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06 December 2021, Volume 36 Issue 12 Previous Issue    Next Issue

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Expert consensus on home treatment for hemophilia in children Pediatric Group of HTCCNC 2021, 36(12): 881-889.  DOI: 10.19538/j.ek2021120601 Abstract ( )

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Diagnosis and treatment guidelines to tumor lysis syndrome in children Pediatric Tumor Committee of China Anti-Cancer Association 2021, 36(12): 890-896.  DOI: 10.19538/j.ek2021120602 Abstract ( )

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Expert consensus on joint treatment for children with upper airway inflammation Ear-Nose-Throat Committee of Chinese Association of Pediatricians, Pediatric Allergy Committee of Chinese Maternal and Child Health Association 2021, 36(12): 897-903.  DOI: 10.19538/j.ek2021120603 Abstract ( )

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Causes and prevention of digestive foreign bodies ingestion in children MEI Tian-lu, WU Jie 2021, 36(12): 904-908.  DOI: 10.19538/j.ek2021120604 Abstract ( )   Foreign body ingestion in children is a common accident，which may cause serious complications and affect the children’s health. This paper introduces the causes and preventive measures of foreign body ingestion in children. The causes of disease include children’s limited cognitive ability，the children being lively and active，the supervisor’s neglect of supervision，the lack of relevant knowledge and awareness of prevention of gastrointestional foreign bodyes. In order to effectively prevent the occurrence of foreign bodies ingestion in children，it is crucial to establish a list of dangerous articles and clear signs，strengthen publicity and education and improve the awareness of children，guardians and the whole society about fordign bodies in children’s digestive tract.

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Principles of endoscopic treatment for digestive foreign bodies in children FANG Ying 2021, 36(12): 908-912.  DOI: 10.19538/j.ek2021120605 Abstract ( )   Foreign body of digestive tract is one of the common diseases in pediatric emergency department. In mild cases，there may be no symptoms and the foreign bodies can be naturally discharged，while in serious cases，there may be life-threatening complications such as digestive tract perforation and aortoenteric fistula. The diagnosis can be made according to the history，clinical manifestations，auxiliary examinations，etc. Once the diagnosis digestive foreign body is made，different treatment measures should be adopted according to the type，retention location，ingestion time，complications，etc. At present，endoscopic removal of foreign bodies in the digestive tract is an effective treatment method，and standardized and reasonable treatment principles are the premise and guarantee for doctors to formulate treatment plans for children.

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Surgical treatment for digestive foreign bodies in children HOU Chong-zhi, FANG Ying 2021, 36(12): 912-916.  DOI: 10.19538/j.ek2021120606 Abstract ( )   The foreign body of digestive tract refers to objects that are trapped in the digestive tract and can not be absorbed by the digestive tract after oral intake. It is one of the comon emergencies in children，which can cause serious harm to children’s health. Usually，the diagnosis can be made clear through the medical history，clinical manifestations and X-rayexamination，and some special foreign bodies need to be found by CT examination or digestive endoscopy. Endoscopic treatment has been the primary diagnosis and treatment means of foreign bodies in the digestive tract，but surgery is also a necessary treatment measure for patients with failed endoscopic treatment and serious complications. Through the comprehensive analysis of the nature and size of the foreign body，retention time，intraoperative situation and other related factors，a personalized treatment plan can be formulated.

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Management principles of foreign bodies like fruit cores in children’s digestive tract WANG Yue-sheng, LI Xiao-qin 2021, 36(12): 916-920.  DOI: 10.19538/j.ek2021120607 Abstract ( )   Foreign body ingestion mostly occurs in children aged 6 months to 6 years，and most objects can be excreted naturally. Among these，the incidence of accidental ingestion of sharp fruit core is very high among children in our country；especially，sharp fruit core stuck in the esophagus needs to be identified early and treated urgently. If not diagnosed and treated in time，severe esophageal perforation or fistula may occur，infringing on the aortic arch，or even being life-threatening．Therefore，it’s important to strengthening the education of foreign bodies in the digestive tract to prevent children from mistakenly ingesting special foreign bodies such as sharp fruit core and to give standardized management，which plays a vital role in the prevention and management of special foreign objects such as sharp fruit core in the digestive tract.

