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06 December 2023, Volume 38 Issue 12 Previous Issue   

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Expert consensus on the management of airway mucus hypersecretion in children Group of Respiration, Professional Committee of Child Allergology, China Maternal and Child Health Association, Editorial Committee of Chinese Journal of Practical Pediatrics 2023, 38(12): 881-887.  DOI: 10.19538/j.ek2023120601 Abstract ( )   Airway mucociliary apparatus is the first line of defense of airway immunity. The dynamic equilibrium between mucus secretion and clearance is the guarantee for maintaining the normal physiological function of airway. Excessive mucus secretion， accumulation and/or increase in viscosity in the airway may affect the development and prognosis of the disease， resulting in recurrent respiratory tract infections， gas exchange disorders， and even changes in airway structure in severe cases. It is important to pay attention to mucinous obstructive pulmonary disease caused by excessive airway mucus secretion and provide effective treatment and management in order to maintain normal airway function and achieve pulmonary rehabilitation.

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Interpretation of the use of blended diets in children with enteral feeding tubes： A joint position paper of ESPGHAN ZHAO Shi-guo, LOU Xiao-fang, ZHOU Hong-qin, et al 2023, 38(12): 888-892.  DOI: 10.19538/j.ek2023120602 Abstract ( )   In 2023， the European Society for Paediatric Gastroenterology， Hepatology and Nutrition（ESPGHAN）， Committees of Allied Health Professionals （CAHP） and Nutrition （CON） jointly issued a position paper on the use of blended diet（BD） in children with enteral feeding tubes， aiming at reviewing the current evidence， evaluating the potential difficulties and risks， and providing guidance for professional medical care personnel on how to manage BD. The purpose of this article is to provide clinical guidance for pediatricians/nutritionists in China by interpreting the position paper and the situation at home and abroad.

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Balloon dilation for esophageal stenosis in children CAI Hua-bo, WANG Zhao-xia 2023, 38(12): 893-895.  DOI: 10.19538/j.ek2023120603 Abstract ( )   Esophageal stenosis is a prevalent condition in children， primarily resulting from anastomotic strictures， corrosive substance injuries， congenital anomalies， gastroesophageal reflux-induced esophagitis， and eosinophilic esophagitis. Although various treatment options are available for pediatric patients with oesophagal stenosis， endoscopic balloon dilatation remains a safe and effective therapeutic choice. This article reviews the preoperative preparation， precautions， complications and treatment of balloon dilatation for esophageal stenosis in children.Furthermore， local adjuvant mitomycin-C therapy can relieve dysphagia and reduce dilation frequency in caustic oesophagal stenosis. Local adjuvant steroid hormone therapy could potentially mitigate refractory oesophagal stenosis. After undergoing endoscopic balloon dilation treatment， the observed increase in weight-for-age Z-scores during follow-up indicates an improvement in nutritional status. Gradual extension of dilation intervals or cessation of further dilation within one year can indicate successful clinical treatment.

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Stent therapy for esophageal stenosis in children YANG Hong-bin, LIU Shan, FANG Ying 2023, 38(12): 895-898.  DOI: 10.19538/j.ek2023120604 Abstract ( )   There are many endoscopic treatment methods for esophageal stenosis in children， but for refractory esophageal stenosis， the efficacy of single method or single treatment is not good， and multiple treatments or combination of multiple methods are often required. In the past 30 years， the application of esophageal stents in children with esophageal stenosis has been gradually developed， which has improved the success rate of pediatric esophageal stenosis treatment to a certain extent. In this paper， the indications， types of stent， methods and time， complications and postoperative management of stent treatment for esophageal stenosis in children were reviewed.

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Management of the whole process of endoscopic treatment and nursing for children with esophageal stenosis YAN Nan, YANG Hong-bin, ZHANG Han-hua, et al 2023, 38(12): 898-902.  DOI: 10.19538/j.ek2023120605 Abstract ( )   Esophageal stenosis in children refers to the narrowing of the inner diameter of the esophagus caused by various factors， which leads to dysphagia， eating disorders and bucking， and then causes malnutrition and growth retardation. Esophageal stenosis in children is mostly benign stenosis， including congenital and acquired esophageal stenosis， and the latter is often due to physical injury， chemical erosion and other reasons. The treatment for esophageal stenosis includes surgery and endoscopic minimally invasive treatment. With the vigorous development of endoscopic technology， endoscopic diagnosis and treatment of esophageal stenosis has been widely promoted in clinical practice because of its high safety and effectiveness. Nursing cooperation is very important in perioperative management，including adequate preoperative preparation， meticulous intraoperative cooperation and postoperative follow-up.

