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06 March 2020, Volume 35 Issue 3 Previous Issue    Next Issue

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1st of the recommendations series of experts on clinical practical hot issues of children’s immune related diseases——Application of methotrexate for pediatric rheumatic diseases of in China Pediatric Allergy Immunology Rheumatology Branch of Asia-Pacific Association of Medicine and Bio-Immunology，Editorial Committee of Chinese Journal of Practical Pediatrics 2020, 35(3): 169-173.  DOI: 10.19538/j.ek2020030601 Abstract ( )

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2nd of the recommendations series of experts on clinical practical hot issues of children’s immune related diseases——Expert recommendations on diagnosis and treatment of pediatric connective tissue disease-related interstitial lung disease in China Pediatric Allergy Immunology Rheumatology Branch of Asia-Pacific Association of Medicine and Bio-Immunology，Editorial Committee of Chinese Journal of Practical Pediatrics 2020, 35(3): 174-179.  DOI: 10.19538/j.ek2020030602 Abstract ( )

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Consensus on the screening for hereditary metabolic diseases in preterm，low-birth-weight and sick children Quality Assessment Committee of Newborn Screening for Hereditary Metabolic Diseases，the Clinical Testing Center，National Health Commission 2020, 35(3): 180-184.  DOI: 10.19538/j.ek2020030603 Abstract ( )

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Interpretation of the norms for the diagnosis and treatment of children’s community-acquired pneumonia 2019 LIU Jin-rong，ZHAO Cheng-song，ZHAO Shun-ying 2020, 35(3): 185-187.  DOI: 10.19538/j.ek2020030604 Abstract ( )   Children’s community-acquired pneumonia（CAP） is the most common disease in children in China. At present，it faces the following problems：CAP is one of the main causes of death in children under 5 years of age；severe mycoplasma and adenovirus pneumonia can result in such sequelae as airway occlusion，causing chronic lung disease in children；empirical judgment of pathogens and initial treatment are inadequate，affecting prognosis. For this reason，the National Health Commission of the People’s Republic of China organizes multidisciplinary experts to formulate norms with a view to reduce CAP mortality and sequelae in children and reduce the irrational use of antibiotics. In this article the background and content of the norms，CAP definition and diagnosis and treatment ideas， especially CAP diagnosis and treatment norms are interpreted.

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Attach importance to the standard diagnosis and treatment and clinical research of pneumonia due to adenovirus in children LIU En-mei，FU Zhou 2020, 35(3): 188-190.  DOI: 10.19538/j.ek2020030605 Abstract ( )   Human adenovirus（HAdV） is a non-coated double-stranded DNA virus that is the most common viral pathogen causing severe pneumonia in infants aged 6 months to 2 years. A number of children with severe HAdV pneumonia have been found in many regions of China since 2019，which poses a serious threat to the life and health of children. This paper introduces HAdV genotypes，epidemic trends，disease severity，pathogenic mechanism，and early diagnosis and intervention，treatment methods and so on in children with HAdV pneumonia.

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Reflections on some problems of individual precise treatment for asthma in children KANG Xiao-hui，CAO Ling 2020, 35(3): 191-195.  DOI: 10.19538/j.ek2020030606 Abstract ( )   Asthma is the most common chronic respiratory disease. The specialists are increasingly advocating precise treatment. There are many phenotypes of asthma：onset age， trigger factors，severity，medical?treatment response，etc.，but the phenotype is too rough to guide the treatment of asthma. There are also endotypes of asthma（also known as molecular phenotypes）， which reflect the characteristics observed in the phenotype through some special biomarkers. Among them，induced sputum eosinophil count，exhaled nitric oxide（FeNO），bronchial hyperresponsiveness and so on，are very important biomarkers，which can guide personalized treatment. In addition，according to gene mutation，abnormality and polymorphism，asthma genotypes are classified. Theoretically，this classification is the most accurate way to guide the precise treatment. However，due to the gene polymorphism，the accuracy of detection technology，the correlation between gene variation and clinics，and other factors outside the body，it is not easy to directly use gene sequencing results analysis to guide clinical practice.

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Methodological recommendation for clinical comprehensive evaluation of pediatric respiratory drugs WANG Xiao-ling 2020, 35(3): 195-198.  DOI: 10.19538/j.ek2020030607 Abstract ( )   Because there are many problems in using respiratory medicine in children，it is urgent to carry out comprehensive clinical evaluation to determine the most appropriate therapeutic drugs or treatment programs，and to provide data basis for the government to make drug selection and other decisions. The methodology of comprehensive clinical evaluation of pediatric respiratory medicine includes the following five parts：（1）subject selection；（2）evaluation dimension；（3）evaluation method and data source；（4）report of evaluation result；（5）result review and transformation. In the future，more attention should be paid to the establishment of guidelines to promote the comprehensive clinical evaluation of pediatric respiratory medicine based on real-world data.

