Archive

06 February 2024, Volume 39 Issue 2 Previous Issue   

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

Attention to on invasive pulmonary fungal infections in children FAN Hui-feng, LU Gen 2024, 39(2): 81-85.  DOI: 10.19538/j.ek2024020601 Abstract ( )   In recent years，the incidence of invasive pulmonary fungal infections （IPFIs） in children has increased year by year in susceptible populations，resulting in critical illness and high mortality. It is very important to improve the awareness of IPFIs among clinicians. This review focuses on the research progress of epidemiology，susceptible population，diagnosis and treatment of IPFIs in children，so as to further improve clinicians' understanding of IPFIs.

Select

Progress in diagnosis and treatment of pulmonary candida infection in children YU Gang, ZHANG Hai-lin 2024, 39(2): 86-90.  DOI: 10.19538/j.ek2024020602 Abstract ( )   The candida genus，including candida albicans and non-albicans species，serves as opportunistic pathogens. In instances of compromised immune functionality，inhalation or hematogenous dissemination may cause pulmonary candidal infections. Pediatric pulmonary candidiasis presents with non-specific clinical features，primarily characterized by hyperpyrexia，cough，hemoptysis，or viscous gelatinous sputum，often involving skin，kidneys，and gastrointestines. Hierarchical diagnostic stratification presently prevails in the assessment of pediatric pulmonary candidal infections. Therapeutically，emphasis lies in the treatment of the primary disease and eliminating high-risk factors. Antifungal strategies encompass prophylactic，empirical，and preemptive treatment.

Select

Progress in the diagnosis and treatment of pulmonary cryptococcal infection in children YIN Yong, YUAN Shu-hua 2024, 39(2): 90-94.  DOI: 10.19538/j.ek2024020603 Abstract ( )   Pulmonary cryptococcus infection is a relatively rare pulmonary fungal infection in children. It has become an important infection in both immunocompromised and immunocompetent hosts. It is often accompanied by cryptococcosis of the central nervous system or occurs alone. Cryptococcal infection no specific clinical features，and the clinical diagnosis is difficult. If not given sufficient attention，it is highly likely to be missed or misdiagnosed. Acute respiratory distress syndrome can occur in children with severely impaired immune function，and it can also spread throughout the body，leading to central nervous system or other organ infections，which are life-threatening. Early diagnosis and timely initiation of antifungal infections can improve disease prognosis.

Select

Progress in the diagnosis and treatment of pulmonary mycormycosis in children LU Xiao-xia, DU Qing 2024, 39(2): 94-98.  DOI: 10.19538/j.ek2024020604 Abstract ( )   Mucormycosis is an infection caused by members of the order Mucorales that can involve many organs，including the skin，paranasal sinuses，orbits，brain，lungs，and gastrointestinal tract. Pulmonary mucormycosis is a very common forms which mainly occurs in immunocom-promised patients. The disease tends to progress rapidly with a high mortality rate.Early recognition of infection and active treatment are of great significance.This review covers the following aspects to provide a reference for the diagnosis and treatment of child pulmonary mucormycosis：epidemiology，pathogenesis，clinical presentation，imaging manifestations，diagnosis and treatment.

Select

Advances in the diagnosis and treatment of pneumocystis carinii pneumonia in children CHEN Li, XU Bao-ping 2024, 39(2): 98-103.  DOI: 10.19538/j.ek2024020605 Abstract ( )   Pneumocystis carinii pneumonia is an opportunistic infection，and its incidence in children without HIV-infection has increased in recent years because of the widespread use of transplantation and drugs such as immuno-suppressants. Early diagnosis，treatment，and prevention play an important role in reducing morbidity and mortality. This article reviews the advances in the diagnosis and management of pneumocystis carinii pneumonia in children.