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Treatment principles of special foreign bodies like button battery in children’s digestive tract OUYANG Hong-juan, YOU Jie-yu 2021, 36(12): 920-924.  DOI: 10.19538/j.ek2021120608 Abstract ( )   Foreign body in the digestive tract refers to all kinds of objects that cannot be digested and cannot be discharged in time from the body，which stay in the digestive tract cavity and cause a certain damage to the digestive tract. A foreign body in digestive tract is a common digestive emergency. If not treated promptly，it will cause serious complications（such as bleeding，perforation，et al） and even death. For corrosive in foreign bodies digestive tract——button battery，timely diagnosis and appropriate treatment are particularly important，which can effectively reduce the incidence of related complications. This paper provides an over view of the diagnosis and treatment of special foreign bodies like button battery in children’s digestive tract.

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Management principles of foreign bodies in digestive tract: Magnetic foreign body ingestion CHEN Jie 2021, 36(12): 924-926.  DOI: 10.19538/j.ek2021120609 Abstract ( )   Foreign body ingestion is a common cause of pediatric emergency. In the past 20 years，the incidence of magnet foreign body ingestion has been increasing. Although magnets are not common among all foreign bodies swallowed by children，magnetic foreign bodies，especially neodymium iron boron（NdFeB） magnetic beads can attract each other through the intestinal ring，causing intestinal necrosis，intestinal obstruction，perforation，peritonitis and death. This article presents the background and mechanism of magnet ingestion injury，as well as the recommended treatment methods and potential complications.

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Principles of perioperative management of endoscopy for digestive foreign body in children REN Xiao-xia 2021, 36(12): 926-929.  DOI: 10.19538/j.ek2021120610 Abstract ( )   Digestive foreign body in children is one of the most common emergencies in pediatric clinic. It is one of the main causes of accidental injury of children. With the popularization and development of digestive endoscopy technology in pediatrics across the country，standardized perioperative management is helpful for beginners to shorten the learning curve and reduce the occurrence of complications. This paper will introduce in detail the perioperative management related to digestive endoscopy for the treatment of foreign bodies in the digestive tract，such as equipment，preoperative examination，informed consent，preoperative preparation of patients，operating room layout，possible difficulties encountered during the operation and corresponding measures，postoperative management and follow-up. The perioperative management principles cover a comprehensive range of contents，which contributes to the safe and standardized performance of endoscopic surgery for gastrointestinal foreign body，and provides certain clinical basis and help for primary pediatricians and beginners of endoscopy.

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Study on the incidence of malposition of endotracheal tube in accordance with the PALS guidelines and the formula to predict endotracheal tube insertion depth in children SHEN Yue-tong, WU Bo, XU Wei 2021, 36(12): 930-935.  DOI: 10.19538/j.ek2021120611 Abstract ( )   Objective　To determine the accuracy of the standard techniques for estimating the endotracheal tube insertion depth in children，including the formula from PALS guiding，the clinical evaluation method with auscultation of bilateral breathing and observation of chest fluctuation，then to forma more feasible predictive formula for clinical practice. Methods　we retrospectively collected a total of 177 children with oral endotracheal intubation who were treated from January 2018 to July 2019 in the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University. Theage，gender，and weight of the child for the initial intubation after admission，the intubation depth calculated according to the PALS guideline formula，the actual insertion depth after clinical evaluation，and the distance from the tip of ETT to the lower edge of the second thoracic vertebra and to the carina were documented. The above data were statistically analyzed. Results　About 74.01% tubes that adhered to PALS guideline depth were malpositioned. After clinical evaluation，the ETT malposition rate decreased from 74.0% to 55.9%，which meant that clinical evaluation was of significance to ETT adjustment. A new formula was proposed：in children≤2 year old，11 cm for infants aged 1-5 months，12 cm for infants aged 6-11 months and 13 cm for infants aged 12-23 months were used as the ETT referenced depth children over 2 years：intubation depth（cm）＝age（years）×0.7+12. Conclusion　The rate of malpositioned endotrache tubes adhered to PALS guidelines is high. The rate of proper positioned endotracheal tubes can be improved after the clinical evaluation of auscultation and chest fluctuation. The PALS guideline underestimates the best depth of ETT for children equal to and older than 2 years. The new formula has yet to be verified.

