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06 December 2020, Volume 35 Issue 12 Previous Issue    Next Issue

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Expert consensus on the non-planned vaccination for children in special health status（I）——rotavirus vaccine Disease Prevention and Vaccination Group of Child Health Care Society of Chinese Preventive Medicine Association 2020, 35(12): 913-917.  DOI: 10.19538/j.ek2020120601 Abstract ( )

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Expert consensus on rational use of antimicrobial drugs in children with common wheezing diseases Pediatric Respiration Committee of Chinese Pediatric Doctor Association， Respiration Group of Chinese Association of Pediatricians，Editorial Committee of Chinese Journal of Practical Pediatrics 2020, 35(12): 918-926.  DOI: 10.19538/j.ek2020120602 Abstract ( )

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An introduction to the Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative GAO Heng-miao，QIAN Su-yun 2020, 35(12): 927-933.  DOI: 10.19538/j.ek2020120603 Abstract ( )   Anemia is a common manifestation in critically ill children. The transfusion of red blood cell（RBC） is a commonly used treatment in the Pediatric Intensive Care Unit（PICU）. While saving the lives of the children with critical illness，it also brings blood transfusion-related serious harm to the children. In order to promote reasonable RBC transfusion and reduce the serious hazards related to blood transfusion，Transfusion and Anemia Expertise Initiative（TAXI） panel work out the Consensus Recommendations for Red Blood Cell Transfusion Practice in Critically Ill Children. The consensus is composed of 12 independent articles：one of them is a summary of the consensus recommendations；eight of them deals with the recommendations on 9 specific subgroups respectively with general critical illness，respiratory failure，non-hemorrhagic shock，non-life-threatening hemorrhage or hemorrhagic shock，acute brain injury，acquired or congenital heart disease，hematologic and oncologic diseases，and those receiving extracorporeal membrane oxygenation/ventricular assist device renal replacement/support therapy；the other 3 are the choice and processing of RBC，the consensus recommendation methodology and the implementation of the recommendations respectively. There are 102 specific recommendations totally，of which 57 are clinical recommendations（20 evidence-based，37 expert consensus） and 45 are research recommendations. This article only introduces the clinical recommendations.

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Transfusion strategies for patients in pediatric intensive care units YANG Mei*，QIAN Su-yun 2020, 35(12): 934-937.  DOI: 10.19538/j.ek2020120604 Abstract ( )   Blood transfusion is an important method in clinical treatment，but in practice，there is still a lack of relevant strategies to guide transfusions in critically ill children. This paper discusses the blood transfusion strategies suitable for critically ill children from indications，risks and management，aiming to improve the pediatricians’ understanding of rationality and safety of transfusions.

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Development history and present situation of transfusion ZHAO Ying，LIU Chun-feng 2020, 35(12): 938-942.  DOI: 10.19538/j.ek2020120605 Abstract ( )   With the continuous development and progress of medical standard，blood transfusion has become a commonly used clinical treatment，and the development of blood transfusion medicine has experienced a long process of exploration. This paper briefly introduces the development history of blood transfusion medicine，expounds the main fields and professional contents of modern blood transfusion medicine，such as immunology of blood transfusion，component transfusion，autotransfusion and cross matching，and summarizes the clinical application of blood products，such as the threshold value of blood transfusion and relevant guidelines and suggestions.

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Transfusion-associated graft-versus-host disease LU Tong，WANG Ying 2020, 35(12): 942-947.  DOI: 10.19538/j.ek2020120606 Abstract ( )   Transfusion-associated graft-versus-host disease is a rare and fatal complication of blood transfusion. The possible main pathogenesis includes that donor T lymphocyte proliferation in blood，their engraftment and immune attack on tissues and organs of recipients. The main clinical features of TA-GVHD are pancytopenia and multiorgan failure（skin，liver，gastrointestinal tract，etc）. At present，there is no effective treatment for this disease. Currently，exposure of blood products to γ irradiation is commonly recognized prevention of TA-GVHD，and pathogen inactivation（PI） technology may be an alternative method. In this report，we mainly discuss the pathogenesis clinical characteristics，diagnosis and prevention.

