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06 April 2026, Volume 41 Issue 4 Previous Issue   

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Bethune by our side--a profile of Dr. LIANG Ying-jie YU Fei-hong, WANG Li-bo 2026, 41(4): 265-265.  DOI: 10.19538/j.ek2026040601 Abstract ( )

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Expert recommendations on respiratory rehabilitation for post-infectious bronchiolitis obliterans in children（2026） Medical Association Society of Pediatrics, Respiratory Group, Chinese Medical Doctor Association Pediatrician Branch, Respiratory Group, China Medicine Education Association Pediatric Committee, et al 2026, 41(4): 266-275.  DOI: 10.19538/j.ek2026040602 Abstract ( )   Post-infectious bronchiolitis obliterans（PIBO） is the most common type of bronchiolitis obliterans in children. As a chronic  respiratory disease，it has serious adverse effects on the growth and development as well as the physical and mental health of children. Respiratory rehabilitation is a core non-pharmaceutical intervention method in the long-term management of respiratory diseases，but there is still a lack of unified guideline standards for respiratory rehabilitation in children with PIBO. In view of this，and based on the latest evidence-based medical evidence at home and abroad and combined with the practical experience of clinical experts，this "Expert Recommendations on Respiratory Rehabilitation for Children with Post-infectious Bronchiolitis Obliterans" has been formulated. Under the premise of clearly defining the disease stage of PIBO and according to the stratification of the children's age and the classification of the disease severity，the appropriate respiratory rehabilitation intervention methods and intensities are selected，and individualized rehabilitation plans are made. This recommendation aims to enhance the clinical understanding of respiratory rehabilitation for children with PIBO，and provide standardized references and guidance for clinical diagnosis and treatment，thereby improving the clinical symptoms of children，increasing their quality of life，and optimizing their long-term prognosis.

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Interpretation of the 2025 NASPGHAN position paper on therapeutic drug monitoring targets in pediatric inflammatory bowel disease and comparison with the 2025 Chinese guideline#br# #br# GAO Hui-zhong, HE Wei-mei, ZHANG Min-min, et al 2026, 41(4): 276-285.  DOI: 10.19538/j.ek2026040603 Abstract ( )   In the application of biologic agents for pediatric inflammatory bowel disease（IBD），accelerated drug clearance and immunogenicity often lead to subtherapeutic exposure during induction therapy. Even when short-term clinical response or clinical remission is achieved，failure of early trough concentrations to reach target may still increase the risk of subsequent loss of efficacy and loss of response. This article interprets the North American Society for Pediatric Gastroenterology，Hepatology and Nutrition（NASPGHAN）position paper on therapeutic drug monitoring（TDM）in pediatric IBD（2025 edition）to achieve a proactive exposure target-driven framework. We then compared these recommendations with the Practice Guideline for TDM in Pediatric IBD（2025）by Chinese Medical Association，focusing on target drug concentrations for anti-tumor necrosis factor-α agents and other biologics，optimal timing for TDM，stratified management of anti-drug antibodies，and dose-intensification strategies. Key differences in monitoring approaches for high-risk phenotypes-including acute severe ulcerative colitis，perianal Crohn’s disease，and very early-onset IBD- are summarized to provide reference for clinical practice in China.

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Diagnostic and therapeutic approach to ascites in children ZHONG Xue-mei, GONG You-zhe 2026, 41(4): 286-290.  DOI: 10.19538/j.ek2026040604 Abstract ( )   Ascites refers to the pathological accumulation of free fluid in the peritoneal cavity. It is an important clinical sign in pediatric practice rather than an independent disease. Compared with adults，the etiological spectrum of ascites in children is more specific，often involving congenital，genetic-metabolic，and infectious diseases. Its onset can be insidious or acute，posing greater diagnostic and therapeutic challenges. This article aims to outline the diagnostic and therapeutic approach to ascites in children，focusing on etiological classification，physical examination，and laboratory and imaging examinations，and discusses corresponding comprehensive management strategies，in order to enhance pediatricians’ability to diagnose and treat ascites-related conditions.

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Diagnostic and therapeutic strategy for pediatric chronic abdominal pain YUJing, WU Jie 2026, 41(4): 291-295.  DOI: 10.19538/j.ek2026040605 Abstract ( )   Chronic abdominal pains（CAP）often affect children and their families’daily life. Due to its complicated etiology，detailed history-collecting and physical examination are of great significance. Meanwhile，social and psychological factors should be taken into account in case of excessive examinations. Although most pediatric CAP are functional，keeping various alarm symptoms in mind is key to preventing misdiagnosis. Pursuing relief of symptoms and better quality of life is the therapeutic goal，which needs comprehensive treatment and long-term management. Focusing on children’s mental health education and enhancing parents’understanding of the disease can effectively improve prognosis.

