Journal of Clinical Pediatrics

Bronchodilation test and its clinical application in children

ZHANG Hao, CHI Yanxia

Journal of Clinical Pediatrics. 2023, 41(5): 321-327. doi:10.12372/jcp.2023.23e0206

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Bronchodilation test (BDT) is a method to detect the reversibility of spastic airway, which is mainly used in the diagnosis, differential diagnosis, treatment and follow-up of wheezing diseases. As awareness of the importance of the bronchodilatation test has increased, its clinical use has rapidly increased. Recently, a large number of researches both nationally and internationally have focued on how to interpret the results in clinical and define the positive thresholds. The purpose of this paper is to explore new standards and opinions, sort out the idea and make recommendations that are suitable for Chinese children.

Application of exhaled nitric oxide in the diagnosis and treatment of respiratory allergic diseases in children

WU Jinhong

Journal of Clinical Pediatrics. 2023, 41(5): 328-332. doi:10.12372/jcp.2022.23e0182

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Expiratory nitric oxide detection is a non-invasive method to assess the state of eosinophilic airway inflammation and can predict the responsiveness of respiratory allergic diseases to corticosteroid treatment. It is mainly used for the diagnosis, differential diagnosis, treatment, and predicting prognosis and management of respiratory allergic diseases.

Effect of SARS-CoV-2 infection on pulmonary function in children with asthma

WANG Jinrong, MIAO Yu, MA Guangzeng, CAO Luofei

Journal of Clinical Pediatrics. 2023, 41(5): 333-338. doi:10.12372/jcp.2022.23e0163

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The pandemic of COVID-19 raises new challenges in the management of pediatric asthma. We analyzed airway injury in children with asthma from molecular mechanism to pathological alterations and explored the effect of SARS-CoV-2 on pulmonary function, which will inform clinicians in the diagnosis and management of childhood asthma in the context of the new coronavirus epidemic.

Clinical analysis of the criteria of obstructive ventilation dysfunction in children in Shanghai

WU Yufen, DONG Wenfang, PAN Chunhong, ZHANG Hao

Journal of Clinical Pediatrics. 2023, 41(5): 339-345. doi:10.12372/jcp.2023.23e0183

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Objective To analyze the clinical rationality of pulmonary function parameters associated with obstructive ventilation dysfunction in children. Methods Children aged 6-18 years who attended the respiratory department and completed pulmonary function tests from January to December 2021 were selected and grouped at an age interval of one year. The relevant lung function parameters such as forced vital capacity (FVC), maximum vital capacity (VC_max), forced expiratory volume in the first second (FEV₁), FEV₁/FVC, FEV₁/VC_max were detected. The clinical consistency between measured and measured/predicted value of FEV₁/FVC, measured and measured/predicted value of FEV₁/VC_max, respectively, in the interpretation of obstructive lesions was compared. Results A total of 7025 children were enrolled, including 4543 males and 2482 females with median age of (8.6±2.5) years old, with the largest number of children aged 6-10 years old. Except for 10-11 and 11-12 age group, the volume correlation parameters FVC, VC_max and FEV₁ were greater in males than in females, and their absolute values increased with the increase of age. There was a slight difference between VC_max and FVC in all age groups, and VC_max was slightly higher than FVC. The measured and predicted values of FEV₁/FVC in females were higher than those in males except 15-16 and 16-17 age group. The measured and predicted values of FEV₁/VC_max for females were higher than those for males except for 13-14 and 16-17 age group. When the measured value of FEV₁/FVC < 80% and the measured/predicted value of FEV₁/FVC < 92%, the interpretation inconsistency rate is 6.8%, and the interpretation inconsistency rate between the measured value of FEV₁/FVC and the measured value of FEV₁/VC_max is 5.0%. Finally, the ideal FEV₁/VC_max measured/predicted value is 93.9%. Conclusions The measured/predicted value of FEV₁/VC_max<93.9% can be used as a clinical reference standard for the interpretation of obstructive ventilation dysfunction in children.

Effect of respiratory rehabilitation on children with bronchial asthma: a prospective randomized controlled study

YANG Shuhui, LIU Yulin, YANG Fan, LUO Zhengxiu, LIU Enmei

Journal of Clinical Pediatrics. 2023, 41(5): 345-352. doi:10.12372/jcp.2023.22e1353

