"Journal of Clinical Pediatrics" is a monthly magazine. It was founded in 1983. ISSN-1000-3606 is the international magazine and CN:31-1377/R is the national standard magazine. It is a professional academic journal of Pediatrics sponsored by Shanghai Institute of Pediatrics Medicine and Xinhua Hospital affiliated to Shanghai Jiaotong University Medical College. Medical College of Shanghai Jiaotong...
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15 November 2022, Volume 40 Issue 11
  • Application of nutrition screening and assessment tools for hospitalized children
    WANG Ying, LU Lina
    2022, 40(11):  801-806.  doi:10.12372/jcp.2022.22e1352
    Abstract ( 55 )   HTML( 23 )   PDF (1145KB) ( 23 )  

    Nutrition screening, nutrition assessment and nutrition intervention are the key steps of nutrition diagnosis and treatment. Nutritional risk screening is the basis of clinical nutrition management to identify children with nutritional risk and to formulate nutritional support treatment prescriptions with the help of nutritional assessment. In 2022, the National Health Commission issued the guidelines for the construction and management of the clinical nutrition department, which put forward the work for nutrition screening and nutrition assessment, and further standardized the clinical application of nutrition screening and malnutrition diagnosis.

    Clinical problems in the diagnosis and treatment of food protein-induced enterocolitis syndrome
    YAN Weihui, WU Qinging
    2022, 40(11):  807-812.  doi:10.12372/jcp.2022.22e1019
    Abstract ( 30 )   HTML( 35 )   PDF (1237KB) ( 35 )  

    Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy in infants and young children. Acute stage is manifested as repeated vomiting and diarrhea, and severe cases can appear dehydration, lethargy, hypothermia and shock. Chronic stage can even lead to growth retardation. The diagnosis of FPIES was mainly determined by clinic history, symptom improvement after avoidance of suspected allergens, and positive oral food challenge. However, due to lacking of specific clinical manifestations and laboratory tests of FPIES, and insufficient understanding by clinicians, it often leads to delayed diagnosis or misdiagnosis, which may result in unnecessary examination and treatment. The related clinical problems of FPIES are discussed to improve the diagnosis and treatment.

    Precision treatment in pediatric inflammatory bowel disease
    WANG Xinqiong, XU Chundi
    2022, 40(11):  813-818.  doi:10.12372/jcp.2022.22e1048
    Abstract ( 34 )   HTML( 29 )   PDF (1226KB) ( 29 )  

    The incidence of pediatric inflammatory bowel disease (IBD) in China rose these years. Precision treatment can improve the treatment of IBD and increase the remission rate. The development of precision treatment is mainly based on the in-depth understanding of the pathogenesis of IBD. The continuous optimization of biologic applications can improve the treatment outcome of children and reduce the economic burden. New biomarkers are constantly discovered and applied with the development of genomics, transcriptomics, gut microbiome, metabolomics, and artificial intelligence algorithms. Precision treatment will innovate treatment strategies in the near future.

    Retrospective analysis of the characteristics of colonoscopy in 86 infants
    SHEN Yiyi, LIAN Min, LI Mei, GUO Hongmei, ZHANG Zh...
    2022, 40(11):  819-823.  doi:10.12372/jcp.2022.21e1382
    Abstract ( 39 )   HTML( 19 )   PDF (1217KB) ( 19 )  

    Objective To investigate the common causes and clinical characteristics of infant colonoscopy, and to evaluate the safety, feasibility and clinical value of colonoscopy in infants. Methods Clinical data of 86 infants underwent colonoscopy from January 2011 to January 2021 were retrospectively analyzed. Results All infants, including 50 boys and 36 girls, with a median age of 7.0 (4.8-10.0) years, were grouped according to age, ≤6 months group (n=33 ) and 6-12 months (n=53). A total of 91 painless colonoscopies were performed, and 65 reached the ileocecal region (23 in the terminal ileum and 42 in the ileocecal region), with a success rate of 71.4%. The main clinical manifestations include hematochezia (36/86,41.8%), persistent/chronic diarrhea (18/86,20.9%), hematochezia and diarrhea (22/86,25.6%). The difference of the reason for colonoscopy examination was statistically significant between ≤6 months and 6-12 months groups (P<0.05), and the proportion of prolonged/chronic diarrhea was higher in the ≤6 months group. Of the 86 patients, 83 children received the etiological diagnosis after colonoscopy (96.4%), with food allergy-related gastrointestinal disorders (32/86, 37.2%), colonic polyps (19/86, 22.1%), colonic (rectal) inflammation (18/86, 20.9%), and VEO-IBD (6/86,7.0%). There were no serious complications such as respiratory arrest or sudden cardiac arrest during the procedure, two cases had complication after colonoscopy, one case of hemorrhage and the other of intestinal perforation. Conclusion The infant underwent colonoscopy have the different disease spectrum from older children, and colonoscopy plays an important role in the diagnosis of the chronic diarrhea and hematochezia in infant. The risk of infant colonoscopy operation is higher than that of older children, and the indications for colonoscopy should be strictly controlled.