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Differential diagnosis of abnormal liver function in children CHEN Ying, XU Ling-fen 2026, 41(4): 296-299.  DOI: 10.19538/j.ek2026040606 Abstract ( )   Abnormal liver function is one of the most common and clinically challenging findings in pediatric practice. The etiologies are diverse, encompassing infections, genetics and metabolism, immunity, abnormal structure, and drugs. Different from adults, the spectrum of pediatric liver diseases changes significantly with age, and clinical manifestations are often various. Determining the diagnostic direction amid complex laboratory abnormalities and non-specific symptoms  remains a major challenge in clinical practice. Based on recent domestic and international research progress as well as clinical experience, this review outlines a clinical diagnostic approach to pediatric liver dysfunction, beginning with abnormal biochemical patterns and integrating age-specific etiologic features. Particular emphasis is placed on timely recognition of severe conditions, rational sequencing of examinations, and attention to follow-up in order to provide practical reference for clinical work.

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Diagnostic approach to hepatoplenomegaly in children HUANG Li, SHAN Qing-wen 2026, 41(4): 300-303.  DOI: 10.19538/j.ek2026040607 Abstract ( )   Hepatosplenomegaly in children is a common clinical sign in pediatrics，with etiologies involving multisystem diseases. Currently，there are problems such as non-standard medical history collection，omissions in assessment，disordered examinations，delayed initiation of multidisciplinary collaboration（MDT），narrow coverage of existing literature，and poor practicality. Based on clinical needs and practice，this article clarifies the definition and etiologies of hepatosplenomegaly，proposes that the diagnosis should follow the principle of“first evaluating acute/critical conditions，then conducting screening”，and identifies the etiologies through systematic medical history collection，physical examination，and progressive auxiliary examinations，thereby providing a practical reference for standardizing clinical diagnosis.

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Diagnosis and treatment strategies for abdominal distension in children XU Juan, YAN Wei-hui, WANG Ying 2026, 41(4): 304-309.  DOI: 10.19538/j.ek2026040608 Abstract ( )   Abdominal bloating/distension is a common symptom and/or sign in clinical pediatric practice，which can be either a subjective sensation of bloating or an objectively measurable distention. Its etiology is various，encompassing functional gastrointestinal disorders，medical organic diseases，and surgical organic diseases. In clinical practice，clinicians must reduce unnecessary examinations related to functional disorders while avoiding missed diagnosis and misdiagnosis of organic diseases.Dysbiosis and translocation of intestinal microbiota also contribute to the development of abdominal bloating/distension.Herein，we propose a standardized diagnostic and treatment strategy for pediatric abdominal bloating/distension and summarize the latest advances to provide references for clinical practice.

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Etiological identification and management of pediatric constipation WANG Rui-feng, LI Xiao-qin 2026, 41(4): 310-315.  DOI: 10.19538/j.ek2026040609 Abstract ( )   Constipation is one of the common pediatric conditions，categorized into organic constipation and functional constipation，with the latter accounting for over 90% of cases. The prevalence of childhood constipation has shown an increasing trend in recent years，with approximately one-third of cases presenting as refractory functional constipation，which significantly impacts children’s quality of life and academic performance，even leading to growth and developmental delays as well as psychological and behavioral problems. With the continuous advancement in medical research，continuous progress has been made in identification of the causes，diagnostic methods and management approaches for childhood constipation. This article reviews recent advances in the etiology，diagnosis and management of pediatric constipation to provide references for individualized comprehensive treatment of childhood constipation.

