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06 March 2022, Volume 37 Issue 3 Previous Issue    Next Issue

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Clinical diagnosis and treatment path of recurrent respiratory tract infection in children（2022 edition） Allergy Group of Chinese Association of Pediatricians, Respiration Group of Chinese Medical Association of Pediatrics, Rheumatology and Immunology Group of Chinese Association of Pediatricians, et al 2022, 37(3): 161-168.  DOI: 10.19538/j.ek2022030601 Abstract ( )

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Intervention measures to improve physical function of children and teenagers with cerebral palsy：International clinical practice guideline published by Developmental Medicine & Child Neurology in 2021：Interpretation of Chinese experts Subspecialty Group of Rehabilitation of Chinese Association of Pediatrics 2022, 37(3): 169-175.  DOI: 10.19538/j.ek2022030602 Abstract ( )   Cerebral palsy is the most common physical disability in children. In recent years，the rehabilitation concept of cerebral palsy has been constantly updated，and the intervention measures are increasing day by day. In August 2021，Developmental Medicine & Child Neurology published an international clinical practice guideline regarding interventions to improve physical function of children and teenagers with cerebral palsy. In the framework of ICF，the guideline comprises four evidence-based grading recommendations and nine ungraded good practice recommendations in the intervention measures of children and teenagers with cerebral palsy，which is aimed to improve their function and increase their ability of movement and participation. This paper will interpret the guideline based on the current situation of cerebral palsy rehabilitation in China，in order to update the rehabilitation concept，improve the intervention effect and provide help and guidance for families.

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Extracorporeal membrane oxygenation and neonatal respiratory support HONG Xiao-yang, ZHANG Hui-ling, FENG Qiu-shuang 2022, 37(3): 176-181.  DOI: 10.19538/j.ek2022030603 Abstract ( )   Extracorporeal membrane oxygenation （ECMO），a life-saving therapy for respiratory and cardiac failure when maximal conventional therapy has failed，plays an essential role in neonatal critical illness. The application of ECMO faces great challenge in premature infants，low-birth-weight infants and neonates with respiratory failure，The research mainly focuses on technological innovations such as non-thrombogenic circuits，extracorporeal artificial placenta，implantable artificial lungs，extracorporeal carbon dioxide removal，and awake ECMO and optimation of follow-up as well as interventions，which has broadened the scope of its application. In this paper，the latest progress and the prospect in the application and management of ECMO support for neonatal respiratory failure and follow-up of prognosis are reviewed.

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Clinical application of extracorporeal membrane oxygenation in pediatric acute respiratory distress syndrome CHEN Rong-xin, CAO Jia-ying, CUI Yun 2022, 37(3): 181-185.  DOI: 10.19538/j.ek2022030604 Abstract ( )   Acute respiratory distress syndrome （ARDS） is a common clinical critical illness，and the incidence and mortality are still high. ARDS causes high pediatric intensive care unit admissions and is the main cause of death. Extracorporeal membrane oxygenation（ECMO）can partially or completely replace the cardiopulmonary function in children，and can provide cardiopulmonary support for children with severe cardiopulmonary failure for a long time.At present，the timing and mode selection of ECMO intervention in children with ARDS are still controversial.In many adult clinical practices，VV-ECMO model is recommended as the first choice for ARDS.In recent years，ECMO technology has made great progress.ECMO may play a role in improving the prognosis of severe intrapulmonary and extrapulmonary ARDS.

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Strategies of prone ventilation for acute respiratory stress syndrome assisted by extracorporeal membrane oxygenation CHEN Zhen, TIAN Jia-hao, WANG Yi 2022, 37(3): 185-189.  DOI: 10.19538/j.ek2022030605 Abstract ( )   Veno-venous Extracorporeal membrane oxygenation (VV-ECMO) is commonly used in the treatment of severe ARDS. It improves gas exchange，“rests” the lungs，and reduces ventilator-induced lung injury in ARDS patients with refractory hypoxemia and/or hypercapnia. Prone positioning (PP) is recommended by the guidelines for improving oxygenation and reducing mortality in moderate-to-severe ARDS patients. Due to the lack of clinical research evidence and relevant experience associated with prone positioning during extracorporeal support，patients on VV-ECMO support have historically been managed in supine position. Recently，a number of studies have reported the feasibility of PP during VV-ECMO assistance，which is associated with an improvement of oxygenation，CO2 clearance and respiratory system compliance. This paper reviews the research progress of PP application during VV-ECMO assistance by collecting relevant research evidence.