    Comparison of clinical features of food protein-induced proctocolitis and Salmonella enteritis
    CHEN Fan, JIAN Cui, SHU Sainan
    2022, 40(11):  824-830.  doi:10.12372/jcp.2022.21e1075
    Abstract ( 25 )   HTML( 10 )   PDF (1234KB) ( 10 )  

    Objective To compare the clinical characteristics of food protein-induced proctocolitis (FPIP) and Salmonella enteritis, and to provide basis for early differential diagnosis. Methods The clinical data of infants with FPIP and Salmonella enteritis in the pediatric ward from January 2013 to December 2019 were retrospectively analyzed. Results There were 191 patients in FPIP group, of 106 males and 85 females, with a median age of 3.8 (1.5-7.4) months. There were 120 cases in the salmonella enteritis group, of 75 males and 45 females, with a median age of 14.7 (9.9-20.0) months. Compared with Salmonella enteritis group, the FPIP group had a younger age of onset, a longer duration of illness, and a higher proportion of eczema history, with statistically significant differences (all P<0.01). The age distribution of onset was significantly different between the two groups (P<0.05). The onset age of FPIP group was <6 months, while that of Salmonella enteritis group was 6-24 months. FPIP occurred throughout the year, while Salmonella enteritis mainly occurred in summer and autumn (June to October). Compared with Salmonella enteritis group, the incidence of gross blood stool, mucinous stool and mucinous blood stool was higher in FPIP group, while the incidence of vomiting and fever was lower; the differences were statistically significant (all P<0.05). Compared with Salmonella enterocolitis group, the proportion of C-reactive protein >10 mg·L-1 and anemia was lower in FPIP group, and the eosinophil count and platelet count were higher, neutrophil count and 25 hydroxyvitamin D level were lower, and the positive rate of food allergen sIgE was lower in FPIP group; the differences were statistically significant (all P<0.05). The utilization rate of antibiotics in Salmonella enteritis group was higher than that in FPIP group, and the difference was statistically significant (P<0.01). Conclusions FPIP is more common in children less than 6 months of age without fever and with bloody stools, which may be accompanied by eczema and eosinophilia. Salmonella enteritis is more common in children aged 6-24 months, usually occurring in summer and autumn, often accompanied by fever and increased c-reactive protein.

    Characteristics of dynamic changes in the gut microbiome of infants with cow's milk protein allergy
    LI Xinyue, WANG Shuo, ZHANG Hua, LI Zailing
    2022, 40(11):  831-838.  doi:10.12372/jcp.2022.21e1524
    Abstract ( 30 )   HTML( 8 )   PDF (1925KB) ( 8 )  

    Objective To dynamically monitor and analyze infants with cow’s milk protein allergy (CMPA), milk protein tolerance and changes in gut microbiome during clinical treatment. Methods Fifty infants with CMPA attended the pediatric outpatient clinic were selected as the CMPA group, and 20 infants underwent health checkups were selected as the healthy control groupat the Child Health Development Center of Peking University Third Hospital from September 2020 to March 2021. The differences in gut microbiome between the two groups were compared. Results There were 50 patients in the CMPA group, including 21 males and 29 females, with a median age of 4 months. The control group consisted of 20 cases, of 12 males and 8 females, with a median age of 4 months. There were no statistically significant differences between the CMPA group and the control group in terms of age inmonths, sex, birth mass, mode of delivery, and feeding mode (all P>0.05). The baseline data of the children in the two groups were comparable. Follow-up of treatment and regression of children in the CMPA group at months 1, 3, and 6 revealed that a total of 38 children had established immune tolerance by 6 months, and 12 others still had CMPA. The Shannon index and Shannoneven index were statistically higher in the CMPA group compared with the control group (P<0.05), and the Anosim test showed statistically significant differences in community composition between the two sample groups (R=0.26, P=0.001). The relative abundance of Actinobacteria was significantly lower in the CMPA group. The relative abundance of Firmicutes was higher in the tolerant group than in the allergic group after six months of follow-up. During the treatment of CMPA-tolerant infants, species with progressively higher abundance were observed for Bifidobacterium (P<0.01), Blautia (P<0.01), Ruminococcus (P<0.01) and Faecalibacterium (P<0.01). Except for Bifidobacterium, all other species were known as butyrate producers. Conclusion The gut microbiome of children with CMPA differs from that of healthy children. The relative abundance of Bifidobacterium and butyrate-producers microbiome in the intestine of children with CMPA was increased during the establishment of immune tolerance.

