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06 September 2024, Volume 39 Issue 9 Previous Issue   

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Expert consensus on clinical application of tetracycline antibiotics in children（2024 Edition）  Pediatric Pharmaceutical Committee of Chinese Pharmaceutical Association, Cooperative Group of Rational Drug Use, Respiratory Group, Pediatrics Society of Chinese Medical Association, Respiratory Group of Professional Committee of Child Allergology, China Meternal and Child Health Association, et al 2024, 39(9): 641-651.  DOI: 10.19538/j.ek2024090601 Abstract ( )   Tetracycline antibiotics have strong antibacterial effect on a variety of pathogens including mycoplasma pneumoniae and chlamydia， and their application in children is gradually increasing. Due to the different physiological characteristics of children from adults， there is an urgent need for a special guidance document for the clinical use of tetracycline antibiotics in children. The consensus gives comprehensive recommendations on the clinical application of tetracycline drugs in pediatrics from the aspects of pharmaceutical characteristics， mechanism of action， antibacterial activity， status and mechanism of drug resist-ance，effects in children with infectious diseases， adverse reactions and off-label drug use， so as to guide clinical rational use.

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Expert consensus on integrated traditional Chinese and western medicine diagnosis and treatment of post-infectious cough （PIC）  with respiratory tract in children  （2024 Edition）  Children's Health Collaborative Innovation Platform of China Association of Chinese Medicine, Respirative Group of Professional Committee of Child Allergology, China Maternal and Child Health Association, Editorial Committee of Chinese Journal of Practical Pediatrics 2024, 39(9): 652-658.  DOI: 10.19538/j.ek2024090602 Abstract ( )   Post-infectious cough （PIC） of respiratory tract in children belongs to the non-specific cough category of chronic cough， which refers to a type of disease in children，in which the cough persists even after the acute symptoms of respiratory tract infections have disappeared. PIC is the third leading cause of chronic cough in children. After the outbreak of novel coronavirus infection （hereinafter referred to as COVID-19）， the original spectrum of infectious diseases of the respiratory system in China has changed greatly， and PIC has increased. At present， the pathogenic characteristics of PIC are not clear， and there are few targeted reports on the pathogenesis. Standardized diagnosis is not yet mature. In clinical practice， the combination therapy of traditional Chinese and western medicine for PIC is often recognized by doctors and patients. The combination of traditional Chinese and western medicine is not just the use of chemical drugs supplemented with traditional Chinese medicine， but requires individualized "prevention-treatment-rehabilitation" guidance through the interaction of traditional Chinese and western medicine. The establishment of a systematic diagnosis and treatment approach and the formation of an integrated plan of traditional Chinese and western medicine have been put on the agenda. Therefore， this consensus was jointly initiated and organized by the Children's Health Collaborative Innovation Platform of China Association of Chinese Medicine， Group of Respiration of Professional Committee of Child Allergologyof China Maternal and Child Health Association， and Editorial Committee of Chinese Journal of Practical Pediatrics， in order to provide guidance for the integrated diagnosis and treatment of PIC with traditional Chinese and western medicine.

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Recommendations on staging management of heart failure in Chinese children Collaborating Group of Heart Failure of Subspecialty Group of Cardiology, the Society of Pediatrics, Chinese Medical Association, Collaborating Group of Precise Diagnosis and Treatment of Cardiomyopathy of Subspecialty Group of Cardiology, the Society of Pediatrics of Chinese Medical Association, Pediatric Cardiovascular Disease Committee of College of Cardiovascular Physicians of Chinese Medical Doctor Association, et al 2024, 39(9): 659-664.  DOI: 10.19538/j.ek2024090603 Abstract ( )   Heart failure is a clinical syndrome with continuous development. It contains four stages， A， B， C， and D， according to its development pattern， covering the entire process from heart failure risk factors to end-stage heart failure. In order to enhance pediatricians' recognition and understanding of the concept of heart failure staging， this recommendation is developed based on the latest guidelines and clinical research results on heart failure staging management in adults， as well as the national conditions and clinical practice experience in pediatrics in our country. The aim is to clarify the definition， criteria， and management strategies of heart failure staging in children， and provide a basis for early prevention and treatment and precise management of children with heart failure.