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Drug treatment for esophageal stenosis in children         WANG Xing, LIU Hai-feng, GU Zhu-jun 2023, 38(12): 902-907.  DOI: 10.19538/j.ek2023120606 Abstract ( )   Esophageal stenosis is not uncommon in children， which may lead to clinical symptoms such as vomiting， cough，dysphagia and malnutrition；as a result，the growth and development of the children are seriously affected. Benign esophageal stenosis in children is mainly benign and is mainly caused by congenital malformation or acquired esophageal injury， surgical management is the mainstay of therapy for the disease， which includes endoscopic dilation， incision， stent implantation， and surgical procedures， etc. In addition to surgical intervention， the application of different drugs also plays an important role in the treatment of the disease. This article summarized the mechanism and drug treatment of esophageal stenosis in children.

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Nutritional management of esophageal corrosive ingestion in children YU Fei-hong, WU Jie 2023, 38(12): 907-910.  DOI: 10.19538/j.ek2023120607 Abstract ( )   Esophageal corrosive ingestion mostly occurs in children under 6 years old，mostly caused by accidental ingestion of corrosive substances，which is one of the most common causes of esophageal stenosis in children.Nutritional management，as a part of comprehensive treatment is important for the treatment and prognosis of children with esophageal corrosive ingestion. The article aims to introduce the evaluation of esophageal corrosive ingestion and timing and methods of nutritional management for children.

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Endoscopic incision for esophageal stenosis in children MEI Tian-lu, WU Jie, YU Fei-hong 2023, 38(12): 910-912.  DOI: 10.19538/j.ek2023120608 Abstract ( )   Esophageal stenosis in children is one of the most common causes of eating disorders，which can lead to difficulty in swallowing，vomiting，weight loss，malnutrition and poor quality of life.Endoscopic therapy is the preferred treatment for esophageal stenosis，including endoscopic balloon dilation，stent placement，drug injection，endoscopic incision and combination therapy.Each of these treatment methods has its own advantages and disadvantages.This article will introduce endoscopic incision for esophageal stenosis.

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Clinical evaluation of colloidal gold immunochromatography in Mycoplasma pneumonia infection WANG Liang-yu, ZHU Hong-bin, SHI Da-wei, et al 2023, 38(12): 913-917.  DOI: 10.19538/j.ek2023120609 Abstract ( )   Objective    To evaluate the clinical value of colloidal gold immunochromatography in the diagnosis of Mycoplasma pneumoniae infection.  Methods    A retrospective study was used in this study. Totally 115 paired sera of children with MP infection were collected from December 2016 to January 2017 in Shengjing Hospital Affiliated to China Medical University，and from October to December 2019 in Baotou Children's Hospital. The colloidal gold immunochrom-atography was used to detect acute serum.Passive agglutination （PA ） was used to detect the paired serum. Taking the 4-fold increase or decrease of the specific antibody titer of the double serum as the gold standard，the receiver operating characteristic curve  （ROC curve） was drawn to compare and evaluate the colloidal gold method in MP infection. Results    1. The sensitivity and specificity of colloidal gold method were 86.4% and 98.2%. The area under the ROC curve was 0.90 and the accuracy was 0.91， indicatingits high accuracy of method. 2. The course of disease was 5~7 days，the sensitivity and specificity of colloidal gold assay were 82.6% and 100%，and the area under the ROC curve was 0.91. Taking 1∶40 as judgment standard， the sensitivity，specificity and misdiagnosis rate of the passive agglutination method were 73.9%，85% and 15% respectively，whereas by 1∶160，the sensitivity was 39.1%，the specificity was 100%，and the missed diagnosis rate was 60.9%.3.When the disease course was  more than 7 days，the sensitivity and specificity of colloidal gold assay were 93.1%，94.7%. The sensitivity of the PA assay for 1∶40 and 1∶160 positive criteria were both 82.6%，and specificity were 89.4%，100%. Conclusion    1. The advantages of being simple， economical，sensitive，fast and highly specific make the colloidal gold immunochromatography suitable for rapid diagnosis of mycoplasma pneumoniae in outpatient and grass-root hospitals. It can be used as a reference index for M.pneumoniae infection.2. When the course of disease is in 5~7days and colloidal gold assay is positive，MP infection should be considered，and anti-MP infection treatment can be used clinically.，When PA method is used，with 1：40 as the positive judgment standard，there is a 15% misdiagnosis rate， and the diagnosis should be made by combination with clinical manifestations and other laboratory test results.  If the sensitivity of 1∶160 is only 39.1%，the rate of missed diagnosis is high. When the blood collection time is 7 after days of disease，both colloidal gold method and passive agglutination method have high sensitivity.3. If the blood sample is collected early， the antibody test is positive，and MP infection is highly possible in clinic. it is suggested that antibody be rechecked at one week after the disease or nucleic acid test be performed.