    Correlation between whole blood zinc and severity of rotavirus gastroenteritis
    JI Cuihong, YU Jun, JIANG Lirong
    2022, 40(11):  839-842.  doi:10.12372/jcp.2022.21e1253
    Abstract ( 19 )   HTML( 7 )   PDF (1250KB) ( 7 )  

    Objective To study the correlation between blood zinc level and severity of rotavirus (RV) gastroenteritis (RVGE) by measuring whole blood zinc level in children with RVGE. Methods One-hundred-and-sixty-eight (168) children with RVGE in Fengxian District Central Hospital of Shanghai from October 2018 to December 2020 were selected as the RV group, and were divided into RV zinc deficiency group and RV normal zinc group, based on their blood zinc levels. The two groups were divided further into RV zinc deficiency treatment group, RV zinc deficiency control group, RV zinc normal treatment group and RV zinc normal control group. There were 124 healthy children who came to the hospital for physical examination in the same period were selected as the healthy control group. The whole blood zinc level of each group was detected by atomic absorption spectrometer. Results The whole blood zinc of RV group (62. 81± 10.92 μmol/L) was significantly lower than that of the healthy control group (71.31±7.74 μmol/L.) The proportion of zinc deficiency in RV group was higher than that in the healthy control group (P<0.05); The whole blood zinc level in the mild group of children with RVGE was (66.1± 10.6 μmol/L), which was higher than that of the moderate group (61.2±10.9 μmol/L) and the severe group (56.0±5.1 μmol/L), with statistically significant differences (P<0.05). The differences in severity of disease typing, proportion of dehydration, and number of stools between the RV zinc deficiency group and the RV zinc normal group were statistically significant (P<0.05). The disease course of the RV zinc deficiency control group was longer than that of the RV zinc deficiency treatment group, the RV zinc normal treatment group and the RV zinc normal control group, the difference was statistically significant (all P<0.05). Conclusion The level of whole blood zinc in children with RVGE decreased significantly, and the incidence of zinc deficiency was higher than that in healthy children. There was a correlation between the level of zinc and the severity of RVGE. Zinc supplementation was effective in the treatment of zinc deficiency children with RVGE..

    Transcatheter closure and short- and medium-term follow-up of 46 children with congenital coronary artery fistula
    LIU Yue, ZHU Diqi, LI Fen, FU Lijun, LIU Tingliang...
    2022, 40(11):  843-847.  doi:10.12372/jcp.2022.21e1291
    Abstract ( 24 )   HTML( 8 )   PDF (1355KB) ( 8 )  

    Objective To analyze the efficacy,complications and prognosis of transcatheter closure (TCC) of congenital coronary artery fistula (CAF) in children. Methods Clinical data of patients diagnosed with CAF and underwent TCC from January 2013 to January 2021 were retrospectively analyzed. Results A total of 46 patients with CAF were enrolled in the study, including 22 boys and 24 girls, with median age of 36.0 (24.5-49.5) months and median body weight of 14.9 (12.2-20.0) kg. In 46 patients with CAF, the fistula shunt was3.4 (3.0-4.4) mm, and there were varying degrees of widening of the involved coronary artery with an internal diameter of 6.1 (4.5-7.8) mm at the opening. It was considered difficult to perform TCC in the other 9 patients. Among the 35 patients who underwent successful TCC, arteriovenous loop was established to perform retrograde closure in 15 patients. The other 20 patients underwent antegrade closure through the aorta. PDA device (8 cases), VSD device (2 cases), coil (3 cases) and vascular plug (22 cases) were used in these patients.Among the 35patients who underwent successful TCC, 10 patients showed immediate residual shunt after closure. Tiny residual shunt disappeared during follow-up in eight patients. Two patients still showed residual shunt at the last follow-up. Thrombosis formation was found in two cases. Conclusion TCC is a safe and effective method for the treatment of CAF in children. It is necessary to fully evaluate the course, opening and collateral vessels of CAF to improve the success of intervention. For patients suffering risk of thrombosis, a longer course of routine anticoagulation after TCC may be required.