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Interpretation of 2023 Clinical Practice Guidelines： Management of Severe Bronchiolitis in Infants Under 12 Months of Age in the Pediatric Intensive Care Unit BAN Feng-ting, DING Ya-ping, XIA Shan-shan, et al 2024, 39(9): 664-668.  DOI: 10.19538/j.ek2024090604 Abstract ( )   Bronchiolitis is the most common acute respiratory infection in infants and young children， which can be life-threatening when severe. Currently， there are differences in the treatment of bronchiolitis in different regions. In 2023， a foreign pediatric critical care and emergency nursing group developed guidelines for the management of severe bronchiolitis in infants under 12 months of age in pediatric intensive care units. The guidelines include 40 recommendations （including 23 expert recommendations） covering six areas： admission criteria for intensive care units， auxiliary examinations， patient placement and treatment， nutritional support and fluid replacement， ventilatory support， and adjunctive therapy. These recommendations aim to assist clinical physicians to better identify， understand， and manage severe bronchiolitis， thereby improving the level of treatment and prognosis of affected children. This article interprets the guidelines to provide reference for clinical practice.

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Treatment for children with septic shock based on pathophysiology YING Jia-yun , LU Guo-ping 2024, 39(9): 669-673.  DOI: 10.19538/j.ek2024090605 Abstract ( )   Sepsis is a dysregulated host response to infection leading to life-threatening organ dysfunction with a complex pathophysiology that involves major mechanisms including immune imbalance， microcirculatory disorders， and mitochondrial dysfunction. Septic shock， a combination of sepsis with cardiovascular dysfunction， is one of the etiologic factors contributing to high mortality in critically ill children. This article summarizes the key points of treatment of septic shock in children based on pathophysiology， including infection control， immunomodulation， and improvement of microcirculation and mitochondrial function， which will help clinicians understand the treatment of septic shock in children.

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Best practice of fluid resuscitation for septic shock in children CHEN Xi-long, ZHOU Bing-ying, ZHANG Tai-ning, et al 2024, 39(9): 674-679.  DOI: 10.19538/j.ek2024090606 Abstract ( )   Septic shock belongs to children's critical illness， and it is also one of the main causes of children's death all over the world. The pathophysiologic mechanisms of septic shock are complex， and fluid resuscitation is the cornerstone of the managemnt of septic shock. Reasonable resuscitation treatment is crucial to the improvement of the condition. We introduce the concept of SOSD to correctly identify and understand the transition and changes of the four periods of fluid resuscitation in children with septic shock， and to elaborate on resuscitation strategies such as what kind of resuscitation fluids to choose， the total amount of fluid to be resuscitated， and the fluid resuscitation rate， in order to provide references for clinical practice of fluid resuscitation in children with septic shock.

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Intervention strategy for coagulopathy in children with sepsis QIAN Tian-wei, BAI Zhen-jiang 2024, 39(9): 679-685.  DOI: 10.19538/j.ek2024090607 Abstract ( )   Sepsis is a life-threatening disease， which is often accompanied by severe coagulation disorders， known as sepsis-induced coagulopathy （SIC）. This condition results from complex dysregulation of the inflammatory and coagulation systems， involving the release of inflammatory mediators， activation of the coagulation system， inhibition of the fibrinolytic system， impairment of anticoagulant mechanisms， endothelial dysfunction， and platelet abnormalities. SIC in children is characterized by high incidence and mortality rates. Timely and effective intervention is crucial for improving outcomes.

