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06 August 2025, Volume 40 Issue 8 Previous Issue   

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Chinese expert consensus on the diagnosis，treatment and management of hypertrophic cardiomyopathy in children（2025） Precision Diagnosis and Treatment of Pediatric Cardiomyopathy Collaborative Group, Cardiovascular Group, Society of Pediatrics, Chinese Medical Association, Heart Failure Collaborative Group, Cardiovascular Group, Society of Pediatrics, Chinese Medical Association, Inherited Metabolic Cardiomyopathy Collaborative Group, Cardiovascular Group, Society of Pediatrics, Chinese Medical Association, et al 2025, 40(8): 617-636.  DOI: 10.19538/j.ek2025080601 Abstract ( )   Hypertrophic cardiomyopathy (HCM) is one of the most important causes of sudden cardiac death in children and adolescents. Since the publication of the first Chinese consensus on pediatric HCM diagnosis in 2019, new and significant advances have been made in the diagnosis and management of HCM. To address these developments, the Cardiovascular Subspecialty Group of the Pediatrics Branch, Chinese Medical Association, in collaboration with the Precision Diagnosis and Treatment Collaborative Group for Childhood Cardiomyopathy, the Heart Failure Collaborative Group, the Genetic and Metabolic Cardiomyopathy Collaborative Group, and the Editorial Board of Chinese Journal of Practical Pediatrics, organized experts to develop this updated consensus. The consensus focuses on the definition, diagnostic approaches, risk stratification, and management of pediatric HCM,with the aim of improving the standardization of diagnosis and treatment of pediatric HCM, thereby enhancing its quality of life and improving prognosis.

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Expert consensus on the management of mucosal injury repair in children Committee of Pediatric Allergy, China Maternal and Child Health Association 2025, 40(8): 637-644.  DOI: 10.19538/j.ek2025080602 Abstract ( )   Mucosal injury in pediatric patients frequently occurs in delicate mucosal tissues such as the oral cavity，nasal passages，and gastrointestinal tract，as these areas are particularly susceptible to physical trauma or chemical irritation.Effective management of these injuries requires an approach that prioritizes patient safety，treatment efficacy，and the distinct physiological and psychological needs of pediatric patients. This expert consensus recommends core strategies for the repair of mucosal injuries，including the early assessment of injury range，severity and infection risk，and the development of personalized treatment plans tailored to the age and compliance of the child.Key interventions include wound cleaning，protective measures，moist wound healing and appropriate nutritional support, in order to promote healing，while focusing on pain management and infection prevention. Meanwhile，long-term follow-up is necessary to prevent the risk of scarring and functional impairment. This expert consensus aims to provide a practical，evidence-based management plan for the clinical diagnosis and treatment，and optimize the repair strategies for mucosal injuries in pediatric patients.

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Interpretation of the 2024 edition of Update on Diagnosis and Management of Kawasaki Disease：A Scientific Statement From the American Heart Association JU Chen-hui, XIAO Yan-yan, GAO Lu, et al 2025, 40(8): 645-651.  DOI: 10.19538/j.ek2025080603 Abstract ( )   Kawasaki disease（KD）is an acute self-limiting febrile disorder that mainly affects children under 5 years old.The 2024 edition of“Update on Diagnosis and Management of Kawasaki Disease：A Scientific Statement From the American Heart Association” updates and summarizes the clinical research progress related to diagnosis，acute-phase cardiac imaging examinations，and long-term management since the American Heart Association released the KD scientific statement in 2017.The new statement updates the diagnostic criteria for patients at high risk of coronary artery aneurysms in the North American population，who may benefit from more aggressive initial treatment.Advances in cardiovascular imaging technology have enhanced our ability to identify coronary artery stenosis in KD patients.The latest research on KD treatment has deepened our understanding of the safety and dosage regimens of multiple anti-inflammatory treatments for KD.The new statement also explores key clinical issues such as the application of new oral anticoagulants，management plans for myocardial infarction，selection of anti-platelet drugs，anti-coagulation treatment strategies，and methods for assessing myocardial ischemia，with particular emphasis on long-term follow-up management strategies for patients with coronary artery complications.

