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06 March 2026, Volume 41 Issue 3 Previous Issue   

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Expert consensus on rational application of anti-influenza virus drugs in pediatrics（2026 edition） Respiratory Group of the Pediatric Branch of the Chinese Medical Association, Infectious Diseases Group of the Pediatric Branch of the Chinese Medical Association, Respiratory Group of the Pediatric Branch of the Chinese Medical Doctor Association, et al 2026, 41(3): 177-186.  DOI: 10.19538/j.ek2026030601 Abstract ( )   Influenza is an acute respiratory infectious disease caused by influenza viruses. Children are highly susceptible and at increased risk of severe illness. To standardize the clinical use of antiviral agents for pediatric influenza in China，the Respiratory and Infectious Diseases Groups of Pediatric Branch of the Chinese Medical Association jointly convened a national multidisciplinary panel of pediatric clinicians，pharmacists，and experts in viral etiology and epidemiology. With an integrated “diagnosis-treatment-prevention” framework as the core，the panel addressed seven key clinical questions，including diagnostic criteria，recognition of severe and critical cases，and antiviral therapy in children，and developed 16 evidence-based recommendations through problem construction，systematic evidence review and comprehensive analysis，as well as in-depth discussion. This consensus provides guidance for the standardized use of anti-influenza virus agents in pediatric，general，and primary practitioners.

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Key points in the updated guidelines for determining brain death/death by neurologic criteria in children and adults in the United States WU Jie, WANG Quan, QIAN Su-yun 2026, 41(3): 187-191.  DOI: 10.19538/j.ek2026030602 Abstract ( )   In 2023，the American Academy of Neurology，in collaboration with seven prominent academic organizations，released a new version of the guidelines for determining brain death/death by neurologic criteria. This guideline systematically integrates evidence-based medical evidence from the past decade and makes clear responses to controversial issues encountered in clinical practice. Its content has some differences from the current brain death determination framework implemented in China. This article aims to elucidate and interpret the core updates of this guideline by examining aspects such as diagnostic criteria， operational standards，and management of special populations，with the intention of providing valuable references for clinical practice.

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Evolution of the concept of severe pneumonia YANG Wen-hao, LIU Han-min 2026, 41(3): 192-194.  DOI: 10.19538/j.ek2026030603 Abstract ( )   Severe pneumonia represents a common severe respiratory condition that poses a substantial threat to pediatric health. Its conceptual framework has been progressively refined with advancements in medical science. A clear understanding of its definition is essential to effective clinical diagnosis and treatment. The conceptual evolution of severe pneumonia has undergone three distinct phases. Currently，the definition of severe pneumonia encompasses both severe respiratory lesions and extrapulmonary organ involvement，but the integration of traditional system classification with modern objective indicators still deserves further exploration.

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Pathophysiology of hypoxemia in severe pneumonia FU Hong-min, SUI Ming-ze 2026, 41(3): 195-197.  DOI: 10.19538/j.ek2026030604 Abstract ( )   Severe pneumonia is an important cause of acute respiratory failure，and its core pathology is hypoxemia. This article elaborates on the criteria for hypoxemia，the conditions for the body to maintain normal oxygen partial pressure，the mechanism of hypoxemia in severe pneumonia，and the compensatory manifestations of the body.

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Pathophysiological mechanism of immune injury in severe pneumonia WEN Shun-hang, ZHANG Hai-lin 2026, 41(3): 198-201.  DOI: 10.19538/j.ek2026030605 Abstract ( )   The nature of severe pneumonia primarily involve an uncontrolled immune response and damage triggered by pulmonary infection. The recognition of pathogens leads to the excessive activation of the immune system，characterized by an imbalance in macrophage polarization and dysregulated formation of neutrophil extracellular traps（NETs），which are critical factors in this process. Excessive inflammatory responses are closely related to tissue cell damage and are the core mechanism of intrapulmonary and extrapulmonary immune pathological damage. Disorders of neuroimmune regulation may also play an important role. In the late stages of severe pneumonia，T cell depletion and immune paralysis occur，increasing the risk of secondary infections. Shifting the treatment strategy from simple anti-infection to immune regulation can help break the vicious cycle of immune imbalance and improve prognosis.

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Comparison of diagnostic criteria for severe childhood pneumonia：domestic and international perspectives ZHU Si-yu, DONG Xiao-yan 2026, 41(3): 202-207.  DOI: 10.19538/j.ek2026030606 Abstract ( )   Community-acquired pneumonia（CAP） remains the leading infectious cause of death in children under 5 years old worldwide. In 2019，pneumonia accounted for approximately 22% of all deaths in children aged 1~5 years globally. Early and accurate identification is a crucial link in reducing its mortality rate. However，due to differences in epidemiological characteristics，clinical practice needs，and medical resource allocation across countries and regions，a unified diagnostic standard for severe childhood pneumonia has not been established domestically or internationally. This article systematically summarizes the diagnostic criteria for severe childhood pneumonia at home and abroad，explores the advantages and limitations of each standard by comparing their similarities and differences，and puts forward thoughts and prospects for optimizing the diagnostic system based on with etiological changes，technological advancements，and clinical needs. It aims to provide a reference for promoting the standardized diagnosis and treatment of severe childhood pneumonia.