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Transfusion-associated circulatory overload and transfusion-related acute lung injury DANG Hong-xing，XU Feng 2020, 35(12): 947-953.  DOI: 10.19538/j.ek2020120607 Abstract ( )   Transfusion-associated circulatory overload（TACO） and transfusion-related acute lung injury（TRALI） are common fatal complications in major surgery and the intensive care unit. TACO is characterized by cardiogenic（non-inflammatory） pulmonary edema，and TRALI is characterized by non-cardiogenic pulmonary edema. However，they have overlapping features，which makes the differentiation between the two difficult. There has been no specific treatment up to now. In this article，we briefly describe the concepts，epidemiology，pathophysiology，clinical features，diagnosis，and possible prevention and management of TACO and TRALI.

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Component transfusion or whole blood transfusion for children ZHOU Ji-hua，LU Guo-ping 2020, 35(12): 953-958.  DOI: 10.19538/j.ek2020120608 Abstract ( )   At present，component blood transfusion has been widely used in clinical practice，and whole blood transfusion is only used in a few clinical scenarios. The advantages of component blood transfusion are that it has good curative effect，small side effect，can save blood resources，and is convenient for preservation and transportation. Common components of transfusion products include red blood cells，platelets，fresh frozen plasma and cryoprecipitate. The purpose of this paper is to discuss the clinical problems involved in pediatric component transfusion，such as the selection of major blood components，indications，threshold，dosage，infusion speed and special requirements.

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Short and long term complications of blood transfusion ZHOU Yi-ping，ZHANG Yu-cai 2020, 35(12): 958-962.  DOI: 10.19538/j.ek2020120609 Abstract ( )   Blood transfusion is the most common therapeutic procedure performed in hospitalized patients，and some 15% of inpatients receive blood products during their stay. However， there are certain risks in blood transfusion，including acute blood transfusion reaction and delayed blood transfusion reaction，whose symptoms include chills，fever，rash，tachycardia，shortness of breath and restlessness. Approximately 1% of transfused products result in serious adverse reactions，including hemolytic transfusion reactions，anaphylactic shock and so on. During blood transfusion，patients should be carefully observed for any signs and symptoms of discomfort. Establishing a national blood warning system can reduce the incidence of adverse reactions caused by blood transfusion.

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Clinical features and prognosis of Mycoplasma pneumoniae bronchiolitis in children WEN Xiao-hui，XU Hui，TANG Xiao-lei，et al 2020, 35(12): 963-967.  DOI: 10.19538/j.ek2020120610 Abstract ( )   Objective　To summarize the clinical features and prognosis of Mycoplasma pneumoniae bronchiolitis in children and improve the understanding about the disease. Methods　Seventy-one children with Mycoplasma pneumoniae bronchiolitis were recruited from Beijing Children’s Hospital，who received treatment from March 2017 to March 2020. The clinical data of these children were retrospectively analyzed. Results　（1）The median onset age of the 71 children was 6.6 years. Fever（69/71，97.2%） and cough（97/97，100%） were the common symptoms，while wheezing（26/71，36.6%） and hypoxemia（28/71，39.4%） often occurred in some severe cases. Atopic background was positive in 58 patients（58/71，81.7%）. （2） The median WBC count in blood was 7.6×10^9/L. The level of CRP increased in 56 patients（56/71，78.9%） and the median level was 15mg/L. Reticulo-nodular infiltrate in chest X-ray was found in 29 patients（29/71，40.8%）. Centrilobular nodules and tree-in-bud pattern were the common chest HRCT features，and diffuse bronchiolitis was found in 25 patients（25/71，35.2%），while a little lung consolidation and atelectasis was also found in 27 patients（27/71，38.0%）. Electronic bronchoscopy lavage was conducted in 71 patients and diffuse and sick secretion was found in 6. （3）All patients were treated with azithromycin. Seventy patients（70/71，98.6%） were treated with systemic methylprednisolone. The maximum dose of methylprednisolone ranged from 1 mg/（kg·d） to 6 mg/（kg·d），and the median initiation time was on Day 10 and the median course was 14 days. All patients were followed up for 2.5 to 6 months；6 patients（6/71，8.5%） developed mild bronchiolitis obliterans，while the other 65 patients（65/71，91.5%） were cured. （4）The proportion of wheezing，hypoxemia and diffuse bronchiolitis in patients who developed BO was higher than that in patients who didn’t develop BO，and P value was 0.041，0.006 and 0.033，respectively. Conclusion　The children with Mycoplasma pneumoniae bronchiolitis often have atopic background. The lung HRCT shows diffuse lesion in lung，and the children who have wheezing and hypoxemia are more likely to develop BO.