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Value of serum vitamin D3 level detection in children with obstructive sleep apnea DING Ying, WU Bei-rong, GU Hao-xiang, et al 2023, 38(12): 918-923.  DOI: 10.19538/j.ek2023120610 Abstract ( )   To evaluate the relationship between serum vitamin D3 level and obstructive sleep apnea in children and its clinical diagnosis value. Methods    T otally 227 children with snoring，aged from 2 to 14 years old，were enrolled for retrospective analysis，who were treated in the Respiratory Department of Shanghai Children's Hospital from January 1，2018 to December 31，2021. A total of 236 healthy children were included as healthy control group at the same time. Polysomnography （PSG） was performed in all the children. The gender，age，neck circumference，height，weight，body mass index（BMI），longest time of apnea（LTA），longest time of hypoventilation（LTH），lowest oxygen saturation（LSaO2），average oxygen saturation（ASaO2），sleep efficiency（SE），snoring index （SI），arousal index（ARI），REM phase ratio，obstructive apnea hypopnea index（OAHI） and other items were recorded. At the same time，serum 25-VitD3 level was detected. According to OAHI，the patients were divided into OSA group （80 cases） and non OSA group （147 cases）. The differences in 25-VitD3 between the two groups were compared. Meanwhile，the correlation between serum 25-VitD3 level and PSG indexes in OSA group was analyzed. Results    There were significant differences in OAHI，AHI，OAI，LSaO2，ASaO2，LTA，LTH and ARI between OSA group and non-OSA group（P<0.05）. In terms of blood lipid，the difference in TC between the two groups was statistically significant（P<0.05）. The serum cholesterol of-OSA group was higher than that of non-OSA group. The serum25-VitD3 level in OSA group and non OSA group was significantly lower than that in healthy control group，while that in OSA group was significantly lower than that in non-OSA group（P<0.05）. There was significant statistical significance between serum 25-VitD3 level of SDB and other indicators（general indicators，TC，TG and PSG indicators） in the multiple regression model（P<0.05）. SE and age had statistically significant effects on 25-VitD3 level（P<0.05）. Serum 25-VitD3 level was positively correlated with LSaO2（P<0.05） and negatively correlated with AHI and OAHI （P<0.05） in children with OSA. Conclusion    The serum 25-VitD3 level in OSA group is significantly lower than that in non OSA group and healthy control group. The detection of serum 25-VitD3 level has certain clinical diagnosis value for children with obstructive sleep apnea.

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Analysis of clinical characteristics and impact on the expression of molecules related to JAK/STAT signaling pathway  in the treatment of systemic lupus erythematosus in children with belimumab LI Feng, CHEN Hui-shan, TANG Ying, et al 2023, 38(12): 924-931.  DOI: 10.19538/j.ek2023120611 Abstract ( )   Objective    To investigate the effects of belimumab on disease activity，inflammatory factor levels，T/B/NK cell subpopulations，and epression of JAK/STAT signaling pathway related molecules in children with systemic lupus erythematosus（SLE）. Methods    Totally 30 children with systemic lupus erythematosus admitted to Guangzhou Women and Children's Medical Center from April 2021 to April 2022 were selected，and another 10 healthy children who underwent normal physical examination were selected as the normal control group. The 30 children with SLE were divided into two groups based on medication： 10 cases were treated with belizumab as the experimental group，and 20 cases were treated with immunosuppressive agents as the disease control group. Compare the clinical immune indicators，T/B/NK cell subgroup levels，inflammatory factor levels，and protein levels of JAK/STAT signaling pathway mRNA expression among three groups. Results    After the experimental group received medication for 3 months and 6 months，there was statistical difference in CD4+，CD19+B，IFN-ɑ，IFN-γ，TNF-ɑ，IL-2，IL-6，JAK1，STAT1，STAT3，STAT5，SOCS1 and SOCS3 between the experimental group and the disease control group（P<0.05）. There was a significant difference in protein levels of STAT3，p-STAT3，and SOCS3 between the experimental group and the  disease control group before treatment and the normal control group（t=2.87，P=0.01）. There was no significant difference in protein levels of STAT3 and p-STAT3 between the experimental group after treatment and the normal control group （t=1.81，P=0.07）. There was still a significant difference in protein levels of STAT3，p-STAT3，and SOCS3 between the disease control group after treatment and the normal control group（t=2.75，P=0.01）. Conclusion    Belizumab can effectively alleviate the symptoms of low to moderate SLE，significantly improve the inflammatory state and autoantibody levels of the body，and effectively reduce T/B/NK cell subpopulations and inflammatory factors. The specific mechanism of action may be related to inhibiting the activation of JAK/STAT signaling pathway and the release of inflammatory factors.