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CT imaging features of paranasal sinuses in children with primary ciliary dyskinesia LYU Hui-ying, GUO Zhuo-yao, PAN Li-li, et al 2021, 36(12): 936-940.  DOI: 10.19538/j.ek2021120612 Abstract ( )   Objective　to study the CT imaging features of paranasal sinuses in children with primary ciliary dyskinesia（PCD）. Methods　A retrospective study was performed on children with PCD receiving treatment from July 2018 to March 2021 in Children‘s Hospital of Fudan University. Data included medical history，paranasal sinus computed tomography（CT） scans，nasal endoscopy，chest radiography，chest CT，echocardiography，abdominal ultrasound and genetic tests，etc. Paranasal sinus CT scans were assessed and scored according to the Lund-Mackay staging system. The Lund-Mackay score was compared between PCD patients and patients receiving functional endoscopic sinus surgery（FESS） for chronic rhinosinusitis（CRS）. The correlation between age and the Lund-Mackay score was analyzed using Spearman’s correlation. Results　24 children with confirmed PCD visited in our ENT department. Paranasal sinus CT scans of 21 children were obtained and included in the final analysis，including 15 males and 6 females，aged from 1 to 17 yrs，with a mean age of（7.4±4.3） yrs. Among these patients，21 patients（100.0%） had paranasal sinusitis，4 patients（19.0%） had adenoid hypertropy，and 18 patients（85.7%） had otitis media. Five patients were given nasal endoscopy，but none had nasal polyps. 11 patients（52.4%） had situs inversus. Elevenpatients（52.4%） had lung consolidation and pulmonary atelectasis. eight patients（38.1%） had different degrees of bronchiectasis. Twelve patients（57.1%） had a history of neonatal respiratory distress，and only 1 patient was born prematurely. One patients（4.8%） had atrioventricular septal defect. Mean Lund-Mackay score in children with PCD was 15.1±3.8，while mean Lund-Mackay score in CRS patients was 12.1±6.0，the difference being statistically significant（P＜0.05）. The inflammation was most severe at the ostiomeatal complex. Compared with CRS patients，PCD patients had higher Lund-Mackay scores at the ostiomeatal complex，sphenoid sinus and posterior ethomoid sinus（P＜0.05）. There was a negative correlation between patients’age and the Lund-mackay score（r＝-0.5270，P＜0.05）. Conclusion　Most pediatric patients with PCD suffer from chronic paranasal sinusitis. Compared with ordinary CRS patients，PCD patients suffer from more severe sinusitis，especially at posterior ethomoid sinus.It is suggested clinicians pay attention to patients with intractable sinusitis and recurrent lower respiratory tract infections，or to those full-term neonates with a history of neonatal respiratory distress，PCD diagnosis should be taken into consideration.

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Clinical characteristics of pertussis in children and risk factors for severe pertussis WANG Jing-juan, PANG Lin, MI Rong, et al 2021, 36(12): 941-946.  DOI: 10.19538/j.ek2021120613 Abstract ( )   Objective　To explore the clinical characteristics of children with pertussis and the risk factors of severe pertussis in order to provide reference for clinical diagnosis and treatment. Methods　The Central Laboratory of the Capital Institute of Pediatrics was used as the testing center to review the case data of 114 inpatients with whooping cough diagnosed from January to December 2019. According to the severity of the children’s condition and whether they were associated with other pathogenic infections. 73 cases of whooping cough were included in the single pertussis group and 41 cases were in mixed infection group. A hundred cases were the common group and 14 cases in the severe group. Single factor comparisons were performed between the groups，and the risk factors of severe pertussis were analyzed by binary Logistic regression. Results　1）A total of 66 cases（62.2%） of whooping cough occurred in autumn and winter. The predominant children were ≤6 months old，with a total of 79 cases（69.3%）. Totally 89 cases（78.1%） were not immunized，and 25 cases（21.9%） were immunized. 2）Univariate analysis showed that the mixed infection group was more likely to have hypoxemia，three depression sign，fever，and pulmonary rales than the simple pertussis group（P＜0.05）. The proportion of patients who had a history of premature delivery，bruising after coughing，three depression sign，fever，pulmonary rales，pneumonia，and mixed infection in severe group was higher than that in the ordinary group（P＜0.05）. The mixed infection group and severe group had longer hospital stay than the single pertussis group and common group（P＜0.05）. The peak value of white blood cells in the severe group was higher than that in the common group（P＜0.05）. Logistic regression analysis showed that increased WBC peak was arisk factor for severe pertussis（OR＝1.096，P＜0.05）. 3）A total of 114 cases of confirmed children were treated with macrolide antibiotics. Only 10 cases（8.8%） were treated within 7 days of the disease course，and 33 cases（28.9%） were treated within 8 to 14 days of the disease course. The rest were treated more than 14 days of the course of disease，of which 5 severely ill children were treated more than 21 days. 4）Children with severe whooping cough who were less than 4 months old were prone to severe complications，such as pneumonia，whooping cough encephalopathy，and cardiopulmonary failure. Among them，8 children were treated with invasive ventilation. After active treatment，one child died，and therest were improved and discharged. Conclusion　Whooping cough is more common in the babies under 6 months old whoare not immunized and the babies often require hospitalization. The incidence of complications in younger babies with whooping cough is higher. Co-infection and delayed medication may aggravate whooping cough and extend the length of hospital stay. It helps to judge disease severity to monitor the peak value of white blood cells.