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Remedial treatment strategy for refractory septic shock in children HU Yan, GUO Yu-xiong 2024, 39(9): 685-690.  DOI: 10.19538/j.ek2024090608 Abstract ( )   Refractory septic shock （RSS） is the most common cause of early death in children with septic shock.The mortality of RSS remains high.How to successfully diagnose and treat RSS has become the focus and difficulty of pediatric intensive care unit （PICU）， and it is also an important means to reduce the mortality of SS. RSS often presents with refractory shock and persistent hyperlactacemia. Catecholamines are the first-line drugs to improve hypotension and hypoperfusion. However， with the increase of drug dosage， related complications also increase significantly， and new strategies need to be further sought. At present， there is no clear and unified saving strategy for children's RSS. The article review the updating of RSS  guidelines， suggestions on hemodynamic evaluation methods， progress of therapeutic drugs and treatment methods， aiming to provide help for clinical optimization of RSS treatment.

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Evaluation of circulatory injury in pediatric septic shock HAO Yun , HONG Xiao-yang 2024, 39(9): 691-695.  DOI: 10.19538/j.ek2024090609 Abstract ( )   Septic shock is a common critical condition in children， which occurs in sepsis complicated with cardiovascular dysfunction， and its pathogenesis is complex and its early identification is difficult. The circulatory injury is an important link in septic shock， and it is of great significance for rapid identification， accurate treatment and improved prognosis .

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Intervention strategy for capillary leak syndrome due to pediatric septic shock YANG Chun-feng, ZHANG Zhen, LI Yu-mei 2024, 39(9): 695-699.  DOI: 10.19538/j.ek2024090610 Abstract ( )   Capillary leak syndrome is caused by the increased capillary permeability due to various reasons， and fluid shift from the intravascular to the extravascular space， resulting in intravascular hypovolemia， extravascular tissue edema ， and hypoperfusion in severe cases. Septic shock is one of the causes of capillary leak syndrome. After septic shock， capillary leak syndrome may occur or worsen， which can form a vicious cycle and increase the risk of death in children. The intervention strategy for capillary leak syndrome due to pediatric septic shock consists of two parts： one is rapid and radical treatment for septic shock， and the other is comprehensive treatment for capillary leak syndrome， including fluid management， control of inflammatory response， improvement of vascular endothelial function， and traditional Chinese medicine and supportive therapy.Clarifying the mechanism of capillary leak syndrome caused by septic shock and taking effective interventions can significantly improve the clinical outcomes of children.

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Immune inflammatory injury of sepsis in children and the evaluation and intervention  LIU Ting-yan, LU Guo-ping 2024, 39(9): 699-704.  DOI: 10.19538/j.ek2024090611 Abstract ( )   Sepsis is a common cause of death in children.Immune inflammatory response is a key mechanism in the pathogenesis of sepsis.Sepsis with different stages of disease， excessive proinflammatory compensatory anti-inflammatory response and reaction causes the immune system balance， eventually leading to immune. Comprehensive understanding of children sepsis immune inflammatory response and development，attaches great importance to the children of sepsis immune dynamic evaluation， is advantageous to the precise treatment and individualized treatment， diagnosis and treatment to improve children's sepsis，improve disease and after， and to reduce the financial burden of medical purpose.

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Continuous blood purification intervention for septic shock in children ZHOU Yong, WANG Yi 2024, 39(9): 704-709.  DOI: 10.19538/j.ek2024090612 Abstract ( )   Sepsis is considered tobe a global health problem， with patients dying from sepsis accounting for almost 20% of all deaths worldwide each year. Due to the development featuresof immune system， children have a higher chance of infection in respiratory system， digestive system and nervous system than adults， and are easy to develop sepsis after infection. At present， the sepsisin children isgaining increasing social concern， and its higher mortality rate has not decreased with increased awareness. With the development of material science， more and more new techniques and new materials are applied to the manufacture of blood purificationfilters. This allows us to intervene from a specific step in a complex immune process of pathogens， leukocytes， endotoxins， cytokines， etc. Blood purification is given high expectation toin the treatment of sepsis. This paper will introduce the selection of blood purification modes and filters from various stages of the occurrence and development of sepsis.