Select

Progress in diagnosis and treatment of invasive aspergillosis in children TIAN Man 2024, 39(2): 103-107.  DOI: 10.19538/j.ek2024020606 Abstract ( )   Aspergillus is widely distributed in nature. When the temperature and humidity are suitable，Aspergillus can grow into hyphae and produce conidia，which can colonize the human respiratory tract through air transmission. When in the host's immune function is low，the diseases related to pathogenic Aspergillus are likely to develop，most of which are lung involvement，that is，invasive pulmonary aspergillosis （invasive pulmonary aspergillosis，IPA）. Compared with adult patients，the imaging manifestations of children with IPA are more atypical，and the current research on serological markers is not sufficient，making the diagnosis of IPA in children mostly difficult. At the same time，antifungal medications that are safe for children remain to be explored. Therefore，this article reviews epidemiology，pathogenic mechanism，clinical manifestations，diagnostic techniques，and treatment of IPA in children.

Select

Progress in diagnosis and treatment of pulmonary talaromyces marneffei infection in children XU Xue-hua, LU Gen 2024, 39(2): 107-111.  DOI: 10.19538/j.ek2024020607 Abstract ( )   Talaromyces marneffei is an endemic opportunistic pathogenic fungus，mainly prevalent in Southeast Asia and southern China. Recently，the morbidity of talaromyces marneffei infection has been increasing，and most are inborn errors of immunity among children. Talaromyces marneffei mainly invades human body through the respiratory tract，which can involve multiple tissues and organs，and most commonly infects the lung. The lack of specific clinical manifestations lead to misdiagnosis or delayed diagnosis and high mortality. This article mainly introduces the talaromyces marneffei and the pathogenic mechanism，clinical characteristics，and the progress in diagnosis and treatment of its infection.

Select

Associations of maternal pre-pregnancy overweight and obesity with congenital heart disease in offsprings：A large sample retrospective cohort study in Kunshan of Jiangsu Province CHEN Xiao-tian, WU Bing, FENG Pei, et al 2024, 39(2): 112-118.  DOI: 10.19538/j.ek2024020608 Abstract ( )   Objective    To evaluate the associations of maternal pre-pregnancy body mass index（BMI） with congenital heart disease（CHD） and its sub-types in offsprings. Methods    In this retrospective cohort study，we analyzed the maternal data of 19992 women in Kunshan city with more than five-time antenatal examination records in local maternal hospitals and their live newborns from the Maternal and Child Care Information System of Jiangsu Province（from Jan. 2019 to Oct. 2021）. Maternal pre-pregnancy BMI，antenatal examination information and delivery data were all collected via the system. CHD outcomes were obtained by the newborn CHD dual-index screening programs and cardiac ultrasound test at 3 month-old，which were divided into groups concerning maternal BMI before pregnancy according to the definitions for the Chinese population. Multivariate generalized linear models were used to analyze the relationship between maternal BMI befare pregnancy and CHD in offsprings and to estimate adjusted risk ratios（aRRs） and 95% confidence intervals（CIs）. Results    A total of 280 CHD cases（including 23 complex CHD cases） were screened among 19992 leveraged pregnant women. High maternal BMI before pregnancy increased the risk of CHD in offsprings（unadjusted RR 1.04，95% CI 1.01-1.08；P<0.001）. The associations remained significant even after adjustment for covariates ［aRR 1.05，95% CI 1.01-1.09；P<0.001］. Compared with normal weight，maternal obesity before pregnancy increased the risk of CHD in offsprings（aRR 2.20，95% CI 1.40-3.46；P=0.001）. Subgroup analysis showed that the maternal overweight or obesity resulted in 3.7-fold higher risk of complex CHD in overweight/obesity group than in control group（aRR 3.76，95% CI 1.62-8.69；P=0.002）. Conclusion    The increase in maternal BMI before pregnancy increases the risk of offspring CHD ，especially the risk of complex CHD. To reduce the risk of CHD and improve the health level of offsprings，more attention should be paid to the intervention of maternal pre-pregnancy obesity in clinical practice.