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Recent pulmonary complications of severe pneumonia in children ZHANG Shu-lan, ZHAO De-yu 2026, 41(3): 208-211.  DOI: 10.19538/j.ek2026030607 Abstract ( )   Recent pulmonary complications of severe pneumonia in children are an important reason for the aggravation of their lung conditions and the prolongation of hospital stay. They can also cause long-term complications such as oblusive bronchiolitis，bronchiectasis，and lung damage. In severe cases，they can even lead to death. In recent years，with the change of the pathogen spectrum of pneumonia infection in children and the increase in pathogen drug resistance，in addition to the common pulmonary complications such as atelectasis，empyema，pyopneumothorax，lung abscess and necrotizing pneumonia，previously rare complications such as pulmonary embolism and plastic bronchitis have emerged in the recent pulmonary complications. This article will elaborate on the clinical characteristics，diagnostic methods and management principles of short-term pulmonary complications of severe pneumonia，with the aim of being helpful for the early detection and timely management of short-term pulmonary complications of severe pneumonia，reducing long-term complications and lowering the mortality rate of pneumonia in children.

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Short-term extrapulmonary complications of severe pneumonia in children SONG Jia-yao, WANG Ying-shuo, CHEN Zhi-min 2026, 41(3): 212-216.  DOI: 10.19538/j.ek2026030608 Abstract ( )   Severe pneumonia is a major cause of hospitalization and death in children. Its harm is not limited to lung damage itself，but also lies in the systemic inflammatory response and multi-organ dysfunction caused by infection. In recent years，more and more attention has been paid to the extrapulmonary complications of severe pneumonia in children. These complications are key factors affecting disease prognosis，increasing mortality，and causing long-term consequences. This article summarized the current researches on common short-term extrapulmonary complications in children with severe pneumonia，thereby providing a scientific reference for pediatricians to enhance early recognition and clinical management of such children.

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Long-term intrapulmonary complications of severe pneumonia in children LIU Jin-rong, ZHAO Shun-ying 2026, 41(3): 217-220.  DOI: 10.19538/j.ek2026030609 Abstract ( )   Long-term intrapulmonary complications of severe pneumonia primarily include chronic conditions that currently have no specific treatment，persist over time，and exert varying degrees of long-time or even life-long impact on patients. These complications occur following severe pneumonia，and mostly present as a continuous process of pneumonia，with no clear onset time. Common complications include organizing pneumonia，bronchiolitis obliterans/obliterative bronchitis，and bronchiectasis. Severe long-term complications can lead to symptoms such as shortness of breath，wheezing，dyspnea，and persistent moist rales in the lungs. They may also result in recurrent hospitalizations due to repeated respiratory infections，impairing both pulmonary and physical growth and development in patients，while milder cases may present no clinical symptoms. Once long-term complications occur，treatment outcomes are generally poor. Thus，the keys in diagnosis and treatment lie in early screening，prevention，diagnosis， and intervention.

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Severe pneumonia in immunocompromised children YANG Zhi-mei, LUO Zheng-xiu 2026, 41(3): 221-223.  DOI: 10.19538/j.ek2026030610 Abstract ( )   Pneumonia is a common and frequently-occurring disease that harms children’s health. Immunocompromised children have a high risk of severe pneumonia. Immunocompromised status usually refers to immunodeficiency，including both primary immunodeficiency diseases（PID） and secondary immunodeficiencies. We focus on severe pneumonia in children with PID to elucidate the etiological characteristics，clinical manifestations，early identification clues for severe pneumonia in children with PID，as well as diagnostic and therapeutic strategies and key management points，aiming to provide clinicians with references for clinical practice.

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Outcome and prognosis evaluation of severe pneumonia in children ZOU Ying-xue 2026, 41(3): 224-228.  DOI: 10.19538/j.ek2026030611 Abstract ( )   Severe pneumonia in children remains a leading cause of mortality globally，and its prognostic evaluation is a critical and challenging aspect of clinical management. This review explores the pivotal factors influencing the prognosis of children with severe pneumonia， including pathogen characteristics，host immune response，the occurrence of complications，and the adequacy of initial therapeutic interventions. Prognostic assessment should extend beyond traditional survival rate metrics，and it is advocated to the establish a comprehensive evaluation framework encompassing acute disease management，organ function recovery，and prevention and management of complications，and an emphasis should be placed on long-term quality of life. This article explores the application value and limitations of clinical symptoms and signs，imaging modalities，serum biomarkers，and pulmonary function tests in predicting outcomes of severe pneumonia，in order to achieve. The transitioning of therapeutic goals from infection control to lung functional recovery.

