IL-17F，IL-21，IL-22 and IL-25 were determined by ELISA. Results　The serum levels of IL-17A，IL-17F，IL-21 and IL-22 were significantly increased in pediatric UC and CD patients，and levels of IL-25 were significantly decreased（P＜0.05）. The serum levels of IL-17A，IL-17F and IL-21 were positively correlated with disease activity index of pediatric UC patients（P＜0.05）. The serum levels of IL-21 in pediatric UC patients were positively correlated with levels of IL-17A and IL-17F（P＜0.05）. Conclusion　Th17-related cytokines are dysregulated in serum of pediatric IBD patients，which might help to further explore the role of Th17 cells in pediatric IBD development. The serum levels of IL-17A，IL-17F and IL-21 are positively correlated with disease activity index of pediatric UC patients，indicating that IL-17A，IL-17F and IL-21 might the triggers of pediatric UC by Th17 cells.

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Clinical study on the effect of sublingual immunotherapy for patients with allergic rhinitis of different severity PANG Chong*，LIANG Jie-qiong，LIU Chuan-he，et al 2020, 35(2): 142-146.  DOI: 10.19538/j.ek2020020614 Abstract ( )   Objective　To evaluate the clinical efficacy of sublingual immunotherapy（SLIT） in children with allergic rhinitis of different severity. Methods　Children with allergic rhinitis（AR） aged 3-14 years admitted between May 2017 and December 2017 to the Department of Otolaryngology，Affiliated Children’s Hospital，Capital Institute of Pediatrics，were divided into control group（n＝92，being given conventional drug therapy） and SLIT group（n＝89，being given dust mite immunotherapy） according to different treatment methods. According to the total nasal symptoms score（TNSS），the control group was divided into mild subgroup（n＝35），moderate subgroup（n＝28），and severe subgroup（n＝29）；SLIT was divided into mild subgroup（n＝27），moderate subgroup（n＝33） and severe subgroup（n＝29）. The children were followed up for 6 months，1 year and 2 years and the data of TNSS，total rhinitis medication scores（TRMS） and visual analogue scale（VAS） at each time point were collected. Results　（1）After 2 years of treatment，TNSS in the SLIT group and the control group was （0.61±0.73） and （1.61±1.17），TRMS was （0.21±0.41） and （0.59±0.70），and VAS was （0.63±0.70） and （1.53±1.24），respectively. There were significant differences between the two groups（Z values were 6.269，4.139 and 5.174，P＜0.05）. （2）Analysis in mild-subgroup（n＝62） showed that，comparing SLIT group（n＝27） with control group（n＝35），there was no significant difference in TNSS，TRMS or VAS in 6 months and 1 year after treatment（Z values were -0.108，0.232 and 0.788；0.774，0.033 and -0.718；P＞0.05）；TRMS and VAS had no statistical difference after 2 years of treatment（Z values were 0.230，1.255，P＞0.05），but there were significant differences in TNSS（Z values was 2.528，P＜0.05）. （3）Intra-group analysis in moderate subgroup（n＝61） showed that，comparing SLIT group（n＝33） with control group（n＝28），there was no significant difference in TRMS or VAS after 6 months of treatment（Z value was -0.413，0.412，P＞0.05），but TNSS had statistical difference（Z value was 2.397，P＜0.05）. There were significant differences in TNSS，TRMS and VAS between the two groups after 1 year and 2 years of treatment（Z values were 4.952，2.740 and 3.293；4.743，2.505 and 3.330；P＜0.05）. （4）Analysis in severe subgroup（n＝58） showed that comparing SLIT group（n＝29） with control group（n＝29），there were significant differences in TNSS，TRMS and VAS after 6 months，1 year and 2 years of treatment（Z values were 2.567，2.086 and 2.781；4.996，4.264 and 2.756；4.253，4.480 and 4.515；P＜0.05）. Conclusion　SLIT with standardized dust mite drops for 2 years in AR children can achieve better curative effect than symptomatic treatment alone，and children with severe symptoms of rhinitis will benefit more.

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Pseudo-Bartter syndrome in Chinese infants with cystic fibrosis and literature review：A report of 2 cases LI Zhi-chuan*，BAO Yan-min，CHI Qiao-mei，et al 2020, 35(2): 147-151.  DOI: 10.19538/j.ek2020020615 Abstract ( )   Objective　To summarize the clinical features of two cases of cystic fibrosis with pseudo-Bartter syndrome and review the literature. Methods　The clinical data of two cases of cystic fibrosis diagnosed in Department of Respiratory Medicine of Shenzhen Children’s Hospital from 2017 to 2018 were analyzed retrospectively. The clinical features of cystic fibrosis manifested in two cases of pseudo-Barter syndrome were reviewed and the related literature was reviewed. Results　Case 1，Male，one year old；Case 2，male，seven months old；They were repeatedly coughing and sputum at 2 months of age，accompanied by intermittent episodes of frequent vomiting，manifested as hyponatremia，hypokalemia，hypochloremia and metabolic alkalosis，presenting with pseudo-Bartter syndrome. Case 1 repeated 2 times，perennial steatorrhea，sweat test revealed elevated chlorid 102 mmol/L，the second generation sequencing confirmed the presence of CFTR gene complex heterozygous mutation（c.1423delC/c.1657C＞T），which derived respectively from her parents；Case 2 repeated 5 times，sweat test revealed elevated chlorid 91mmol/L and 97mmol/L，the second generation sequencing confirmed the presence of CFTR gene complex heterozygous mutation（c.595C＞T/ c.95T＞G），which derived respectively from her parents，were diagnosed with cystic fibrosis both. Literature review found that there were 11 cases of cystic fibrosis in patients with pseudo-Bartter syndrome in China，all of which were malnourished，10 had chronic or repeated respiratory infections，2 had chronic diarrhea，and most cases（9/11） occurred in the southern China and coastal areas，the median age of diagnosis was 11 months. Conclusion　Chinese children with pseudo-Bartter syndrome should be alert to cystic fibrosis when they have chronic respiratory tract infection. Sweat test and CFTR genetic analysis should be performed to confirm the diagnosis.

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Effect of Huaiqihuang Granules on serum levels of BAFF and IL-10 and immune function in the treatment of SLE children YANG Yong-chang，LIU Lei，ZHAO Cheng-guang，et al 2020, 35(2): 152-156.  DOI: 10.19538/j.ek2020020616 Abstract ( )

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Epidemiological changes of pertussis before and after the use of vaccines LIU Dan-dan，PAN Yue-na，JIAO An-xia，et al 2020, 35(2): 157-162.  DOI: 10.19538/j.ek2020020617 Abstract ( )

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Application progress in drug treatment for persistent pulmonary hypertension in the newborn CHEN Yi-xian，FU Jian-hua 2020, 35(2): 163-168.  DOI: 10.19538/j.ek2020020618 Abstract ( )