Archive

06 June 2025, Volume 40 Issue 6 Previous Issue   

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

Expert consensus on clinical application of macrolide antibiotics in children（2025 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, et al 2025, 40(6): 441-451.  DOI: 10.19538/j.ek2025060601 Abstract ( )   Macrolide antibiotics have been developed since a long time ago with various types，and are widly used in clinical practice，which rank No.1 in the use of antibiotics in domestic pediatric outpatient departments. Macrolide antibiotics have a strong antibacterial effect on a variety of pathogens，however the resistance rate of pediatric isolates of Streptococcus，Staphylococcus and Mycoplasma pneumoniae to macrolide antibiotics is also very prominent. The 14-membered and 15-membered ring macrolides have some anti-inflammatory and immunomodulatory effects in addition to broad-spectrum antibacterial activity. Given that children’s dynamic physiological development differs from adults’，it is urgent to have a specific guidance document for the clinical application of macrolides in children. The consensus gives a systematic summary of drug characteristics，pharmacokinetics and pharmacodynamics of macrolide antibiotics；meanwhile，the consensus gives comprehensive recommendations on the use of macrolide antibiotics in children with infectious diseases，adverse reactions and non-antibacterial effects，so as to standardize their rational clinical use.

Select

Analysis of the changes in the AHA 2023 neonatal resuscitation guidelines and the differences between contemporary American and European guidelines SHAN Jia-ni, ZHANG Chen-mei, ZHAO Shi-guo, et al 2025, 40(6): 452-458.  DOI: 10.19538/j.ek2025060602 Abstract ( )   This paper interprets the AHA 2023 Neonatal Resuscitation Guidelines and analyzes the differences and complementarities between the American and European guidelines regarding the selection of resuscitation equipment，the operation of positive pressure ventilation，and umbilical cord management. The American guidelines provide more specific recommendations on the use of T-piece resuscitators and umbilical cord milking， while the European guidelines emphasize the broad applicability of delayed cord clamping and continuous positive airway pressure （CPAP）. Based on domestic clinical practice， this article proposes a tiered approach to resuscitation，aiming to optimize neonatal resuscitation and umbilical cord management.

Select

Emphasis on standardized diagnosis and treatment of infectious diarrhea in children WU Jie 2025, 40(6): 459-463.  DOI: 10.19538/j.ek2025060603 Abstract ( )   Infectious diarrhea is a common pediatric emergency and one of the important causes of death in children under 5 years of age worldwide. In recent years， with the change of pathogen spectrum， the advancement of diagnosis and treatment technology， and the prominence of antimicrobial resistance， standardized diagnosis and treatment has become a core issue in clinical research. Based on the latest domestic and international guidelines and clinical research， this article systematically describes the characteristics of pathogens， principles of diagnosis and treatment， and controversial points， with the aim of providing evidence-based basis for clinical practice.

Select

Diagnosis and treatment of Salmonella-infected enteritis in children ZHANG Wan-min, LI Xiao-qin 2025, 40(6): 464-469.  DOI: 10.19538/j.ek2025060604 Abstract ( )   Salmonella-infected enteritis in children is a foodborne infectious disease caused by non-typhoidal Salmonella（NTS）， the diagnosis of which depends on bacterial culture. However， with the widespread use of antibiotics， the drug resistance problem of Salmonella has become more and more prominent， which brings challenges to clinical diagnosis and treatment. Here， the etiology， clinical manifestations and diagnosis and treatment progress of NTS are described， aiming to improve the understanding of Salmonella， in order to achieve early prevention， accurate diagnosis and timely treatment.

Select

Diagnosis and treatment of intestinal fungal infection in children ZUO Heng-jie, YU Jing, LI Xiao-qin 2025, 40(6): 469-474.  DOI: 10.19538/j.ek2025060605 Abstract ( )   The incidence of intestinal fungal infections in children has been rising in recent years， significantly affecting their growth and development. These infections can also lead to a range of complications， even threatening the patients’lives. Therefore， early diagnosis and effective treatment of intestinal fungal infections in children are crucial. This article aims to describe the common pathogenic fungi， risk factors， clinical manifestations， diagnostic and therapeutic strategies， as well as preventive measures in order to improve prognosis.