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Interpretation of “Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children” WANG Ying-shuo, ZHUANG Hai-ning 2025, 40(8): 652-655.  DOI: 10.19538/j.ek2025080604 Abstract ( )   Mycoplasma pneumoniae is one of the significant pathogens causing community-acquired pneumonia in children. Since 2000，macrolide-resistant Mycoplasma pneumoniae（MRMP）has begun to spread in the Western Pacific region，including China. MRMP infection often results in prolonged fever and duration of antibiotic use，increased use of glucocorticoids and second-line antibiotics，and an increased risk of complications and sequelae. In 2024，28 pediatric respiratory experts in our country formulated the “Expert consensus on the diagnosis and treatment of MRMP pneumonia in children”.In this article，we will interpret the hot issues in the consensus to guide pediatricians to grasp the diagnosis and treatment of MRMP pneumonia more accurately.

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Several issues that should be paid attention to in children with severe pneumonia FU Hong-min, LU Quan 2025, 40(8): 656-659.  DOI: 10.19538/j.ek2025080605 Abstract ( )   In the new era of prevention and control of COVID-19，the characteristics of pediatric pneumonia have undergone some changes，such as the diversity and complexity of pathogens，and alteration in clinical characteristics，etc. Besides，much attention should be paid to respiratory virus-associated sepsis，obstructive respiratory failure caused by mucus hypersecretion after infection，and severe pneumonia complicated with pulmonary embolism. It is also necessary to strengthen the illness evaluation and early warning of severe pneumonia in children，and accelerate the application of artificial intelligence in the diagnosis and treatment of severe pneumonia. Clinicians should pay special attention to these issues in order to achieve better diagnosis，treatment，and prevention of severe pneumonia in children.

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Effect of changes in pathogens of severe pneumonia in children on the clinical diagnosis and treatment DONG Xiao-yan 2025, 40(8): 660-666.  DOI: 10.19538/j.ek2025080606 Abstract ( )   Pneumonia is a common respiratory disease among children and is also one of the important causes of death in children under the age of 5.In the new stage of controlling the spread of the SARS-Cov-2 infection，as the epidemic situation changes and non-pharmaceutical prevention measures are importanted，the epidemiological trend of pathogenicity of severe pneumonia in children has undergone significant changes.This article analyzes and summarizes relevant domestic and foreign literature and clinical studies.We hope that clinicians can recognize the importance of respiratory pathogen monitoring, make adjustment of diagnosis and treatment methods for severe pneumonia in children，and especially,have a new understanding of the value of preventive measures such as vaccination.

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Evaluation model and early warning value of severe pneumonia in children ZOU Ying-xue, WANG Xue-lin 2025, 40(8): 666-669.  DOI: 10.19538/j.ek2025080607 Abstract ( )   The assessment models for severe pediatric pneumonia are centered on clinical features，and integrated with laboratory and imaging indicators to form a multidimensional early warning system.Different predictive models have specific clinical contexts，strengths，and limitations.When applied appropriately，they can significantly enhance early detection，optimize hierarchical diagnosis and treatment pathways，and reduce mortality of children with severe pneumonia. Future efforts should focus on further validation and simplification of these models to promote their widespread application in primary healthcare settings.

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A new perspective on the assessment of respiratory hypoxia in　children FU Hong-min, SUI Ming-ze, LU Quan 2025, 40(8): 669-673.  DOI: 10.19538/j.ek2025080608 Abstract ( )   Accurately assessing the presence and severity of hypoxia is of great significance. Hypoxia is currently diagnosed based on the criteria of hypoxemia，but the three types of hypoxia—circulatory，hematological，and histotoxic—do not present with hypoxemia. Actually，the current criteria of hypoxia is only applicable to the assessment of hypotonic（respiratory）hypoxia caused by respiratory diseases. This article elaborates on the types of hypoxia，its correlation with hypoxemia，compensatory mechanisms of respiratory hypoxia，and new assessment indicators.