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Progress in precision diagnosis and treatment of childhood leukemia WEN Fei-qiu, TANG Xue 2026, 41(3): 229-235.  DOI: 10.19538/j.ek2026030612 Abstract ( )   This article focuses on three main lines：precise diagnosis，precise treatment，and precise management. By integrating recent key clinical trials and mechanism studies，it mainly discusses the selection of clinically feasible strategies，toxicity balance，and future challenges. It emphasizes that precision medicine for childhood leukemia will further progress from genotyping-driven to pan-genomics and intelligent decision-making era，ultimately achieving the long-term goal of equally prioritizing cure rate and quality of life.

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Changes in epidemiology and clinical characteristics of human parainfluenza virus in hospitalized children in Suzhou between 2016 and 2025 YANG Qu-ying, LI Wei-qi, JIANG Wu-jun, et al 2026, 41(3): 236-245.  DOI: 10.19538/j.ek2026030613 Abstract ( )   Objective　To describe epidemiologic and clinical changes in human parainfluenza virus（HPIV） infection among hospitalized children before，during，and after the COVID-19 pandemic（2016—2019，2020—2022，and 2023—2025），and to analyze host risk factors for severe pneumonia among children hospitalized with single HPIV infection. Methods　We retrospectively reviewed clinical data of children hospitalized with acute respiratory tract infection（ARTI） who underwent respiratory virus nucleic acid testing at the Children’s Hospital of Soochow University from January 2016 to August 2025. Results　The HPIV positivity rate was 3.07%-3.61% in 2016—2019，which increased to 4.08%-10.57% in 2020—2022，and further rose to 7.21%-12.25% in 2023—2025. The peak gradually shifted from spring to autumn and summer，The higher rates in 2016—2019 were observed in children<2 years of age（1-2 years：4.56%；<1 year：4.22%），whereas rates were lower in preschool and school-age/adolescent groups. In the post-pandemic period，positivity rates increased across all age groups<6 years，with the preschool group reaching the highest rate in 2025（19.09%）. Among HPIV-positive cases，1，426（25.43%） had at least one additional respiratory virus detected，with human rhinovirus，bocavirus，and respiratory syncytial virus being most common. In the single-HPIV hospitalization cohort，fever was more frequent during and after the pandemic；upper respiratory symptoms increased，while wheeze-related manifestations decreased. Prematurity（adjusted OR=3.28，95%CI 1.51-7.13） and chronic underlying diseases（adjusted OR=8.24，95%CI 3.90-17.38） were independent risk factors for severe pneumonia，whereas age<3 years （adjusted OR=0.90，95%CI 0.39-2.08） and pandemic period were not significantly associated with the risk of severe diseases. Conclusion　After the COVID-19 pandemic，HPIV positivity rate increases among hospitalized children，accompanied by seasonal peaks and the affected age distribution shifting toward later months and older age groups. However，overall disease severity does not markedly worsen among hospitalized children with single HPIV infection. The risk of severe pneumonia is primarily related to prematurity and chronic underlying disease.