Select

Diagnosis and treatment of intestinal tuberculosis in children QIAN Xia, WANG Zhao-xia 2025, 40(6): 474-479.  DOI: 10.19538/j.ek2025060606 Abstract ( )   Intestinal tuberculosis is a major form of extrapulmonary tuberculosis， affecting various segments of the gastrointestinal tract. The clinical manifestations of intestinal tuberculosis lack specificity， particularly similar to those of othergastrointestinal diseases （such as Crohn’s disease， tumors），thereby presenting significant diagnostic challenges. The diagnosis and treatment of pediatric intestinal tuberculosis pose greater challenges compared to adult cases， resulting in delayed diagnosis and increased healthcare expenditures. Early diagnosis and prompt initiation of antituberculous therapy are critical for reducing case-fatality rates. Despite advances in diagnostic modalities， including a series of emerging molecular and immunodiagnostic techniques such as nucleic acid amplification tests， no single laboratory method can reliably establish a rapid and accurate diagnosis. A comprehensive diagnostic approach integrating epidemiological data， clinical presentation，radiological findings， histopathological examination， and multiple nucleic acid amplification tests is required for definitive diagnosis. The treatment of pediatric intestinal tuberculosis remains primarily pharmacological， with endoscopic intervention and surgical treatment performed when necessary.

Select

Re-understanding of Helicobacter pylori infection：from basic research to clinical practice GENG Lan-lan, GONG Si-tang 2025, 40(6): 479-482.  DOI: 10.19538/j.ek2025060607 Abstract ( )   Helicobacter pylori infection is the main cause of peptic ulcer and gastritis， and is closely related to the occurrence of gastric cancer. Every year， approximately 800 000 new cases of gastric cancer are caused by Helicobacter pylori infection worldwide. In recent years， the research in mechanism of Hp induced gastric cancer has made significant progress， and screening and eradication strategies have shown effective preventive effects in areas with high incidence of gastric cancer. The continuous increase in drug resistance rates has led to the emergence of new drugs and treatment plans. There is controversy over the expansion of treatment indications. Based on the latest research progress， this article explores the key issues of Hp infection from multiple perspectives， from basic to clinical， aiming to provide reference for clinical practice and public health decision-making.

Select

Diagnosis and treatment of pediatric small intestinal bacterial overgrowth ZHAO Yan, QIN Xiu-min 2025, 40(6): 482-487.  DOI: 10.19538/j.ek2025060608 Abstract ( )   Small intestinal bacterial overgrowth （SIBO） is caused by an abnormally elevated number of bacteria and/or changes in the flora in the small intestine. It mainly presents with non-specific symptoms such as abdominal pain， bloating，constipation， and diarrhea. The etiology is complex and related to many diseases. It is common in clinical practice but has not been fully recognized. This article aims to review the epidemiological features， pathogenesis， diagnostic approaches， and treatment strategies of pediatric SIBO， with the goal of providing reference for clinical practice.

Select

Epstein-Barr virus and pediatric gastrointestinal diseases CHEN Ying, WANG Guan-qiao, XU Ling-fen 2025, 40(6): 488-492.  DOI: 10.19538/j.ek2025060609 Abstract ( )   Epstein-Barr virus （EBV） is a B-cell-tropic double-stranded DNA virus belonging to the gamma herpesvirus family， characterized by high susceptibility and predominantly transmitted through bodily fluids. Primary EBV infection typically targets the epithelial cells of the oropharynx and nasopharynx，with a propensity for long-term latency in lymphoid tissues. Primary EBV infections are common in children and often involve many systems, leading to a variety of effects on multiple organs. The effect of EBV infection on digestive system of children is gaining more and more attention， and EBV is closely related to digestive diseases including liver， gastrointestinal tract， pancreas and cholecyst， etc. Its pathogenesis often involves immune inflammatory reactions， but there is still a lack of large sample, multicenter research.