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Clinical study on invasive fungal infection in children with non-hematologic tumor disease in PICU CUI Li-dan, YAN Gang-feng, ZHU Jun-zhen, et al 2023, 38(12): 932-936.  DOI: 10.19538/j.ek2023120612 Abstract ( )   Objective    To summarize the clinical characteristics of different types of invasive fungal infection （IFI） in children with non-hematologic tumor disease in PICU. Methods    Clinical data of children with non-hematologic neoplastic disease IFI hospitalized in PICU of Henan Children’s Hospital from January 2017 to December 2022 were retrospectively analyzed. Results    There were 267 cases of positive results of fungus in the samples，and a total of 59 children were diagnosed with IFI， including 58 children with non-hematologic neoplasm diseases， 35 males and 23 females， with an average age of （4.11±4.09） years. There were 28 cases of chronic underlying diseases associated with IFI. The most common risk factors for IFI were the use of broad-spectrum antibiotics （100.00%）， the indwelling of various catheters （98.28%）， the use of corticosteroids （41.38%） and malnutrition （20.69%）. Among the 58 children with IFI， 31 cases were Candida infection（53.45%）， 12 cases were Aspergillus infection （20.69%）， and 53 cases were respiratory tract infections （91.38%）. With IFI there were 5 cases of simple virus， 23 cases of simple bacteria and 30 cases of mixed pathogens during the same period. The comparison between children with invasive Candida infection（ICI） and those with invasive Aspergillus infection（IPA）showed that the difference in IgM level was statistically significant（P<0.05）. The difference in risk factors such as malnutrition and granulocyte deficiency between ICI and IPA children were statistically significant （all P< 0.05）. Conclusion    IFI is common in PICU and has a poor prognosis. Candida and Aspergillus are still the main pathogens of invasive fungal infection in PICU， and respiratory tract is the most common site of IFI infection. IFI is often associated with other pathogenic infections， and children with malnutrition and decreased IgM may have a higher probability of ICI， so it should be identified early and antifungal drugs should be empirically used. Children with neutrophil deficiency are more likely to be combined with IPA， and Aspergillus should be covered during early clinical initiation of empirical therapy for these children.

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Diagnosis and treatment of allergic rhinitis in children with tic symptoms：A clinical analysis of 86 cases YANG Zhong-jie, SHEN Ling, LIN Zong-tong, et al 2023, 38(12): 937-941.  DOI: 10.19538/j.ek2023120613 Abstract ( )   Objective    To investigate the clinical characteristics， diagnosis， and treatment of kids with allergic rhinitis （AR） who exhibit tic symptoms. Methods    A total of 86 children with AR manifested as tic symptoms were chosen， and nasopharyngoscopy revealed sinusitis and adenoid enlargement in all of them. The patients were  divided into two groups—those who had comorbidities and those who did not. The symptoms were scored by VAS and YGTSS and treated with appropriate drugs and/or surgery. After 1 month， they were scored by the same methods and effects evaluated. The statistical indicators of each group were analyzed. Results    A total of 76 cases had successful outcomes， with an effective rate of 88.4%. The children included in the group and who had effect were mainly aged 3-6 years， the effective rate of which was 96.9%. There was a positive correlation between the VAS and YGTSS scores before and after therapy as well as the difference between the two. In comparison to patients without complications， those with complications had higher VAS and YGTSS scores. The group without complications had the best curative effect; their effective rate was 97.8%. Conclusion    One of the signs of AR is tic symptoms， which are also aggravated by sinusitis and adenoid hypertrophy. Particularly those aged 3-6 years old should have their sinusitis， adenoid hypertrophy， and AR examined in addition to receiving the conventional full treatment for tic symptoms.