Select

Construction and validation of a predictive model for patients with sepsis after congenital heart disease surgery LUO Yu-ting, CHEN Chun-ling, GUO Yu-xiong, et al 2024, 39(2): 119-124.  DOI: 10.19538/j.ek2024020609 Abstract ( )   To investigate the predictive factors of death in patients with sepsis after congenital heart disease surgery，and establish a nomogram prediction model. Methods    The clinical data of children who developed sepsis after cardiopulmonary bypass thoracotomy at Guangdong Provincial People's Hospital between January 2012 and December 2021 were collected. Univariate and multivariate logistic regression analysis was conducted to identify the risk factors associated with mortality in children with sepsis after congenital heart disease. Based on the results of the analysis，a nomogram prediction model was developed and the Bootstrap resampling method was used for internal verification. Results    A total of 157 children were included in the study，with 135 survivors and 22 deaths. Univariate analysis and multivariate logistic regression analysis revealed several independent risk factors for death in children with sepsis after congenital heart disease  surgery.These factors included the total time of postoperative fever （OR=1.084，95% CI 1.022-1.151），asoactive-inotropic score on the third day after surgery （OR=1.162，95% CI 1.070-1.263），and secondary thoracotomy （OR = 6.033，95%CI 1.906  -19.098）. Based on the above-mentioned three indepe-ndent risk factors，a nomogram prediction model was developed with an area under curve of  0.909（95% CI：0.852  -0.966）.  The identification C index of the Bootstrap resampling method was 0.9139（95%CI 0.9100-0.9178）. The Hosmer-Lemeshow goodness of fit test demonstrated that the nomogram model accurately predicted the risk of death in children with sepsis after surgery （χ2=7.617，P=0.472）. Conclusion    The duration of postoperative fever，vasoactive-inotropic score on the third day after surgery，and secondary thoracotomy are independent risk factors for death of children with sepsis after congenital heart disease surgery. Based on the risk factors，the nomogram prediction model is successfully constructed and verified to predict the survival outcome of sepsis patients with congenital heart disease after surgery.

Select

Analysis of risk factors and prognostic outcomes of twin premature infants with pulmonary hypertension LUO Gang, PAN Si-lin, WANG Si-bao, et al 2024, 39(2): 125-129.  DOI: 10.19538/j.ek2024020610 Abstract ( )   Objective    To analyze and summarize the risk factors and prognostic outcomes of pulmonary hypertension （PH） in premature infants. Methods    The twins admitted to Women and Children's Hospital，Qingdao University，from January 2016 to June 2022 were taken as the research subjects. One of the twins was diagnosed with PH，and comparison of paired twins. The clinical data，risk factors and follow-up results were analyzed retrospectively. Results    In this study，33 pairs of premature twins with PH were included. Compared to the control，a higher frequency of PH was observed in Twin's second and were small in terms of the age of gestation，the duration of respiratory support and the length of hospital stays （P<0.05）. There was no significant statistical difference in the prevalence of complications between the children of the two groups，such as persistent pulmonary hypertension，sepsis，neonatal asphyxia，intraventricular hemorrhage，neonatal respiratory distress syndrome，and congenital heart disease （P>0.05）. The incidence of moderate to severe BPD was higher in the PH group （P<0.05）. There were no significant differences in laboratory indicators between the two groups concerning the initial blood gas analysis， blood routine tests and bio-markers（P>0.05）. In the PH group，16 children were given early postoperative drugs to decrease pulmonary hypertension，as well as cardiotonic and diuretic medicines. The median follow-up time was 5.25 years，and there were no deaths during this period. At the age of 6 months ，PH of 39.4% （13/33） returned to normal，and at 1 year old，81.8% （27/33） returned to normal. Conclusion    This study takes premature twins as research subjects and compares the clinical date of PH in premature twins. The critical condition of early post-natal development，the use of a ventilator and the prolonged hospitalisation are factors that contribute to the development of premature infant PH，which is related to a moderate-to-severe BPD. 81.8% of premature infants with PH return to normal within one year after birth.