Select

Diagnosis and treatment of Clostridium difficile infection in children ZHAO Chun-na, WU Jie 2025, 40(6): 492-496.  DOI: 10.19538/j.ek2025060610 Abstract ( )   Clostridium difficile is one of the main pathogens causing acute infectious diarrhea in children. With the widespread use of antibiotics， the incidence and recurrence rate of C. difficile infection have significantly increased. This paper summarizes relevant researches， guidelines and consensuses at home and abroad， and elaborates the diagnosis and treatment of C. difficile infection in children from the aspects of epidemiology， risk factors，clinical features， and prevention and control measures.

Select

Comparison and interpretation of treatment for group A streptococcus pharyngitis in different diagnosis and treatment guidelines CHEN Si-yu, YANG Ying, HUANG Qian, et al 2025, 40(6): 497-501.  DOI: 10.19538/j.ek2025060611 Abstract ( )   Group A streptococcus (GAS) is the most common bacterial pathogen of pharyngitis. Unlike other causes of pharyngitis， untreated or poorly treated GAS pharyngitis can often lead to a variety of complications， resulting in a serious disease burden. As a typical self-limiting disease， the treatment goals for GAS pharyngitis include symptom relief， shortening disease duration， preventing complications， and reducing bacterial transmission risks. Recommendations from different guidelines regarding GAS pharyngitis management remain inconsistent， with ongoing debates about the necessity for antimicrobial therapy， optimal timing for using antibiotics， and specific medication regimens， and there is not a clearly dominant therapeutic approach. When considering antimicrobial treatment for patients with GAS pharyngitis， careful evaluation of local GAS complication prevalence and individual patient risks is essential. Additionally， personalized management and treatment strategies are required for special patient groups related to GAS pharyngitis， such as GAS carriers， patients with recurrent infections， and those at high risk of acute rheumatic fever.

Select

Clinical efficacy analysis of rock salt aerosol inhalation therapy as an adjuvant treatment for communityacquired pneumonia in children WANG Tian-yue, ZHANG Han, WANG Xiao-yan, et al 2025, 40(6): 502-507.  DOI: 10.19538/j.ek2025060612 Abstract ( )   Objective To evaluate the effectiveness and safety of rock salt aerosol inhalation therapy for communityacquired pneumonia in children. Methods A single-center， randomized， controlled clinical trial design was used，involving 60 hospitalized children aged 3-14 with community-acquired pneumonia， who were hospitalized for treatment in Pediatric Respiratory Department of Shengjing Hospital Affiliated to China Medical University from Jan. 2024 to Jun. 2024. These children were divided into control and experimental groups in a 1∶1 ratio. The experimental group received basic disease treatment along with rock salt aerosol inhalation， using the portable rock salt aerosol therapy device produced by Jiangsu Chunfan Biotechnology Co.， Ltd.（YQ-S101）， once a day， 30 minutes per time. The control group received basic disease treatment along with 1mg nebulized budesonide suspension for inhalation， twice a day. Treatment was ended after 7 days or when clinical symptom score reached 0. The efficacy and safety of rock salt aerosol therapy were observed. The symptom scores of daytime and nighttime cough， expectoration and wheezing before and after treatment were compared between the two groups. The changes in serum inflammatory factors（CRP， PCT， serum IL-4， IL-6， IL-10， IL-17， TNF-α， IFN-γ levels） were compared， and adverse reactions during medication were collected. Results Both the experimental and control groups showed a decrease in the symptom scores of cough， sputum and wheezing， and the total symptom scores after treatment compared to before （P<0.01）， but there was no significant difference between the two groups （P>0.05）. Through scatter plot analysis， it was found that 2 children in the experimental group（7.4%）and 7 children in the control group （24.1%）still had significant symptoms （both total scores>2） after treatment. Whether the total symptom score was greater than 2 was used as the dependent variable， and regression analysis was conducted， which revealed a negative correlation between the experimental group and symptom total score， but the correlation was not significant （r=-1.381，P=0.1057）. After treatment， the levels of CRP， PCT， and IL-6 significantly decreased in both the experimental and control groups compared to before treatment （P<0.01）， while other inflammatory factors （serum IL-4， IL-10， IL-17， TNF-α，IFN-γ levels） showed no significant differences before and after treatment （P<0.05）. Significant differences were observed in the change of PCT between the two groups before and after treatment （P=0.016）， while the changes in CRP and IL-6 were not significant （P>0.05）. No adverse events occurred in either group during the trial. Conclusion Rock salt aerosol inhalation therapy as an adjuvant treatment for community-acquired pneumonia in children is equivalent to nebulized budesonide suspension for inhalation in terms of efficacy， both demonstrating good effectiveness and safety.