    Clinical analysis of severe cytokine release syndrome caused by CAR-T cell therapy in children's intensive care unit
    ZHU Qiujiao, PAN Tao, BAI Zhenjiang, DING Xin, LI ...
    2022, 40(11):  848-853.  doi:10.12372/jcp.2022.21e0516
    Abstract ( 35 )   HTML( 13 )   PDF (1191KB) ( 13 )  

    Objective To analyze the clinical features of severe cytokine release syndrome (sCRS) in children with relapsed B lineage acute lymphoblastic leukemia (B-ALL) treated by CAR-T cell therapy, and to summarize their treatment methods. Methods The clinical data of 14 cases of CAR-T cell therapy relapsed B-ALL children admitted to the intensive care unit from January 2019 to June 2020 were collected, and retrospectively analyzed. Results After CAR-T cell infusion, nine cases developed sCRS, eleven children developed hemodynamic instability, five cases required mechanical ventilation, ten cases had neurological symptoms, and seven cases had liver damage. All 14 patients were treated with tocilizumab, some of them were given glucocorticoids, and five patients were treated with continuous blood purification. Three patients died, and eleven patients recovered within two weeks. Conclusion CRS is a common toxic reaction after CAR-T cell infusion, which can cause multiple organ dysfunction. The severity of CRS was positively correlated with the levels of cytokines IL-6 and IFN-γ. Tocilizumab and corticosteroids are the main treatments, and the blood purification can also be used as a special treatment for CRS.

    TBCD gene variation causing tubulinopathy with atypical spinal muscular atrophy: one case report
    ZHOU Lulu, DING Le, ZHENG Guo
    2022, 40(11):  854-857.  doi:10.12372/jcp.2022.21e1128
    Abstract ( 49 )   HTML( 35 )   PDF (1404KB) ( 35 )  

    Tubulinopathy is a rare autosomal recessive hereditary disease caused by TBCD variation and characterized by early-onset progressive encephalopathy. The patient was a boy aged 11 months. At the age of 8 months, he had a febrile convulsion which was a focal seizure. It appeared after bathing or fever in his early stage, and convulsions occurred at any time in the later stage. Since the onset of the disease, the psychomotor function has been progressively retrogressed. At the age of 11 months, the activity of his limbs gradually decreased, and the results of electromyography showed extensive neurogenic damage. The cranial magnetic resonance imaging showed the widened sulcus, thinned corpus callosum and cerebral dysplasia. The results of whole exome gene sequencing indicated that the child carried complex heterozygous variations of TBCD gene: a heterozygous missense variation of c.230A>G (p.H77R) in exon 2 and a heterozygous termination variation of c.1306C>T (p.R436*, 757) in exon 13. The two variants have not been reported. The father carried c.230A>G variation, and the mother carried c.1306C>T variation. Finally, the child was diagnosed with tubulinopathy with atypical spinal muscular atrophy (SMA). At the age of 1 year and 4 months, the child was treated with four antiepileptic drugs and had fewer convulsions. The phenotype in this case was accompanied by atypical SMA, which enriched the clinical phenotypes spectrum of the disease. A new termination mutation and a new missense mutation detected by genetic testing enlarged the TBCD gene variation spectrum.

    Risk factors of hemophagocytic lymphohistiocytosis secondary to severe pneumonia in children
    TU Xiaobo, SHU Chang, DENG Fang, LEI Shangchun, WE...
    2022, 40(11):  858-863.  doi:10.12372/jcp.2022.21e0784
    Abstract ( 34 )   HTML( 17 )   PDF (1227KB) ( 17 )  