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Advances in the treatment of rare diseases involving the respiratory system in children WANG Hao，XU Bao-ping 2020, 35(3): 198-202.  DOI: 10.19538/j.ek2020030608 Abstract ( )   Rare diseases refer to a group of diseases with very low incidence and prevalence in the population or involving a small number of patients，most of which are related to genetic factors. About 50% of the diseases occur during childhood，and most are life long. Some of these diseases mainly involve the respiratory system or begin with respiratory symptoms，such as cystic fibrosis，combined immunodeficiency，pulmonary alveolar proteinosis，etc. Symptomatic treatment is the basic treatment for these diseases. In recent years，with the rapid development of medicine，more and more pathogenesis is clarified. Treatments for rare diseases also have great progress. Some patients can get more targeted treatments，such as molecular orthodontic treatment，alternative treatment，gene therapy，etc.，which help the patients prolong survival time and improve the quality of life.

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Rational administration of medicine for recurrent respiratory tract infections in children CHEN Li-na*， LIU Han-min 2020, 35(3): 202-206.  DOI: 10.19538/j.ek2020030609 Abstract ( )   Recurrent respiratory tract infections（RRTIs） are very common in children with multiple episodes which interfere with growth and development. Not every pediatrician is aware of this condition and can manage it well. Early recognition of this modality and finding possible etiology are prerequisites to correct management. Pediatricians should perform medication rationally and take good care of those children with RRTIs.

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Problems and norms of drug treatment of common cold in children CHENG Qi，SHANG Yun-xiao 2020, 35(3): 206-209.  DOI: 10.19538/j.ek2020030610 Abstract ( )   The common cold is the most common upper respiratory tract infectious disease in children，and it’s also the most prone to drug abuse in pediatrics. This article analyzed the problems of abuse of antibiotics，antivirals，medicines for common cold，traditional Chinese medicines and proprietary Chinese medicines，and unreasonable treatment methods，etc.，proposed the importance of standardized treatment，and gave guidance on how to use drugs rationally. Doctors，pharmacists，and parents need to understand the common cold correctly. Misunderstandings and drug abuse should be avoided when choosing medicines for common cold.

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Drug therapy for chronic cough in children XU Xiu-juan，LUO Zheng-xiu 2020, 35(3): 209-212.  DOI: 10.19538/j.ek2020030611 Abstract ( )   Chronic cough is one of the most common symptoms in childhood. Recurrent and prolonged cough may affect the growth and development of children and the life qualities of families. However，the managements of chronic cough in children remain diversities. Pediatricians should evaluate chronic cough comprehensively to choose drugs reasonably. The treatment principle of chronic cough is etiological treatment. Symptomatic treatment should be used cautiously before etiologies were identified. Pediatrician should pay attention to the principle of observation，and waiting follow-up，and pay attention to the diagnostic treatment for related causes and the reevaluation after treatment.

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Clinical multicenter study of budesonide?inhalation in the treatment of bronchiolitis WANG Tian-yue*，SHANG Yun-xiao， FAN Ying-hong， et al 2020, 35(3): 213-216.  DOI: 10.19538/j.ek2020030612 Abstract ( )   Objective　To make clear the therapeutic effect of budesonide inhalation on mild or moderate bronchiolitis. Methods　A multicenter， randomized， controlled clinical trial was conducted. Totally 209 infants with bronchiolitis from 18 pediatric respiratory centers in China were selected and were randomly divided into 3 groups： the control group， the budesonide treatment group 1（0.5 mg /time） and the budesonide treatment group 2（1.0 mg /time）. There was no statistical difference in the basic data of children concerning age，gender，course of disease，WBC count on admission，C-reactive protein（CRP）or severity of disease（P＞0.05）. After treatment， the three groups were given scores regarding the severity of gasping， coughing， wheezing， bubbling rales， and three concave signs. Results　On the first day of treatment，scores were given every 2 hours； on the second day，scores were given every 4 hours； on the 3rd to 7th day， scores were given every 6 hours. There was no significant difference among the three groups in the scores given at each of the above time points（P＞0.05）. Conclusion　Budesonide?inhalation does not effectively reduce the clinical symptom score in children with mild or moderate bronchiolitis.