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Multi-center study on the verification of diagnosis criteria for asthma in children under 6 years of age Pediatric Allergy and Asthma Group of Chinese Medical Association of Allergy（under construction） 2021, 36(12): 947-950.  DOI: 10.19538/j.ek2021120614 Abstract ( )   Objective　Toestablish objective and stable diagnostic criteria for asthma in children under the age of 6. Methods　In total of 22 medical centers，2263 children with less than 6 years of age with a wheezing history were included in the related information from September to December 2020. A standardized medical record system was designed，and a database was established. Wheezing children were divided into 1151 asthma and 1112 non-asthma groups according to the existing diagnostic criteria and rediagnosed with "33111 scoring system" to test for their specificity and sensitivity to the two groups. Results　In the asthma group，1068 children were still diagnosed with asthma according to the "33111 scoring system"，while 83 cases were not diagnosed as asthma. In the non-asthmatic group，950 children were still undiagnosed with asthma and 162 children were diagnosed with asthma according to "33111 score"  among the wheezing children diagnosed as non-asthma according to the existing guidelines，950 cases were also diagnosed as non-asthma according to the "33111 scoring system"，while 162 cases were diagnosed as asthma. Compared with the existing guidelines，the area under the ROC curve of the "33111 scoring system" was 0.934，with a 95% confidence interval（0.924，0.934）. The positive predictive value was 86.80%. The negative predictive value was 92.00%. The positive likelihood ratio was 6.36. The negative likelihood ratio was 0.084. The Youden index was 0.752. Conclusion　The "33111 scoring system" has been proved to have strong stability and high operability through multi-center and large sample verification，indicating it has high clinical value.

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Evaluation of plasma exchange treatment for neonates with hyperbilirubinemia（extremely severe） WANG Yi, TIAN Jia-hao, MA Le, et al 2021, 36(12): 951-957.  DOI: 10.19538/j.ek2021120615 Abstract ( )   Objective　To investigate the effect and safety of the treatment for severe hyperbilirubinemia in neonates by plasma exchange. Methods　Aretrospective study was conducted. The newborns who received plasma exchange or peripheral arteriovenous synchronous exchange transfusion for extremely severe neonatal hyperbilirubinemia in the Pediatric Intersive Care Unit of the Children’s Hospital Affiliated to Xi’an Jiaotong University from January 2019 to December 2020 were enrolled as the research subjects. The general demographic data were collected and the changes in serum-related indexes before and after treatment and the changes in mean arterial pressure during treatment were recorded. Social and economic factors of the two treatments were compared. Results　Plasma exchange was performed in 18 cases and a total of 36 children who were treated by peripheral arteriovenous synchronous exchange transfusion were matched by propensity score. There was no statistically significant difference in baseline data between the two groups（P＞0.05）. The mean value of total bilirubin（TBil） and indirect bilirubin（IBil） was significantly reduced by both treatments；plasma exchange therapy［ TBil（μmol/L）：571.21±113.31 vs．235.82±66.71，IBil（μmol/L）：529.06±107.85 vs．218.92±6.36，P＜0.05］；peripheral arteriovenous synchronous exchange transfusion［ TBil（μmol/L）：567.15±99.18  vs．294.34±96.17，IBil（μmol/L）：536.25±87.79 vs．288.54±46.73，P＜0.05］；the bilirubin clearance ratio of plasma exchange was higher than that of peripheral arteriovenous synchronous exchange transfusion，and the differnece was statistically significant（P＜0.05）. The utilization rate of albumin，intravenous immunoglobulin，albumin combined with intravenous immunoglobulin，the amount of plasma used，the amount of red blood cell suspension used，the duration of blue light treatment，and the hospital stay time for single disease were all lower in plasma exchange group than in the peripheral arteriovenous synchronous exchange transfusion group，the differences being statistically significant（all P＜0.05）. Conclusion　Plasma exchange can achieve rapid，effective and safe removal of bilirubin on the basis of maintaining the stability of the internal environment of the body，reducing the transfustion of blood products，and saving social resources. It may be an effective clinical technique in pediatric intensive care unit.

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Interleukin-6 receptor antagonist in the treatment of children with Takayaus arteritis: One case report ZENG Yue, ZHAO Cheng-guang, DU Yue 2021, 36(12): 958-960.  DOI: 10.19538/j.ek2021120616 Abstract ( )