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Clinical characteristics and prognosis analysis of immunocompromised children with tuberculosis SUN Wen-yu, YANG Hai-ming, ZHAO Shun-ying, et al 2026, 41(3): 246-251.  DOI: 10.19538/j.ek2026030614 Abstract ( )   Objective　To summarize the clinical characteristics of tuberculosis in immunocompromised children and to investigate the factors influencing their prognosis. Methods　A retrospective analysis was conducted on the clinical data of pediatric tuberculosis patients admitted to the Respiratory Center of Beijing Children’s Hospital between January 2017 and December 2022. The prognosis of these children was followed up，and a regression analysis was performed on the risk factors affecting the prognosis. Results　Among the 269 children with tuberculosis，58（21.56%） were in the immunocompromised group，of which 40（68.97%） had primary immunodeficiency diseases，with chronic granulomatous disease being the most common（15 cases，37.50%）. The control group with normal immune function comprised 211 cases（78.44%）. The immunocompromised group was more prone to extrapulmonary tuberculosis（P<0.05），and had a lower rate of tuberculosis contact history（84.48%），a lower rate of positive BCG scar after BCG vaccination（66.67% vs. 81.55%），and a higher rate of delayed diagnosis（P<0.01）. The immunocompromised group was more likely to present with dyspnea，lymphadenopathy，hepatosplenomegaly，and severe tuberculosis（P<0.05）；the positive rates of tuberculin skin test，interferon-γ release assay，and Mycobacterium tuberculosis DNA detection were all lower than those in the normal immune function control group；and the percentage of CD4+ T lymphocytes was significantly lower（P<0.01）. The proportion of children in the immunocompromised group who received second-line treatment was 62.07%（36/58），which was higher than 42.65%（90/211） in the control group（P<0.05）. The duration of anti-tuberculosis drug treatment was 26（18，31） months，which was significantly longer than 18（16，24） months in the control group（P<0.01），and the incidence of adverse reactions to anti-tuberculosis drugs was higher（78.85% vs. 53.37%，P<0.01）. Among the 58 children in the immunocompromised group，33（63.46%） had a poor prognosis，including 13 deaths（25.00%）. The risk factors for poor prognosis were the presence of primary immunodeficiency diseases（OR：4.050，P= 0.030） and the severity of the disease（OR：5.000，P=0.012）. Conclusion　Immunocompriomised children with tuberculosis often have no history of tuberculosis contact，the clinical symptoms are atypical，and they are prone to severe tuberculosis and extrapulmonary tuberculosis. The positive rates of immunological tests and pathogen detection are low，and multiple detection methods need to be combined for diagnosis. In terms of treatment，a stronger chemotherapy regimen and a longer course of treatment are required，and the prognosis is often poor with a higher mortality rate.

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Application of respiratory sound characteristic parameter analysis based on electronic stethoscope in the diagnosis of childhood pneumonia LING Gong-xia, HU Yan-qing, JIN Wei-gang, et al 2026, 41(3): 252-258.  DOI: 10.19538/j.ek2026030615 Abstract ( )   Objective　To study the application value of respiratory sound characteristic parameter analysis based on electronic stethoscope in pediatric pneumonia，and evaluate effectiveness of the zero-crossing rate and short-term energy parameters in identifying pulmonary crackles and wheezes. Methods　Utilizing an electronic stethoscope，we collected respiratory sounds from children hospitalized with pneumonia at The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from July 2021 to December 2022，extracted four feature parameters—maximum zero-crossing rate（zcrMax），minimum zero-crossing rate（zcrMin），maximum short-term energy（enMax），and minimum short-term energy（enMin）-to construct a model for the identification of pulmonary crackles and wheezes，and assessed the model performance via the receiver operating characteristic（ROC） curve，accuracy，sensitivity，and specificity. Results　In this study，a cohort of 5，157 respiratory sounds data entries were included. The maximum zero-crossing rate in Group A（crackles only） was significantly higher than that in the other three groups（P<0.001）. The maximum short-term energy in Group B（wheezes only） was greater than that in both Group A and Group D（normal breath sounds）（P<0.001）. A significant difference in the minimum shortterm energy was observed between Group B and Group C（both crackles and wheezes）（P=0.004）. Random forest model demonstrated higher accuracy compared to linear discriminant analysis，support vector machine，and Logistic regression model. The random forest model achieved an accuracy of 68.5% in identifying the presence of abnormal breath sounds，and its accuracy reached 75.2% for identifying the co-existence of both crackles and wheezes. Conclusion　It is feasible to use the zero-crossing rate and short-term energy as characteristic parameters to distinguish pulmonary crackles and wheezes. Constructing the random forest model using these characteristic parameters of breath sounds based on electronic stethoscope demonstrates certain advantages in the diagnosis of childhood pneumonia and provides a new technical approach for auxiliary diagnosis.

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One case of protein-losing enteropathy LI Di, YE Xiao-lin, CHENG Yin, et al 2026, 41(3): 259-264.  DOI: 10.19538/j.ek2026030616 Abstract ( )   This case involves a 6-month-old male infant who has been admitted to the hospital repeatedly due to diarrhea since the age of 2 months. Later，the diarrhea gradually worsened，accompanied by manifestations of protein-losing enteropathy（PLE） such as fever and edema. The patient visited Beijing Children’s Hospital Affiliated to Capital Medical University on May 22，2025，and a multidisciplinary team（MDT） conducted joint diagnosis and treatment. The final confirmed diagnosis was Langerhans cell histiocytosis（LCH）. After treatment with targeted anti-tumor drugs and symptomatic therapy，the infant’s condition improved. The core challenge of this case lies in the clinical rarity of LCH presenting with gastrointestinal symptoms as the initial manifestation. For children with diarrhea，hematochezia，and fever that respond poorly to conventional treatment，especially those with multisystem damage，early gastrointestinal mucosal pathology combined with special immunohistochemical tests should be performed based on clinical manifestations to confirm the diagnosis as soon as possible. Attention should be paid to strengthening inter-departmental communication and administering specialized treatment at an early stage to improve the prognosis of such children.