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Brain monitoring and prognosis evaluation of children during extracorporeal membrane oxygenation WEN Guang-fu , XU Wei 2022, 37(3): 189-194.  DOI: 10.19538/j.ek2022030606 Abstract ( )   In recent years，there have been more reports on brain complications in children with ECMO. In addition to common complications，such as hemorrhage，infarction，seizures and cerebral hypoperfusion，there are some other less clear but related injuries and clinical manifestations which affect the prognosis of children with ECMO in the short term，and even determine the success of ECMO treatment. Therefore，brain monitoring is particularly important and necessary in the management of ECMO patients.Whats more，people have gradually realized that neurological complications may not only occur in the early stages，but children with ECMO are also prone to long-term neurocognitive adverse events，such as learning and working disorders. At present，there is no unified clinical management strategy and plan for the monitoring of brain function in children with ECMO. In particular，the neurocognitive function and neuropsychological follow-up of children after discharge from the hospital need more systematic and scientific management process.

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Extracorporeal membrane oxygenation in children with fulminant myocarditis GAO Qian, JIN You-peng 2022, 37(3): 195-199.  DOI: 10.19538/j.ek2022030607 Abstract ( )   Fulminant myocarditis is a kind of acute hemodynamic disorder as the main manifestation of acute critical disease，rapid onset and progress，high mortality.At present，there is no specific drug treatment for the disease，symptomatic and supportive therapy is generally used.In recent years，extracorporeal membrane oxygenation（ECMO）can provide effective life support for children with fulminant myocarditis，gain time for the recovery of cardiac function and improve the success rate of rescue.This article reviews the application and progress of ECMO in children with fulminant myocarditis.

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Application of extracorporeal membrahe oxygenation in critically ill children after cardiac surgery HU Yan, GUO Yu-xiong 2022, 37(3): 199-204.  DOI: 10.19538/j.ek2022030608 Abstract ( )   Extracorporeal membrane oxygenation （ECMO） has been widely used in the transition of further clinical decision making，and has brought about an improved prognosis.Post-cardiotomy ECMO （PC-ECMO） support is increasingly becoming a cornerstone of the life-saving treatment for cardiopulmonary failure after cardiac surgery. Although ECMO-supported cases are increasing each year，the overall survival rate has not increased significantly.The paper reviews the application of ECMO in critically ill children after cardiac surgery，and introduces the timing，indications，contraindications，clinical applications and outcomes，respectively，aiming to improve the use of ECMO in critically ill children after cardiac surgery.

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Extracorporeal membrane oxygenation in children with septic shock CHENG Ye, LU Guo-ping 2022, 37(3): 204-208.  DOI: 10.19538/j.ek2022030609 Abstract ( )   Refractory septic shock in children can quickly progress to multiple organ failure with high mortality rate. Extracorporeal membrane oxygenation （ECMO），as a rescue method for refractory septic shock highlighted as circulatory collapse after the failure of fluid resuscitation and inotrope therapy，is receiving more and more attention . However，the exact efficacy，timing，modality and routes of catheterization of ECMO in refractory septic shock are still unclear. In this paper，the history，application principle，points at issue and concerns during the operation of ECMO in the treatment of these children are discussed for more reasonable and standardized application of ECMO technology in children with refractory septic shock in order to improve their survival rate.

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Prevention and control of nosocomial infection during extracorporeal membrane oxygenation in pediatric patients CHENG Dong-liang, SHI Chang-song, SHEN Zhi-qiang 2022, 37(3): 208-213.  DOI: 10.19538/j.ek2022030610 Abstract ( )   Extracorporeal membrane oxygenation （ECMO） is an invasive，lifesaving life-support technique for critically ill children with respiratory and circulatory failure.Nosocomial infection during ECMO is one of the serious complications of ECMO，and the incidence rate of nosocomial infection during pediatric ECMO is 16.6%-22.1%. Studies have found that the duration of ECMO support is an independent risk factor for nosocomial infection.The effect of nosocomial infection on prognosis and mortality in ECMO patients is uncertain.Coagulase-negative staphylococcus，candida and enterobacter are common pathogenic bacteria of nosocomial infection during ECMO，and prophylactic use of antibiotics is a common practice.The pharmacokinetics of antibiotics changes during the period of ECMO assistance，and the dosage should be adjusted according to the results of drug concentration determination.