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Study on the role of intestinal flora colonization in early period of birth in the development of infant dyschezia ZENG Fan-fei, ZENG Yong-mei, ZHANG Ji-yong, et al 2026, 41(4): 316-322.  DOI: 10.19538/j.ek2026040610 Abstract ( )   Objective　To investigate the influencing factors of early intestinal flora on the occurrence of infant dyschezia by analyzing clinical characteristics and sequencing meconium samples collected within 72h after birth，so as to provide new insights for early intestinal intervention. Methods　Full-term neonates born at Shenzhen Maternity and Child Healthcare Hospital，Southern Medical University between January 2021 and April 2021 were enrolled. Clinical data were collected，and meconium samples were obtained within 72 h after birth. A questionnaire survey was completed by telephone follow-up at 3 months of age，and the infants suspected with dyschezia were recalled for hospital re-evaluation. Those meeting the RomeⅣ criteria were assigned to the infant dyschezia group，and the remaining infants were enrolled as the non-infant dyschezia group using propensity score matching at a ratio of 1︰4. Baseline clinical data were compared between the two groups，and analyze associated factors. In addition，another healthy control group were matched at a ratio of 1︰1 from the remaining cases using propensity score matching. The 16SrDNA sequencing was performed on the meconium samples of the two groups to compare differences in intestinal flora diversity，richness and community structure. Results　The incidence of infant dyschezia was 4.3%. The prophylactic antibiotics use during the neonatal period was significantly different between the infant dyschezia group and the non- infant dyschezia group（P<0.05）. Vaginal delivery and prophylactic antibiotic use during the neonatal period were risk factors for infant dyschezia. There were no significant differences in the diversity and richness of intestinal flora between the infant dyschezia group and the healthy control group（P>0.05）. However，statistically significant differences were found in community structure at the phylum level of Spirochaetes and the genus levels of Bacteroides between the two groups（P<0.05）. Conclusion　Vaginal delivery and prophylactic antibiotic use can increase the risk of developing infant dyschezia. No significant differences exist in the diversity and richness of early intestinal flora between the infants with dyschezia and the healthy infants in the postnatal period，whereas the relative abundance of Bacteroides at the genus level is significant higher than in healthy infants.

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Clinical features and prognosis of diffuse endocapillary proliferative IgA nephropathy in children JI Yi, YING Dao-jing, SHI Pei-pei, et al 2026, 41(4): 323-328.  DOI: 10.19538/j.ek2026040611 Abstract ( )   Objective　To investigate the clinical and pathological characteristics and prognosis of diffuse endocapillary proliferative IgA nephropathy（DEP-IgAN）in children. Methods　A total of 36 children diagnosed with DEP-IgAN by renal biopsy at the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2024 were enrolled. Another 72 age- and sex-matched children with IgA nephropathy（IgAN）without diffuse endocapillary proliferation were included as the non-DEP-IgAN group. The clinical，pathological，and prognostic features between the two groups were compared. Results　Compared with the non-DEP-IgAN group，children with DEP-IgAN had a shorter disease duration before renal biopsy［17.0（12.0，24.8）days vs. 30.0（20.0，61.5）days，P<0.001］ and higher incidences of edema and hypertension. Serum albumin，complement C3，IgG levels，and estimated glomerular filtration rate were significantly lower，whereas 24-hour urinary protein excretion，serum creatinine，and total cholesterol levels were significantly higher（all P<0.05）. Pathologically，the DEP-IgAN group exhibited higher proportion of mesangial hypercellularity，tubular atrophy/interstitial fibrosis and crescents（all P<0.05）. In terms of treatment，more patients in the DEP-IgAN group received immunosuppressive agents（26/36 vs. 37/72，P=0.038），particularly cyclophosphamide and methylprednisolone（P<0.05）. Kaplan-Meier analysis revealed comparable overall remission rates between the two groups；however，the time to complete remission of proteinuria was longer in the DEP-IgAN group［7.0（5.8，9.0） months vs. 4.0（2.0，7.8） months，P<0.05］. Long-term outcomes showed no significant difference in cumulative renal survival between the two groups（P>0.05）. Conclusion　Pediatric DEP-IgAN is characterized by more severe clinical manifestations and pathological injury. Clinicians should pay greater attention to this subtype，as early and intensive immunosuppressive therapy may achieve outcomes comparable to those of non-DEP-IgAN.