    Objective To explore the risk factors of hemophagocytic lymphohistiocytosis (HLH) secondary to severe pneumonia in children. Methods The clinical data of children hospitalized from October 1, 2012 to December 31, 2019 and diagnosed with severe pneumonia secondary to HLH (observation group) were retrospectively analyzed. Children with severe pneumonia hospitalized in 2019 were randomly selected as the control group. Clinical characteristics, laboratory tests and treatment results between the two groups were compared, and the predictive value of different indicators for HLH secondary to severe pneumonia were analyzed. Results There were 38 cases in the observation group and 96 cases in the control group. Compared with the control group, the observation group had a higher age of onset, a higher proportion of 6 months to 2 years old, a higher proportion of fever, lethargy, poor reaction and irritability, a longer median heat course, a higher proportion of liver, spleen, lymph node swelling, rash and edema, and a lower proportion of fine wet rales, shortness of breath and / or cyanosis in lung auscultation (all P< 0.05). In the observation group, ALT, AST and LDH were abnormally elevated, the proportion of albumin < 30 g/L, CRP > 8 mg/L, and PCT > 0.15 ng/mL was higher, the proportion of adenovirus and fungi was higher, and the proportion of RNA virus was lower. The difference was statistically significant (P<0.05). The incidence of pleural effusion, lung consolidation/atelectasis and extensive lesions of both lungs in the observation group were higher than that in the control group (all P<0.05), the length of hospitalization was longer than that in the control group, and the mortality and ICU occupancy rate were higher than that in the control group (all P<0.05). Lactate dehydrogenase has a high predictive value for HLH secondary to severe pneumonia. The area under the curve is 0.93 (0.88-0.98), and the cutoff value is 804.35 IU/L. Conclusion Compared with those without HLH, children with HLH secondary to severe pneumonia have older onset age, longer hospitalization time, higher mortality, higher lactate dehydrogenase and lower albumin. Children with severe pneumonia with adenovirus infection and pleural effusion are more likely to develop HLH.

    Clinical characteristics and related factors of pulmonary involvements in patients with systemic juvenile idiopathic arthritis
    TAN Xiaohua, LI Caifeng, ZHAO Wenjia, KUANG Weiyin...
    2022, 40(11):  864-868.  doi:10.12372/jcp.2022.22e0462
    Abstract ( 27 )   HTML( 12 )   PDF (1257KB) ( 12 )  

    Objective To investigate the clinical characteristics and related factors of systemic juvenile idiopathic arthritis (sJIA) complicated with lung involvement. Methods The clinical data of children who were initially diagnosed with sJIA from January 2017 to January 2022 were retrospectively analyzed. Results A total of 73 children (40 boys and 33 girls) with sJIA were enrolled and the median age was 5.6 (3.1-8.8) years. There were 32 children in sJIA group without lung involvement and 41 children in sJIA group with lung involvement. Compared with sJIA group without lung involvement, the proportion of sJIA combined with macrophage activation syndrome, fatigue, chest tightness and rapid shallow breathing was higher, the level of IL-18 was higher, and the proportion of positive changes in chest radiography and lung high-resolution CT was higher, and the differences were statistically significant (P<0.05). The results of binary logistics regression analysis showed that fatigue, chest tightness, positive changes of chest radiograph and lung high-resolution CT, and increased IL-18 level were independent risk factors for sJIA complicated with lung involvement (P<0.05). Conclusion Early clinical symptoms, serum IL-18 level and pulmonary imaging examination have certain predictive value for the occurrence of sJIA complicated with lung involvement.

    Progress on application of probiotics in inflammatory and functional diseases of digestive tract in infants and young children
    CHEN Yubo, LI Yuning
    2022, 40(11):  869-874.  doi:10.12372/jcp.2022.21e1701
    Abstract ( 37 )   HTML( 26 )   PDF (1206KB) ( 26 )  

    The imbalance of microecological stability hinders the development and maturity of immune function in children, which affects immunity and closely related to the occurrence, development and outcome of a variety of digestive diseases. Probiotics can play an important role in the treatment of infantile diarrhea, inflammatory bowel disease, necrotizing enterocolitis, functional abdominal pain by regulating the balance of intestinal flora, improving immunity, reducing inflammatory damage and reducing the absorption of harmful substances. This article intends to explore the efficacy and safety of probiotics in children's digestive system diseases through the latest literature research, so as to provide reference for the selection of beneficial strains fordifferent diseases.

    Clinical research progress on neonatal sepsis induced by Streptococcus agalactiae
    CHEN Biao, ZHAO Ruiqiu
    2022, 40(11):  875-880.  doi:10.12372/jcp.2022.21e1762
    Abstract ( 41 )   HTML( 32 )   PDF (1134KB) ( 32 )  

    Sepsis is a key cause of neonatal death, andstreptococcus agalactiae is a common pathogen of neonatal sepsis. In recent years, some progress has been made in the diagnosis, treatment and prevention of neonatal sepsis induced by Streptococcus agalactiae. Western countries have issued and updated corresponding clinical guidelines, which have promoted the development of clinical diagnosis and treatment of this disease. This article gives a brief introduction the clinical research progress of neonatal sepsis induced by Streptococcus agalactiae at home and abroad.

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