Select

Clinical characteristics of infection-related plastic bronchitis in children GUO Yong-sheng, ZOU Ying-xue, WANG Yi-fan, et al 2025, 40(6): 508-513.  DOI: 10.19538/j.ek2025060613 Abstract ( )   Objective To analyze the clinical features of infection-associated PB （Plastic Bronchitis） in children， to explore the characteristics of age and season of occurrence， and infectious agents of PB in children， and to provide a basis for the early recognition of PB and the development of feasible treatments. Methods The clinical data of 1062 cases with clinical diagnosis of PB admitted to Tianjin Children’s Hospital from January 2017 to December 2023 were retrospectively analyzed to analyze the patterns of season， age， and etiology of onset， as well as the combined intrapulmonary and extrapulmonary complications of PB and the overall prognostic characteristics. Results A total of 1062 children with infection-related PB were enrolled in this study. The seasonal distribution was： spring （149 cases，14.0%）， summer （186 cases， 17.5%）， fall （367 cases， 34.6%）， and winter （360 cases， 33.9%）， with higher incidence in fall and winter. The age distribution was： 0-1 year old （244 cases， 23.0%）， >1-3 years old （142 cases， 13.4%），>3-6 years old （229 cases， 21.6%）， >6-12 years old （410 cases， 39.4%）， >12-18 years old （28 cases， 2.7%），and the prevalent age was 6-12 years old （39.4%）. The etiologic distribution was as follows： no definite pathogen detected （443 cases， 41.7%）， viral infection （29 cases， 2.7%）， Mycoplasma pneumoniae infection （503 cases，47.4%）， bacterial infection （9 cases， 0.8%）， and mixed infections （78 cases， 7.3%）， with Mycoplasma pneumoniae being the most common pathogen. The incidence of  intrapulmonary complications was pleurisy （245 cases，23.1%）， pulmonary atelectasis （246 cases， 23.2%），and pleural effusion （258 cases， 24.3%）. The incidence of extrapulmonary complications was as follows：neurological system （20 cases， 1.9%）， circulatory system （20 cases， 1.9%）， hematologic system （17 cases， 1.6%）， digestive system （88 cases， 8.3%）， urological system （89 cases， 8.4%）， and skin and mucous membrane injuries （31 cases， 2.9%）， with a predominance of the digestive system and the urinary system. The median length of hospital stay for all patients was 7.0 （5.0， 10.0） days. Follow-up was conducted for 3 months to 1 year after discharge. The resolution of chest imaging findings was observed in 340 cases （32.0%） at 2 weeks after discharge， 702 cases （66.1%） at 4 weeks，954 cases （89.8%） at 8 weeks， and 1，039 cases （97.8%） at 6 months. An additional 23 cases （2.2%） achieved nearcomplete resolution between 6 months and 1 year after discharge， or were with residual linear opacities or fibrotic-like changes at previously affected sites. Conclusion PB occurs more often in fall and winter， mostly in children >6-12 years old， the most common pathogen is Mycoplasma pneumoniae， and the overall prognosis is good.