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Clinical characteristics of severe adenovirus pneumonia and risk factors of concurrent bronchiolitis obliterans XU Xue-ping*，TIAN Man，GU Wei，et al 2020, 35(12): 968-972.  DOI: 10.19538/j.ek2020120611 Abstract ( )   Objective　To summarize the clinical characteristics of severe adenovirus pneumonia（SAP） and analyze the risk factors of concurrent bronchiolitis obliterans（BO）. Methods　The clinical data of 125 children with SAP admitted to the Department of Respiratory Medicine，Children’s Hospital of Nanjing Medical University，from January 2017 to December 2019 were retrospectively analyzed and the clinical features were summarized. The children were divided into BO group and non-BO group according to whether they developed BO，and the clinical data were analyzed. Results　A total of 80 cases（64%） had age of onset ≤ 24 months，115 cases（94.3%） had fever peak≥ 39℃，89 cases（72.9%） had fever duration ≥ 10 d，82 cases（65.6%） had asthma. Adenovirus infection alone was in 35 cases（28%），and 72% were infected with other pathogens［Mycoplasma pneumonia（MP） 40.8%，bacteria 35.2%］；32 cases（25.6%） had respiratory failure，and extrapulmonary complications were common in circulatory system（36%） and digestive system（22.4%）. Of the 125 children with SAP，122 were actually followed up，and 53（43.4%） eventually developed into BO. Multivariate Logistic regression analysis showed that respiratory failure and combined MP infection were independent risk factors for BO after SAP（P＜0. 05）. Conclusion　SAP mainly occurs in infants under 2 years of age，with high fever and long duration. Most children have wheezing and high rate of mixed infection. The most common complications are respiratory failure，cardiac insufficiency，liver function damage and toxic encephalopathy. Respiratory failure and combined MP infection are independent risk factors for BO after severe adenovirus pneumonia.

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Analysis of characteristics and predictors of Mycoplasma pneumoniae necrotizing pneumonia ZHUO Yu-fei*，LIU Jin-rong，LI Hui-min，et al 2020, 35(12): 973-976.  DOI: 10.19538/j.ek2020120612 Abstract ( )   Objective　To summarize the clinical manifestations，imaging characteristics and bronchoscopic changes in Mycoplasma pneumoniae necrotic pneumonia. Methods　All the patients included in the study were hospitalized from January 2013 to August 2017 in our department. Leukocytes count，neutrophils count，C-reactive protein，imaging characteristics and bronchoscopic changes in 22 Mycoplasma pneumoniae necrotizing pneumonia patients were retrospectively analysed and compared with 16 necrotic bacterial pneumonia patients. Results　The neutrophil count and CRP value ??of Mycoplasma pneumoniae necrotizing pneumonia patients within the first 3 days after the onset of fever were（74.62±5.78）% and （58.0±25.8） mg/L respectively，which were significantly lower than those of necrotic bacterial pneumonia［neutrophil count at （88.0±3.15）% and CRP at （164.5±96.6） mg/L］，with P＜0.001. In both groups，neutrophil account and CRP value were significantly elevated in the 4th to 7th day after the onset of fever［neutrophil count at （83.6±6.91）% and （87.68±2.89）%，CRP at （142.3±57.2） mg/L and （155.0±39.5） mg/L respectively］，and no significant difference was found between them with P＞0.05. The white cell account in children with Mycoplasma pneumoniae necrotizing pneumonia didn’t increase within the first 7 days of disease onset. In Mycoplasma pneumoniae necrotizing pneumonia，consolidation of a whole lobe （or nearly a whole lobe） appeared on the 4th to 11th day after disease onset，while in necrotic bacterial pneumonia it appeared within the first 5 days. The necrosis of lung tissue occurred after 2 weeks of disease onset in Mycoplasma pneumoniae necrotizing pneumonia and within 10 days in necrotic bacterial pneumonia. Mucus plug obstruction and mucosal necrosis were found under bronchoscopy in necrotic mycoplasma pneumonia，and more than half of them developed bronchial obstruction，which was not found in bacterial pneumonia. Conclusion　Characteristics of Mycoplasma pneumoniae necrotizing pneumonia include increase of neutrophil count，increase of CRP and consolidation of whole lobe in the 4th to 7th day of disease onset，while there is no increase of white cell count；there is little lung tissue necrosis within 2 weeks of disease onset；there exists mucosal necrosis under bronchoscopy，and later bronchial obstruction is likely to occur.