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Comparison of the diagnostic values of two criteria for the diagnosis of hypertrophic cardiomyopathy in children SHAN Guang-song*，WANG Ben-zhen，GUO En-yu，et al 2020, 35(3): 217-221.  DOI: 10.19538/j.ek2020030613 Abstract ( )   Objective　To compare the diagnostic results and values of two criteria for hypertrophic cardiomyopathy（HCM） in children：Expert Consensus on the Diagnosis of Children Hypertrophic Cardiomyopathy in China（Served as domestic criteria） and 2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy（Served as ESC guidelines）. Methods　The clinical data of 67 patients with HCM who were treated in Qingdao Women and Children’s Hospital from June 2015 to June 2019 were retrospectively analyzed. The diagnosis was made respectively according to the domestic criteria and ESC guidelines，and the results were set as confirmed or excluded. The ECG and genetic testing results were used as the gold standard to compare the sensitivity，specificity and accuracy of the two criteria for the diagnosis of HCM. Results　For the entire group of cases，20 cases were older than 1 year old，and 47 cases were younger than 1 year old. Genetic testing was performed in 22 children（32.8%），and genetic variation was confirmed in 20 children. Based on the echocardiography and genetic testing，36 cases were diagnosed as HCM and others were excluded. According to ESC guidelines，48 cases were diagnosed，but 12 cases were misdiagnosed. Based on domestic criteria，34 cases were diagnosed，and 2 cases were missed，no misdiagnosis. The sensitivity and specificity were 94.4% and 93.5% respectively for domestic criteria，and for ESC guidelines，they were 100.0% and 61.3%；the accuracy was 97.0% for domestic criteria and 82.1% for ESC guidelines. The Youden index had significant difference between domestic criteria and ESC guidelines（U＝2.92，P＜0.01）. For the cases younger than 1 year old，the sensitivity and specificity were 100.0% and 53.8% for ESC criteria，while for domestic guidelines，they were 90.5% and 100.0%，and the accuracy was 76.6% for ESC criteria and 95.7% for domestic guidelines. The Youden index had significant difference between ESC criteria（0.538） and domestic guideline（0.828）（U＝2.87，P＜0.01）. For the cases older than 1 year old，the sensitivity，specificity and accuracy in the two groups were all 100%. Conclusion　The domestic criteria is better than the ESC guidelines，which significantly improves the specificity and accuracy of diagnosis in HCM children. Therefore，the domestic criteria is more suitable for the diagnosis of HCM children in China.

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Correlation between levels of fractional exhaled nitric oxide and peripheral blood IL-9、IL-17 in children with bronchial asthma MA Yu，DAI Yin-fang，ZHANG Xin-xing，et al 2020, 35(3): 222-227.  DOI: 10.19538/j.ek2020030614 Abstract ( )   Objective　To analyze the correlation between FeNO values of different levels in children with bronchial asthma and IL-9，IL-17 in peripheral blood. Methods　A total of 80 children diagnosed with asthma，who were admitted to the Outpatient Department of Children’s Hospital of Soochow University from October 2017 to June 2019，and 20 normal control children from the physical examination center were randomly selected. According to the FeNO value of 25×10-9，children with asthma were divided into FeNO≥25×10-9 group（FeNO high group） and FeNO＜25×10-9 group（FeNO low group）. The levels of IL-4，IL-5，IL-9 and IL-17 in the serum of each group were detected by ELISA kit，and the lung function indexes were detected in each group，including FEV1/FVC%，MEF25，MEF50 and MEF75. The correlation between FeNO levels of children with asthma and IL-4，IL-5，IL-9，IL-17 as well as lung function indexes in peripheral blood was analyzed. Results 　The levels of IL-4，IL-5，IL-9 and IL-17 in peripheral blood of children with FeNO≥25×10-9 were higher than those of FeNO＜25×10-9 group and control group，while those of FeNO＜25×10-9 group were also higher than those of the control group，the differences being statistically significant（P＜0.05）. The lung function indexes of children in FeNO≥25×10-9 group and those in FeNO＜25×10-9 group were lower than those in the control group（P＜0.05）. There was no difference in lung function indexes between children with FeNO≥25×10-9 and those with FeNO＜25×10-9（P＞0.05）. Pearson correlation analysis showed that FeNO level was positively correlated with IL-4，IL-5，IL-9 and IL-17 in peripheral blood（P＜0.05），and had no correlation with lung function indexes（FEV1/FVC%，MEF25，MEF50 and MEF75）（P＞0.05）. Conclusion　The level of FeNO is positively correlated with IL-9 and IL-17 in peripheral blood. FeNO and IL-9，IL-17 together with other cytokinescan jointly reflect airway inflammation，and can reflect the children’s condition with asthma more sensitively than lung function indexes.