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Analysis of hospitalization and follow-up in children with severe tic disorders #br# XIANG Yu-xin, TONG Chang, SUN Dan, et al 2026, 41(4): 329-334.  DOI: 10.19538/j.ek2026040612 Abstract ( )   Objective　To explore the hospitalization characteristics and follow-up outcomes of children with severe tic disorders（TD）， providing a basis for clinical diagnosis and management. Methods　A retrospective study was conducted on 46 children with severe TD who were admitted to Wuhan Children’s Hospital，affiliated to Tongji Medical College，Huazhong University of Science and Technology，from January 2021 to January 2025. Clinical data were analyzed，including clinical features on admission，treatment regimens during hospitalization，and follow-up outcomes（January 2021 to January 2025），and characteristics were summarized. Results　Among the 46 children with severe TD，43 were male（93.48%），with an average age on admission being（10.84±2.79） years，and a median disease duration being 23 months. The main symptoms were vocal tics in the throat（27 cases，58.70%） and complex motor tics involving the whole body（20 cases，43.48%）. Eight children had to suspend schooling due to severe tic symptoms. The comorbidity rate was 58.70%（27/46），with emotional disorders being the most common（23 cases，50.00%）. Medications primarily included sulpiride（32 cases，69.57%） and aripiprazole（24 cases， 52.17%），with no statistically significant difference in drug dosage before and after admission（P>0.05）. Non-pharmacological treatments included transcranial magnetic stimulation（19 cases，41.30%） and acupuncture（13 cases，28.26%）. Seven cases showed elevated serum cytokines（mainly IL-6 and TNF-α）. Follow-up showed that at 3 months，53.33%（8/15） of children had significant symptom improvement，while 33.33%（5/15） still had severe functional impairment. At the last follow-up，93.75%（30/32） of children had no severe functional impairment，but 2 cases still had severe functional impairment due to tic symptoms. Two cases showed gradual reduction of tic symptoms during follow-up but developed some psychiatric and emotional problems. Conclusion　Severe TD requires individualized treatment and may benefit from a combination of pharmacological and non-pharmacological approaches. Attention should be given to comorbidities and long-term psychiatric symptom risks. Immune factors may be involved in disease progression but require further verification.

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Progress and prospects in the clinical pediatric application of food for special medical purposes LI Hong-ai, HUANG Xiao-yan, LIN Qiu-yu, et al 2026, 41(4): 335-342.  DOI: 10.19538/j.ek2026040613 Abstract ( )   Food for Special Medical Purposes（FSMP）is a type of formulated food produced with special processing techniques，designed to meet the specific nutritional or dietary requirements of people with restricted food intake，impaired digestion and absorption，metabolic disorders，or specific disease conditions. In the treatment of special pediatric diseases such as inherited metabolic diseases，food protein allergy，and impaired digestion and absorption，traditional pharmacotherapy and ordinary dietary interventions often fail to fully satisfy the special nutritional needs of these children. In recent years，with the rapid development of medical nutrition and food science，FSMP has played an increasingly important role in the clinical management of these special diseases. This article reviews the classification and characteristics of FSMP，as well as its application progress in special pediatric diseases including inherited metabolic diseases，food protein allergy，and impaired digestion and absorption. It also discusses key points in the clinical management of FSMP and looks forward to its future development trends，challenges，and research directions. It is expected to provide professional guidance for clinical medical staff on the clinical pediatric application of FSMP，so as to optimize nutritional management and improve clinical outcomes in children.

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Treatment exploration and long-term follow-up of a case of refractory Graves’ disease SONG Yan-ning, CHEN Jia-jia, GONG Chun-xiu 2026, 41(4): 343-347.  DOI: 10.19538/j.ek2026040614 Abstract ( )   This article focuses on the treatment and long-term follow-up results of a pediatric patient with refractory and recurrent Graves’ disease，who was treated with methimazole and propylthiouracil sequentially in 9 years and experienced three relapses within three years. The disease is refractory and recurrent. With multidisciplinary teamwork（MDT）， the patient underwent three sessions of ultrasoundguided thyroid microwave ablation. At the last follow-up，the patient has been cured clinically，with normal thyroid function and no further relapse.

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Analysis of a case of human herpesvirus 6 encephalitis complicated with MOG antibody-related disease and literature review SHI Xiao-ya, LIU Peng, CAI Ao-jie, et al 2026, 41(4): 348-352.  DOI: 10.19538/j.ek2026040615 Abstract ( )   The article retrospectively analyzed the clinical data of a pediatric patient with HHV-6 encephalitis combined with MOG antibody-associated disease and reviewed relevant literature. The patient was an 11-year-old girl with acute onset，rapidly presenting with convulsions and coma. Mild cerebrospinal fluid pleocytosis was observed，and next-generation sequencing（NGS）of pathogenic microorganism nucleic acids in cerebrospinal fluid showed a large number of HHV-6. The serum MOG antibody titer was 1:10. MRI revealed extensive inflammatory and demyelinating lesions in the brain parenchyma，optic nerve，and cervical spinal cord. Following treatment with methylprednisolone pulse therapy，intravenous immunoglobulin，and ganciclovir，the patient achieved complete neurological recovery，with significant improvement on imaging. Two case reports on HHV-6 infection complicated with MOG antibody-associated disease were retrieved from the literature，all of which had favorable prognoses after antiviral therapy combined with early immunotherapy. When demyelinating changes are present in HHV-6 encephalitis children with normal immune function，the possibility of concurrent MOG antibody-associated disease should be considered. Early and precise diagnosis can be achieved using cerebrospinal fluid NGS combined with demyelinating antibody detection.