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Clinical characteristics and prognosis of severe pertussis in children： A retrospective analysis LI Xue-qian, YE Feng, HONG Jie, et al 2024, 39(9): 710-716.  DOI: 10.19538/j.ek2024090613 Abstract ( )   Objective    To analyze the clinical characteristics of severe pertussis in children and explore the risk factors of the prognosis. Methods    A total of 54 children diagnosed with severe pertussis who were hospitalized in the PICU of Guangzhou Women and Children's Medical Center from August 2023 to February 2024 were included. Group the enrolled children according to whether tohave undergone blood exchange or mechanical ventilation， and compare the differences in clinical characteristics among the groups. Use Kaplan-Meier survival curves and Log-rank tests to compare differences in survival rates among the groups of differentwhite blood cell and lymphocyte levels， presence or absence of pulmonary hypertension and tricuspid regurgitation; univariate and multivariate COX regression equation methods were used to analyze risk factors affecting prognosis of pediatric patients. Results    A total of 54 children with severe pertussis were included， including 32 males （59.26%）and 40 children aged ≤ 3 months old （74.07%）， and 5 were vaccinated （9.26%）. The childrenweregrouped based on whether to exchange blood. The group comparison results showed that the exchange group had a faster heart rate （P=0.036）， concomitant pulmonary hypertension （P=0.006）， concomitant tricuspid regurgitation （P=0.002）， mechanical ventilation （P=0.014）， increased proportion of vasoactive drugs used （P<0.001）， and elevated activated prothrombin time （P=0.014） andblood creatinine （P=0.004）. The patients were grouped based on whether or not tracheal intubation was performed， and the inter-group comparison results showed that the proportion of vaccination decreased （P=0.021）， heart rate increased （P=0.008）， the patients hadconcomitant tricuspid regurgitation （P=0.035） and blood exchange （P=0.004）， and the proportion of using vasoactive drugs （P<0.001） increased in the invasive mechanical ventilation group;hemoglobin （P=0.021） and albumin decreased （P=0.004）， while CRP （P=0.004） and blood creatinine （P=0.017） increased. The K-M survival curve showed that the survival rates of children in white blood cells ≥ 36.0×109/L group （P=0.012）， lymphocytes ≥ 22.49×109/L group （P=0.012）， combined withpulmonary hypertension （P=0.003）， and combined withtricuspid regurgitation group （P<0.001） decreased. The result of the multivariate Cox regression model analysis indicated that white blood cell （HR=1.045， 95%CI：1.001-1.092， P=0.046） was an independent risk factor affecting the prognosis of children with severe pertussis. The higher the white blood cell， the worse the prognosis. Conclusion    When children with severe pertussis have white blood cells ≥36.0×109/L， lymphocytes ≥ 22.49×109/L， andare with pulmonary hypertension and tricuspid regurgitation， the survival rate decreases， and more active treatments are needed. Elevatedwhite blood cellis an independent risk factor affecting the prognosis of severe pertussis in children.

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A case report on glycogen storage disease type Ⅳ in children HE Shu-li, LI Juan 2024, 39(9): 717-720.  DOI: 10.19538/j.ek2024090614 Abstract ( )   A 1-month-old female patient was admitted to hospital on February 14， 2022， due to "fever， cough， and abdominal distension for 5 days， and found that the liver and spleen size was 1d". The abdomen of the child was obviously distended， with varicose veins in the abdominal wall and hepatosplenomegaly. She was diagnosed with glycogen storage disease type Ⅳ by liver pathology and genetic examination. The patient was followed up for more than 1 year after liver transplantation， and there were no obvious abnormalities in relevant indicators during regular review. The diet， growth and development of the child were normal.