Select

Clinical characteristics of children with Burkholderia cepacia infection and study on drug susceptibility ZHU Ting-ting, XU Ming-ji, WEN Shun-hang, et al 2025, 40(6): 514-518.  DOI: 10.19538/j.ek2025060614 Abstract ( )   Objective To analyze the clinical characteristics of Burkholderia cepacia （BC） infections in pediatric patients and evaluate the drug susceptibility of isolated strains， thereby providing a reference for clinical diagnosis and treatment. Methods Clinical data and drug susceptibility profiles were collected from 58 pediatric patients hospitalized with Burkholderia cepacia infections at the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University between January 1， 2019， and December 31， 2023. A retrospective analysis was performed，encompassing patients’ demographic information， high-risk factors， sample sources， departmental distribution，laboratory test results， antibiotic susceptibility patterns， and clinical outcomes. Results Among the 58 patients， there were 34 males and 24 females， with ages ranging from 49 days to 17 years and a median age of 9 months （4.0-54.3）. The age distribution was as follows：≤1 year： 31 cases （53.4%）; >1-3 years： 8 cases （13.8%）; >3-5 years： 6 cases （10.3%）; >5-10 years： 6 cases （10.3%）; >10 years： 7 cases （12.1%）. The department with the highest incidence was the pediatric intensive care unit （86.2%， 50/58）， followed by pediatric nephrology （10.3%， 6/58）. The sample sources comprised sputum （n=50）， urine （n=6）， blood （n=5）， abdominal effusion （n=3）， catheter tips （n=1）， and cerebrospinal fluid （n=1）， totaling 66 strains. Burkholderia cepacia was detected across multiple sites in 6 patients. The clinical diagnoses encompassed lung infection  （n=50）， urinary tract infection （n=6）， sepsis （n=5），peritonitis （n=3）， among others. Notably， 49 cases （84.5%） were identified as hospital-acquired infections，while 9 cases （15.5%） were classified as community-acquired infections. Among the 58 BC strains analyzed， the resistance rate of Burkholderia cepacia to ceftazidime was 3.4% （2/58）， while levofloxacin exhibited no resistance， though an intermediate susceptibility rate of 6.9% （4/58） was observed. The resistance rate to sulfamethoxazole/trimethoprim was 5.2% （3/58）. Clinical outcomes of the cases were as follows： 35 patients were cured， 12 showed improvement， 9 discontinued treatment， and 2 died. Conclusion Pediatric BC infections are primarily nosocomial infections， frequently occurring in intensive care units （ICUs）， with pulmonary infections representing the most prevalent clinical manifestation， demonstrating a high susceptibility to ceftazidime，sulfamethoxazole/trimethoprim， and levofloxacin.

Select

Advances in the application of bacterial lysates in the prevention and treatment of paediatric respiratory tract infections WU Jia-ying, HONG Jian-guo 2025, 40(6): 519-524.  DOI: 10.19538/j.ek2025060615 Abstract ( )   Respiratory tract infection is a common respiratory disease in children，significantly affecting their quality of life and healthy development. As an immunomodulator，bacterial lysates not only strengthen adaptive immunity but also induce trained immunity by activating the innate immune system，providing a broad，non-specific protective effect against various pathogens. This review aims to synthesize the mechanism and the recent advances in the application of bacterial lysates in the prevention and treatment of paediatric respiratory tract infections for clinical reference. In the future，it is expected to explore the potential of bacterial lysates as a primary preventive measure for pediatric respiratory infections and clarify the target population and duration of medication，to provide more comprehensive evidence for standardised clinical application.

Select

Diabetic ketoacidosis complicated with acute respiratory distress syndrome：a case report ZHU Bi-zhen, YANG Yun-gang, SHI Hui-xuan, et al 2025, 40(6): 525-528.  DOI: 10.19538/j.ek2025060616 Abstract ( )   Acute respiratory distress syndrome is a rare but life-threatening complication of diabetes ketoacidosis. This article reports a case of diabetic ketoacidosis complicated with acute respiratory distress syndrome， who was admitted to the Department of Pediatrics of the First Affiliated Hospital of Xiamen University in July 7，2022. The patient presented with diabetic ketoacidosis complicated with severe dehydration at onset， which rapidly progressed to dyspnea and hypoxemia within a few hours. The chest radiograph showed bilateral diffuse infiltrates. ARDS was confirmed and she was intubated for invasive mechanical ventilation. She also underwent continuous renal replacement therapy（CRRT）. After three days， the patient’s condition was improved and was weaned from ventilator. The article summarizes the clinical diagnosis and treatment process of this case and reviews literature， aiming to improve the understanding of this rare complication among the clinicians.