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Analysis of blood lipids and its influencing factors in children with recent-onset type 1 diabetes GONG Ming，XIN Ying 2020, 35(12): 977-981.  DOI: 10.19538/j.ek2020120613 Abstract ( )   Objective　To analyze the blood lipid status of  newly diagnosed T1DM children and to study its influencing factors. Methods　The clinical data were collected from 348 patients with recent onset type 1 diabetes who were treated between Jan.1，2012 and Dec.31，2017 in our hospital，and the differences in serum lipids between T1DM children and 40 controls were compared. Children with T1DM were divided into two groups according to their blood lipids level：normal blood lipid group（n＝153） and dyslipidemia group（n＝195），the differences in blood lipid between the two groups of children were compared. According to the level of HbA1c，the children were divided into three groups：HbA1c＜11.5%（n＝116），11.5%-13.5%（n＝109） and HbA1c＞13.5%（n＝123），the differences in blood lipid among the three groups were compared. Results　1. TC，TG，LDL and ApoB were significantly higher in children  with T1DM than those in the control group，while HDL and ApoA1 were significantly lower. The results were：TC（mmol/L）（4.29±1.07 vs. 3.85±0.67，P＜0.05），TG（mmol/L）（1.29±1.40 vs. 0.82±0.50，P＜0.01），LDL（2.61±0.91 vs. 2.17±0.57，P＜0.01），etc. 2. The incidence of dyslipidemia in children with T1DM was 56.03%，HbA1c（%） was significantly higher in the dyslipidemia group than in the normal lipid group（12.93±2.16 vs. 12.10±2.37，P＜0.01）. 3. The patients with larger HbA1c had significantly higher TC，TG and LDL. The results were：TC（mmol/L）（3.96±0.78 vs. 4.12±0.94 vs. 4.75±1.25，P＜0.01），TG（mmol/L）（0.91±0.50 vs. 1.38±1.72 vs. 1.56±1.60，P＜0.01），LDL（mmol/L）（2.34±0.72 vs. 2.38±0.73 vs. 3.05±1.03，P＜0.01），etc. Conclusions　The incidence of dyslipidemia is significantly higher in children with T1DM than in normal children. The higher the blood glucose level，the more severe the dyslipidemia.

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Clinical application of PICADAR score in children with chronic wet cough WEI Jian-hua*，FAN Jing-chuan，LUO Jian，et al 2020, 35(12): 982-987.  DOI: 10.19538/j.ek2020120614 Abstract ( )   Objective　To analyze the clinical application of PICADAR score in children’s chronic wet cough. Methods　Retrospective analysis was performed on 42 cases of inpatients with chronic wet cough treated in our hospital from January 2015 to December 2018；they had a course up to 3 monthsand received parallel ciliary ultrastructure examination by transmission electron microscope（TEM），and the PICADAR score，the clinical characteristics，diagnosis and treatment of the cases were summarized. Results　6（14.3%） patients in high PICADAR score group（> 5） and 36（85.7%） patients in the low score group（≤5）. One patient was diagnosed with primary ciliary dyskinesia（PCD） in the high score group，who had normal cilia ultrastructure，but none in the low score group. The level of procalcitonin in the high score group was significantly lower than that in the low score group（P＝0.044），and the length of hospital stay in the high score group was significantly prolonged（P＝0.008）. Among 27 children with abnormal cilia ultrastructure，10（37.0%） had secondary cilia damage（SCD）. Conclusion　When the course of children with chronic wet cough reaches 3 months and the treatment effect is not good，the PICADAR score can help to predict PCD and evaluate the necessity of further genetic testing，which is more efficient than TEM cilia ultrastructure examination.

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Pulmonary cryptococcosis in children with normal immune function：A report of 1 case QIU Wei-ling，WANG Ying-shuo，ZHOU Yun-lian，et al 2020, 35(12): 988-989.  DOI: 10.19538/j.ek2020120615 Abstract ( )

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Necrotizing pneumonia due to influenza A virus and bacteria infection with good prognosis：A report of 1 case WANG Wen-yu，XU Yong-sheng，GUO Wei，et al 2020, 35(12): 990-992.  DOI: 10.19538/j.ek2020120616 Abstract ( )