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Research advancements and application prospect of machine learning in the field of pediatric severe pneumonia DONG Mi-lan, LUO Zheng-xiu 2025, 40(8): 673-676.  DOI: 10.19538/j.ek2025080609 Abstract ( )   Early diagnosis and timely intervention in severe pneumonia play a vital role in reducing mortality rates of children with pneunomia.Machine learning（ML）holds potential advantages in the early diagnosis and treatment of severe pneumonia.This article analyzes the application progress of ML in three key clinical domains of severe pneumonia in children：early warning，diagnosis，and prognosis prediction, aiming to establish intelligent digital tools for early detection，precise diagnosis and treatment，and stratified management of severe pneumonia in children.

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Progress in the diagnosis and treatment of pertussis complicated with severe pneumonia in children WANG Yu-qing, JIANG Wu-jun 2025, 40(8): 679-683.  DOI: 10.19538/j.ek2025080611 Abstract ( )   The incidence of pertussis has shown an upward trend in recent years. Pneumonia is the most common complication，which is mostly seen in newborns and infants under 6 months of age. The clinical manifestations of severe cases are complex，and the disease progresses rapidly，which is very likely to cause serious complications and even death. This article reviews the epidemiological characteristics，clinical manifestations，and the latest treatment strategies of pertussis complicated with severe pneumonia in children. By integrating the latest research progress at home and abroad，this article aims to provide clinical physicians with reasonable diagnosis and treatment regimens to reduce the mortality rate.

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Progress in diagnosis and treatment of severe respiratory syncytial virus infection in children ZHOU Min, WU Chao-fen, CHEN Li-na 2025, 40(8): 683-687.  DOI: 10.19538/j.ek2025080612 Abstract ( )   Respiratory syncytial virus（RSV）is the most common virus causing lower respiratory tract infections in children. Attention should be paid to identifying children at high risk of developing severe infection. There are various detection methods to determine RSV infection，which should be selected rationally. The treatment for RSV infection is mainly symptomatic support，and recent progress in drug research and development is expected to achieve a breakthrough in treatment.

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Application of lung ultrasound in the diagnosis and clinical evaluation of severe pneumonia in children SUN Yi, ZHANG Hao-rong 2025, 40(8): 687-690.  DOI: 10.19538/j.ek2025080613 Abstract ( )   Lung ultrasound （LUS），as a noninvasive and non-radiative imaging technique，has demonstrated significant value in the diagnosis and monitoring of severe pediatric pneumonia in recent years. The article systematically elucidates the basic principles of LUS，abnormal signs （such as pulmonary consolidation，increased B-lines，pleural effusion，etc.），and its diagnostic and evaluation efficacy in severe pediatric pneumonia；it also points out the advantages and limitations of LUS. In the future，it is necessary to promote the establishment of a child-specific LUS scoring system and explore artificial intelligence-assisted analysis techniques to enhance objectivity.