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Research progress of end-expiratory capnography in bronchial asthma SONG Shao-xiu, XU Yong-sheng 2023, 38(12): 942-947.  DOI: 10.19538/j.ek2023120614 Abstract ( )   Bronchial asthma is a chronic inflammatory illness of the airways， and its diagnosis， severity assessment， and efficacy assessment are primarily based on clinical symptoms， signs， and pulmonary function tests. Traditional pulmonary ventilation function tests necessitate a high level of subject compliance;  however， patients with acute asthma exacerbations and preschool children sometimes have trouble complying， which limits the use of pulmonary function in these populations. Capnography is a simple， non-invasive procedure that requires little participation from patients， and  it can be used in the diagnosis， severity evaluation， disease monitoring， and efficacy assessment of asthma. This article reviews the application advancement of end-expiratory capnography in bronchial asthma.

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Research progress on screening methods for latent tuberculosis infection JIANG Wen-wen, XU Yong-sheng 2023, 38(12): 948-952.  DOI: 10.19538/j.ek2023120615 Abstract ( )   Latent tuberculosis infection （LTBI） is a specific condition of tuberculosis infection， about 5%～10% will progress to active tuberculosis （ATB）， and high-risk groups are at higher risk. Early screening and active intervention for LTBI is essential to prevent tuberculosis occurrence and transmission. Exploring effective screening methods for LTBI has become a research hotspot at present， and tuberculin skin test（TST） and interferon-gamma release assay（IGRA） are the most commonly used methods. In recent years， new approaches such as skin tests and QuantiFERON-TB Gold Plus test（QFT-Plus） have been developed， and latency-associated M.tuberculosis antigens， cytokines， tuberculin antibodies detection， and metabolomics have shown excellent potential in searching for evidence of Mycobacterium tuberculosis（MTB） transitioning from latency to active infection. This article reviews the screening methods for LTBI.

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Neonatal developmental and epileptic encephalopathy caused by PACS2 gene mutation: One case report GUO Chen, LIU Yang, ZHANG Fang, et al 2023, 38(12): 953-955.  DOI: 10.19538/j.ek2023120616 Abstract ( )   The clinical data and genetic features of an DEE caused by PACS2 gene mutation diagnosed in the Neonatal Department，TianJin Children′s Hospital in June 2021 was analyzed and the related literature was reviewed. The patient is a girl. At the age of 6 days，she had tonic seizures，which progressed to bilateral tonic seizure. The brain magnetic resonance imaging（MRI）was normal. Dynamic electroencephalogram（EEG）showed excessive sharp waves in the temporal and occipital regions.She showed good response to levetiracetam.Whole exome sequencing identified a heterozygous missense variant（c.625G>A）in PACS2 gene.A total of 24 children were retrieved from 1 Chinese literature and 6 English literature，and totally 25 children including this case were analyzed. All individuals presented with epilepsy as first symptom，the majority with onset during the neonatal period（23/25 case subjects）. A total of 24 cases had facial dysmorphism（such as broad nasal root，thin upper lip，wide mouth with downturned corners，hypertelorism，down-slanting palpebral fissures，synophris，etc）；23 individuals showed developmental delay to different degrees.Brain MRI demonstrated dysgenesis of the cerebellar folia in 13 patients. PACS2-related developmental and epileptic encephalopathy is characterized by neonatal-onset seizure in most cases，usually complicated with developmental delay，facial dysmorphism，and cerebellar dysgenesis.Treatment with levetiracetam may be effective.

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Mesenteric histiocytic necrotizing lymphadenitis in children：A case report CHENG Bei-lei, SHENG Yuan-jian, XU Ying-chun, et al 2023, 38(12): 956-959.  DOI: 10.19538/j.ek2023120617 Abstract ( )   The clinical data of a child with mesenteric histiocytic necrotizing lymphadenitis admitted to the Children's Hospital of Zhejiang University School of Medicine in May 2021 are reported.The case was a male，11 years and 3 months old.He was admitted to our hospital due to "fever for 10 days and abdominal pain for 5 days". He was admitted to the hospital as appendicitis. Necrotizing lymphadenitis of mesenteric histiocytes was confirmed by mesenteric lymph node biopsy. The child recovered after 2 weeks of oral prednisone treatment， temperature turning normal，and his disease has not recurred during the one-year follow-up for 1 year. Histiocytic necrotizing lymphadenitis is rarely characterized by swelling and pain of mesenteric lymph nodes， which leads to difficult diagnosis. Detailed history and appropriate auxillary examination are very important for confirming diagnosis. If necessary， lymph node biopsies should be performed. Choosing the right lymph node for biopsy can reduce the harm to the child patients.