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Pulmonary characteristics of conventional ventilation and impulse oscillometry in children with Mycoplasma infectious lobar pneumonia ZHANG Rui-mei, WANG Qin, WANG Ke, et al 2022, 37(3): 214-220.  DOI: 10.19538/j.ek2022030611 Abstract ( )   Objective　To analyze the pulmonary characteristics of conventional ventilation and impulse oscillometry in children with Mycoplasma infectious lobar pneumonia and the correlation between the two pulmonary function tests，and to explore the characteristics of airway responsiveness in Mycoplasma infectious lobar pneumonia and the influence of different imaging lesions on pulmonary function. Methods　A total of 120 children aged 5-14 years old with Mycoplasma infectious lobar pneumonia hospitalized from January 2018 to December 2019 in the division of Pediatric Pulmonology of Shandong Provincial Hospital Affiliated to Shandong First Medical University，the conventional ventilation and impulse oscillometry were completed during the hospitalization period，according to the different imaging lesions，the children were divided into single lobe group and multiple lobes group，analysis of pulmonary function results and clinical data were analyzed. Results　Among the 120 children，there were 95 cases in single-lobe group and 25 cases in multiple-lobe group. Normal conventional ventilation were 33 cases（27.5%） and abnormal in 87 cases（72.5%）. Among abnormal conventional ventilation the restrictive ventilation dysfunction in 43 cases，two or more of the three small airway indexes were lower than 65% predicted value was in 63 cases. In the 120 cases，impulse oscillometry test showed normal airway resistance in 106 cases（88.3%） and increased airway resistance in 14 cases（11.7%）. Airway resistance indexes are negatively correlated with ventilation indexes. 43 cases of children with FEV1 measured value/expected value<80% completed bronchodilation test，bronchodilation test was positive in 6 cases，and airway resistance was significantly improved in 11 cases. The airway resistance indexes total respiratory impedance（Z5），total airway resistance（R5），and central airway resistance（R20） of the multiple lobes group were lower than that in sigle lobe group，and peripheral elastic resistance（X5） was higher than that in single lobe group，there was no statistical difference. The conventional ventilation index vital capacity（VC），forced vital capacity（FVC），forced expiratory volume in one second（FEV1） of the multiple lobes group was lower than that in single lobe group，have significantly different between the two groups（P<0.05）. Conclusion　The children with Mycoplasma infectious lobar pneumonia mostly have restrictive ventilation dysfunction；the small airway function indexes are significantly damaged and the recovery of small airway indexes is slower than that of large airway indexes；airway resistance indexes have a good negative correlation with the expiratory flow indexes. Mycoplasma pneumoniae infection can induce increased airway responsiveness，and bronchodilation tests in some children show reversible airflow limitation and a significant improvement in airway resistance. Children with lesions involving multiple lobes had more severe reduction in lung volume，and the reduction of expiratory flow indexes was widespread in children with different lesions.

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Intracranial beta human chorionic gonadotropin-secreting germ cell tumor in a girl with central precocious puberty HUANG Meng-tian, ZHENG Ru-jiang, MA Hua-mei, et al 2022, 37(3): 221-227.  DOI: 10.19538/j.ek2022030612 Abstract ( )   Objective　To report a girl with intracranial β-HCG-secreting germ cell tumor（IGCT） and central precocious puberty（CPP） in order to provide the oretical guidance for the precise clinical diagnosis and treatment of CPP. Methods　We summarized the clinical data of a CPP girl with intracranial β-HCG-secreting GCT and reviewed the relative literatures. Results　The girl was admitted to our hospital because of breast development and growth acceleration at 7 years and 3 months，and was diagnosed with CPP concurrently with elevated serum β-HCG levels（56.45-20.7 IU/L） at 8 years and 2 months at local hospital. On admission to the First Hospital of Sun Yat-sen University at 8 years and 9 months，physical examination revealed that serum and cerebrospinal fluid（CSF） β-HCG was increased（40.03 and 103.22 IU/L，respectively） and normal AFP A magnetic resonance imaging scan of the head with enhancement revealed a lestion at the lenticular nucleus in the right basal ganglia considered to be the GCT focus，and pineal cyst. Intracranial non-germinomatous germ cell tumor was diagnosed，and combination chemotherapy was initiated with GnRHa therapy for CPP. The girl was transferred to another grain hospital due to insensitivity to chemotherapy，and the pathology of pineal lesion was ‘central neurocytoma’. Conclusion　This is the first female case of intracranial β-HCG-secreting germ cell tumor concomitant with CPP. In this case，CPP seems unlikely to attribute to the elevated β-HCG-secreted by the tumor. CNS lesion due to the tumor in the right lenticular nucleus and the pineal lesion may contribute to CPP. Detections of serum HCG and AFP should be included for the diagnosis of precocious puberty，regardless of boys or girls. Cranial MRI/CT is also necessary in girls with CPP（even older than 6 years of age） even if there is no abnormal clinical manifestations of central nervous system.

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Progress in the application of tidal lung function monitoring in bronchopulmonary dysplasia HAN Yu-qi, XU Yong-sheng 2022, 37(3): 228-231.  DOI: 10.19538/j.ek2022030613 Abstract ( )

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Diagnosis and treatment progress in aspiration pneumonia in children XU Yue-juan, XU Li-na, HAO Chuang-li 2022, 37(3): 232-235.  DOI: 10.19538/j.ek2022030614 Abstract ( )

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One case report of infantile hypophosphatasia LI Zhi, CHEN Xue-feng, DONG Guan-ping, et al 2022, 37(3): 236-240.  DOI: 10.19538/j.ek2022030615 Abstract ( )