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Establishment of reference ranges for left ventricular functional parameters in neonatal echocardiography：a multicenter，prospective，observational study YANG Jing-li, AN Yan-bin, WANG Jian-ping, et al 2025, 40(8): 691-699.  DOI: 10.19538/j.ek2025080614 Abstract ( )   Objective　To establish reference ranges for left ventricular functional parameters in neonatal echocardiography across different postnatal time intervals，stratified by gestational age（GA），birth weight，and gender，thereby providing reference for left ventricular functional assessment in the application of neonatal critical care bedside cardiac ultrasound. Methods　This multicenter，prospective，observational study enrolled 406 term neonates hospitalized or receiving outpatient care at the Children’s Hospital of Chongqing Medical University，Yinchuan First People’s Hospital of Ningxia Autonomous Region，and Inner Mongolia Maternal and Child Health Hospital between June 2023 and May 2024. Bedside echocardiography was performed by trained neonatologists or sonographers to measure parameters reflecting left ventricular systolic and diastolic function. Reference ranges（95% confidence intervals）were established for postnatal days 1，3，7，14，and 28，with stratification by GA and birth weight. Results　Among the 406 term neonates（204 males，202 females），mean GA was（38.9±1.5）weeks，and mean birth weight was（3197.8±449.5）g. Multiple left ventricular functional parameters—including left ventricular outflow tract stroke volume（LVO），weight-indexed LVO（LVO*），mitral annular plane systolic excursion（MAPSE），mitral valve early（MV-E）and late（MV-A）diastolic inflow velocities，and pulmonary vein S/D ratio—showed significant associations with birth weight and GA（all P<0.05）. LVO，LVO*，MV-E，MV-A，MV-E/e’ratio（early diastolic inflow velocity to lateral mitral annular tissue Doppler e’velocity），pulmonary vein S-wave velocity，and pulmonary vein S/D ratio were correlated with postnatal age（all P<0.05）. No parameters exhibited gender-related differences（all P>0.05）. Conclusion　Neonatal left ventricular systolic and diastolic functional parameters are associated with postnatal age，GA，and birth weight. This study establishes comprehensive reference ranges for left ventricular functional assessment，stratified by age，GA and birth weight，which play a crucial role in guiding refined hemodynamic evaluation and management of critically ill neonates.

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Risk factors and prognostic analysis of delayed excretion of high-dose methotrexate in the treatment of pediatric　medulloblastoma ZHANG Jin, GONG Xiao-jun, SUN Yan-ling, et al 2025, 40(8): 700-704.  DOI: 10.19538/j.ek2025080615 Abstract ( )   Objective　High-dose methotrexate（HD-MTX）is a widely employed chemotherapy regimen for the treatment of medulloblastoma in pediatric patients.This study is aimed to investigate the risk factors associated with delayed methotrexate excretion and to evaluate the correlation between delayed excretion and the prognosis of the children. Methods　A  retrospective analysis was conducted on children with medulloblastoma who received high-dose methotrexate（HD-MTX） treatment in the Department of Pediatrics of Beijing Shijitan Hospital，Capital Medical University between January 2019 and December 2020.Clinical data were collected，including gender，age at onset，histological type，molecular subtype，and disease stage.Additionally，24-hour（C24）and 42-hour（C42）blood drug concentrations，as well as blood routine and liver and kidney function indices，were recorded.The Mann-Whitney U test and Kruskal-Wallis H test were used to analyze the differences in blood drug concentrations across various clinical characteristics.Logistic regression analysis was employed to identify risk factors associated with delayed drug excretion. Furthermore，univariate and multivariate survival analyses were conducted using the Cox proportional hazards model. Results　A total of 41 children（24 boys，17 girls）with medulloblastoma were enrolled in this study，with a median age of 2.9 years（ranging from 0.6 to 13.6 years） at diagnosis.A total of 167 HD-MTX chemotherapy sessions were conducted，of which 31 sessions （18.6%）exhibited delayed excretion. Intrathecal MTX injection was performed in 133 sessions（80%）.C24 levels were significantly elevated in children who did not receive intrathecal injection（P=0.017）and those with leukopenia（P=0.044），and C42 levels were significantly elevated in children aged 3 years or older（P=0.006）and those with cerebrospinal fluid metastasis（P<0.001）.No statistically significant difference in adverse reactions was observed between children with normal excretion and those with delayed excretion. Cerebrospinal fluid metastasis was identified as an independent risk factor for delayed excretion in children with medulloblastoma（P=0.002，OR=4.864，95% CI 1.797 - 13.167）.Delayed MTX excretion was not a factor affecting the prognosis of children with medulloblastoma. Conclusion　The HD-MTX treatment exhibits favorable safety in pediatric patients with medulloblastoma. Cerebrospinal fluid metastasis is identified as a risk factor for delayed MTX excretion；however，the delayed excretion does not have a significant impact on the prognosis of the children.