Select

Comparison and analysis of children hospitalized for acute asthma exacarbations during COVID-19 pandemic HUANG Bing, WANG Yi-fan, ZOU Ying-xue 2024, 39(2): 130-134.  DOI: 10.19538/j.ek2024020611 Abstract ( )   Objective    To compare the clinical characteristics of children hospitalized for acute asthma exacerbations during the COVID-19 pandemic with those hospitalized in the previous year，and to explore the impact of the disease outbreak on disease control in children with asthma. Methods    A retrospective study was conducted on 225 children hospitalized for acute asthma exacerbations at Tianjin Children's Hospital from January 1，2019 to December 31，2020. The study analyzed their general information，clinical manifestations，laboratory tests，imaging findings，and follow-up data. The patients hospitalized in 2020 were assigned to Group A，while those hospitalized in 2019 were assigned to Group B. Results    Group A comprised 124 patients，and Group B comprised 101 patients. The average age at admission was 5 years in both groups，and the peak season for exacerbations was autumn in both groups. There were statistical differences between the two groups in duration of hospital stay （P=0.002），hospitalization costs （P<0.001），the rate of systemic corticosteroid use （P<0.001），the pathogen detection rate （P=0.029），and the proportion of patients with concomitant pneumonia （P=0.009）. Both groups had a lower proportion of patients readmitted within one year during regular follow-up （P=0.018，P=0.045）. Conclusion    During the COVID-19 pandemic，a higher number of patients were hospitalized for acute asthma exacerbations，with longer duration of hospitalization，higher costs，and increased use of systemic corticosteroids. However，the pathogen detection rate decreased compared to that before the pandemic. Regular follow-up can reduce the probability of readmission for asthma in children.

Select

Epidemiological features and influencing factors for congenital hypothyroidism in Xi'an YAN Ying-yu, HE Yu-ying , MENG Xiang-ping, et al 2024, 39(2): 135-139.  DOI: 10.19538/j.ek2024020612 Abstract ( )   Objective    To study the epidemiological characteristics and risk factors of congenital hypothyroidism（CH） in Xi'an，and to provide evidence for making intervention strategies. Methods    From January 1，2020 to December 31，2021，the screening data for neonatal CH at the Xi'an Neonatal Disease Screening Center were gathered. The case group and the control group's fundamental data，clinical characteristics，and other related data were analyzed using univariate analysis by the case-control study technique. From the univariate analysis，a few factors that were statistically different were chosen and were inclucled in the multivariate Logistic regression equation analysis. Results    Between 2020 and 2021，148250 newborns were screened for CH；104 of them were found to have the disease. Multiple Logistic regression analysis revealed that long period of pregnancy，high educational level of mothers， and birth weight being 2.5~4 kg were protective factors of CH（P<0.05）, while the risk factors were birth season being winter，maternal thyroid diseases during pregnancy，mother's advancedage，multiple pregnanay or delivery and cesarean section. Conclution    The incidence rate of CH in Xi'an is basically the same as that in China's iodine-sufficient regions. The CH screening rate in Xi'an has steadily increased in recent years. It is advised that women of childbearing age get ready for pregnancy and receive prenatal care to improve population quality since maternal personal variables and environmental factors affect the etiology of neonatal CH.