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Analysis of clinical data of 158 patients with methylmalonic acidemia in Children’s Hospital Affiliated to Zhengzhou University WU Sheng-nan，CHEN Qiong，CHEN Yong-xing，et al 2020, 35(3): 228-232.  DOI: 10.19538/j.ek2020030615 Abstract ( )   Objective　To analyze the clinical and genetic characteristics of child patients with methylmalonic acidemia（MMA） in Children’s Hospital Affiliated to Zhengzhou University. Methods　The clinical characteristics and genetic mutations of 158 patients were retrospectively studied，who were treated in Children’s Hospital Affiliated to Zhengzhou University from June 2013 to March 2018. The genotyping，treatment and follow-up were made based on chemobiological results. Results　The onset age of these 158 patients ranged from 1 day to 13 years old. Twenty-eight patients（17.7%） were diagnosed with isolated MMA，while the other 130 cases（82.3%） were suffering from MMA combined with homocysteinemia. Among 76 patients（48.1%） diagnosed through newborn screening，forty-two cases had no obvious symptom related to acute metabolic disorder and 20 of them had normal psychomotor development. Twenty-two children had retarded development in motor and language. Thirty（88.2%） of 34 symptomatic patients appeared abnormal clinical presentations within the first year. Eighty-two cases（51.9%） were clinically diagnosed，and 60 of them（56.9%） had first onset in infancy. The first clinical manifestations were，in turn，feeding difficulty，lethargy，vomiting，difficulty in weight gain and convulsion. Totally 126 patients accepted gene testing，among which a total of 200 MMACHC mutations were detected in 103 cases（81.7%）. The most common mutations were c.609G＞A（p.W203X），then was c.80A＞G（p.Q27R）. Totally 46 MUT mutations were found in 23 cases（18.3%），and the most common mutation was c.1106G＞A（p.r369h）. Conclusion　In Children’s Hospital Affiliated to Zhengzhou University，MMA combined with homocysteinemia is the most common type，in which the pathogenic gene is MMACHC. Mutation c. 609G＞A（p.W203X） and c.80A＞G（p.Q27R） may be the hot spot mutations in Henan. More cases are diagnosed through newborn screening. While their prognosis is relatively better，most clinically diagnosed patients suffer from psychomotor retardation.

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Study on distribution of children’s laryngopharyngeal reflux in respiratory diseases ZENG Hui-qin，HU Zhi-fan，WU Jin-zhun 2020, 35(3): 233-236.  DOI: 10.19538/j.ek2020030616 Abstract ( )   Objective　To study the morbidity and distribution characteristics of laryngopharyngeal reflux in respiratory diseases. Method　To review and analyze the clinical data of 97 children with poor routine treatment in pediatric respiratory specialty of the first affiliated hospital of Xiamen University from December 2015 to December 2017，and to monitor the throat pH 24 h all children. Analysis using SPSS20 statistical software. Result　（1）Finally，97 patients were included，and the detection rate of LPR was 55.67%. （2）The clinical symptoms of children with laryngopharyngeal reflux were as follows：cough， wheezing，phlegm sound，runny nose，stuffy nose and clear mulberryal. Initial diagnoses included pneumonia，allergic rhinitis and sinusitis，asthma，chronic cough，tracheomalacia，et al. （3）There was a statistically significant difference in the detection rate of laryngopharyngeal reflux in different respiratory diseases（χ2＝9.107，P＝0.011）. The detection rate in the pneumonia group was higher than that in the asthma group（χ2＝7.583，P＝0.006），and the asthma group was higher than the tracheomalacia group（χ2＝4.44，P＝0.035）. Conclusion　The detection rate of children’s laryngopharyngeal reflux in children’s respiratory diseases is high. The clinical manifestations are diverse and non-specific.Clinical attention should be paid to LPR of children with respiratory diseases.

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Present status of family education on cough in children ZHANG Jing，YIN Yong 2020, 35(3): 237-241.  DOI: 10.19538/j.ek2020030617 Abstract ( )

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Childhood-onset relapsing polychondritis treated for dyspnea：One case report and literature review CUI Fei-fei，CAO Ling 2020, 35(3): 242-245.  DOI: 10.19538/j.ek2020030618 Abstract ( )

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Glycogen storage disease type IXa caused by PHKA2 mutation with the primary manifestation of intermittent bloody stool：One case report SUN Man-qing，LU Wen-li，WANG Wei，et al 2020, 35(3): 246-248.  DOI: 10.19538/j.ek2020030619 Abstract ( )