Select

Genotype and drug efficacy analysis of 42 cases of Alport syndrome in children ZHANG Yong-tao, LIU Yi-nan, YU Shao-wei, et al 2024, 39(2): 140-146.  DOI: 10.19538/j.ek2024020613 Abstract ( )   Objective    To analyze the genotype and phenotype characteristics of 42 pediatric patients with Alport syndrome （AS） and explore the efficacy of angiotensin-converting enzyme inhibitor （ACEI） and angiotensin receptor blocker （ARB） in different gene mutation types of AS. Methods    A total of 42 patients diagnosed with AS admitted to the Pediatrics Department of Guangzhou Red Cross Hospital and the Pediatrics Department of Guangzhou First People's Hospital from January 2016 to December 2022 were selected. All confirmed cases underwent genetic testing for diagnosis and received ACEI and/or ARB treatment. The follow-up period was 3 years（from January 2020 to December 2022），during which the age，gender，course of the disease and genetic testing results were recorded，and monitoring of laboratory indicators during the follow-up period were compared. The laboratory indicators included 24-hour urine protein quantification （mg），urine red blood cell count，plasma albumin （ALB，g/L），blood urea nitrogen （BUN，mmol/L），serum creatinine （Scr，μmol/L），total cholesterol （TC，mmol/L），and prognosis. Results    Among the 42 patients with AS，there were 16 cases of COL4A3/COL4A4 gene mutation and 26 cases of COL4A5 gene mutation. There were 19 cases of missense mutation and 23 cases of non-missense mutation，including 11 cases of nonsense mutation，9 cases of splicing mutation and 3 cases of frameshift mutation. Among them，16 patients had a positive family history of AS，and missense mutation and non-missense mutation had statistical signifi-cance in positive family history （P < 0.05）. AS usually started with gross hematuria or microscopic hematuria，and gradually developed proteinuria. There was no statistical statistical difference in manifestations of onset significance between missense mutation and non-missense mutation （P > 0.05）. However，patients with non-missense mutations had large amounts of hematuria and nephrotic level proteinuria （P < 0.05），were prone to extrarenal manifestations such as hearing and eye abnormalities，and entered end-stage renal disease earlier. Early application of ACEI and ARB can effectively reduce hematuria and proteinuria （P < 0.05） and delay the progression of renal failure. Compared with missense mutations，hematuria and proteinuria decreased more significantly after treatment in patients with non-missense mutations，but remained at a higher level. Conclusion    Genotype affects the severity of disease in AS patients. ACEI and ARB drugs can significantly reduce hematuria and proteinuria in AS patients，delaying the progression to ESRD，and its efficacy may be related to genotype.

Select

Diagnosis and treatment of advanced heart failure in children：Current status and prospect YUAN Yu-xing, PAN Bo, SUN Hui-chao, et al 2024, 39(2): 147-151.  DOI: 10.19538/j.ek2024020614 Abstract ( )   Advanced heart failure is the end stage of heart failure，and serious signs and symptoms will remain even with optimal treatments. The mortality of advanced heart failure in children is remarkably high，which has a tremendous negative impact on the daily life and growth of children. It has becoming a major problem that endangers children's life and health. This article retrospectively analyzes the related guidelines and clinical researches at home and abroad in the recent， and summarizes the definition，epidemiological characteristics，diagnostic basis and treatment plans of advanced heart failure in children，in the hope of providing references for early recognition and treatment.

Select

Analysis of neurodevelopmental disorder and rehabilitation treatment strategy of methylmalonic acidemia ZHENG Hong, MA Bing-xiang, LU Xiang-peng 2024, 39(2): 152-156.  DOI: 10.19538/j.ek2024020615 Abstract ( )   Methylmalonic acidemia（MMA） also known as methylmalonic aciduria，is one of the the most common inherited metabolic disease in China. Although it is a rare disease，it is not uncommon in clinical practice. Nervous system injury is the main complication of methylmalonic acidemia，which seriously affects the quality of life of children. However，the occurrence，mechanism， prevention and treatment still need to be further studied. Early detection and identification of methylmalonic acidemia with neurodevelopmental disorder，and timely and effective intervention can minimize neurological damage and improve long-term prognosis. Starting from the reasons for the formation of neurodevelopmental disorders methylmalonic acidemia，the neurodevelopmental characteristics and rehabilitation treatment strategies of MMA are described.

Select

A case of wheezing attack in children caused by achalasia cardia WENG Jing, MAO Chun-fa, HU Chun-ying, et al 2024, 39(2): 157-160.  DOI: 10.19538/j.ek2024020616 Abstract ( )   The clinical data of a child patient with wheezing episodes due to achalasia cardia admitted in June 2021 were retrospectively analyzed，and relevant literature materials were retrieved. The child，male，5 years old，was admitted to the hospital for cough and wheezing，with poor results after symptomatic treatment. The child had previous achalasia cardia and received balloon dilatation surgery. Considering that the cough and wheezing are related to achalasia cardia，finally endoscopic gastric cardia sphincterotomy was performed， and cough and wheezing disappeared. The main causes of wheezing in children are infection，bronchial asthma，and other common causes，and achalasia cardia is one of the causes of wheezing in children.