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Objective To investigate the effect of respiratory rehabilitation on inspiratory muscle strength, exercise capacity, pulmonary function, asthma control level and quality of life in children with asthma. Methods The children with asthma treated in respiratory outpatient department from June 2021 to February 2022 were selected and randomly divided into experimental group and control group using a random number table. The control group was given routine drug treatment and health education, while the experimental group was combined with respiratory rehabilitation to observe its effects on children with asthma.Results A total of 57 children with asthma were included, all completed the 6-month experiment. There were 38 boys and 19 girls, with the average age of (9.4±2.3) years and the average disease course of 4.0 (2.1-5.5) years. There were 31 children in the experimental group and 26 children in the control group. After 6 months of training, the mean and maximum values of maximum oral inspiratory pressure, 6-minute walking distance, and asthma control level in the experimental group were higher than those in the control group (P<0.05), and the heart rate and quality of life scores after 6-minute walking were lower than those in the control group (P<0.05), but there was no significant difference in blood pressure and pulmonary function between the two groups (P>0.05). After 6 months of training, the mean and maximum values of maximum oral inspiratory pressure, 6-minute walking distance, lung function (FVC, FEV₁, PEF, MEF₇₅, MEF₅₀, MMEF_75/25), asthma control level in the experimental group were higher than those before the intervention (P<0.05), heart rate, systolic blood pressure and quality of life scores in the experimental group were lower than before the intervention (P<0.05), the mean value of maximum oral inspiratory pressure and pulmonary function (FEV₁, FEV₁/FVC, MEF₇₅, MEF₅₀, MEF₂₅, MMEF_75/25) in the control group were higher than those before the intervention (P<0.05). Conclusions Combining respiratory rehabilitation with standardized treatment can improve inspiratory muscle strength, exercise capacity, asthma control level and quality of life in children with asthma, and has good safety. Clinicians can apply respiratory rehabilitation to asthma patients in order to obtain better curative effect.

Characteristics of 900 hospitalized children of asthma attack

LIU Qiuyi, ZHANG Peiling, GUO Rong, YAN Li, GENG Gang, LIU Zheng, TIAN Daiyin, DAI Jihong, LUO Zhengxiu, FU Zhou, NIU Chao

Journal of Clinical Pediatrics. 2023, 41(5): 353-359. doi:10.12372/jcp.2023.22e0955

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Objective To analyze the characteristics of hospitalized children with asthma exacerbation, and provide clinical reference for the diagnose and treatment of asthma. Methods Clinical data of children with bronchial asthma admitted to the Respiratory Center of Children's Hospital of Chongqing Medical University from January 2011 to June 2021 were retrospectively analyzed. Results 900 children were enrolled in the study, including 615 boys and 285 girls, with a median age of 2.3 (1.3-3.9) years. In the study, 559 toddlers, 246 preschool children, and 92 school-age children were enrolled, and significant differences were found in the proportions of boys and in the time distribution of initial diagnosis as asthma among the three age groups (P<0.05). The proportion of children first diagnosed with asthma after admission was 63.5%. The percentage of children admitted for mild acute asthma attacks was 76.6%, with more infants (475 cases, 52.8%) followed by preschool children (180 cases, 20.0%). Among 900 children, 501 (55.7%) had pathogenic bacteria detected by sputum culture, with the highest proportion of Streptococcus pneumoniae (26.9%), followed by Moraxella catarrhalis and Haemophilus influenzae. The positive proportion of four viruses detected in the study, including respiratory syncytial virus, adenovirus, influenza virus, parainfluenza virus, was 25.0%, and of which respiratory syncytial virus had the highest detection rate (16.3%). The difference in the proportions of asthma children combined with allergic rhinitis or sinusitis among the three age groups was statistically significant (P < 0.01). A total of 224 children were tested for allergen sIgE, of which 119 children (53.1%) were positive for inhalant allergens and 76 children (33.9%) were positive for foodborne allergens. Dust mite (27.7%) was the most important allergens, followed by house dust (8.9%). There were significant differences in the positive rates of most inhalant allergens (e.g., dust mite, house dust, cat and dog hair, tree allergens, mulberry, etc.) between the three age groups (P < 0.05). Conclusions Mild acute asthma attacks was the most important cause for hospitalization in children under 6 years old with asthma being firstly diagnosed after admission. Respiratory tract infection was the most important trigger of acute exacerbation of asthma. For children with asthma, allergen screening and allergic rhinitis prevention and treatment should be emphasized.

Summary of clinical characteristics of 23 children with buckwheat allergy

DU Yuyang, WANG Xiaoyang, SHAO Mingjun, LIU Chuanhe

Journal of Clinical Pediatrics. 2023, 41(5): 360-365. doi:10.12372/jcp.2023.22e1639

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Objective To analyze and summarize the clinical manifestation of buckwheat allergy in children in order to increase the awareness and diagnosis of buckwheat allergy in children. Methods Children with buckwheat allergy were enrolled from outpatients in the Department of Allergy, Children’s Hospital of Capital Institute of Pediatrics during July 2019 through April 2022. Clinical data was collected, including skin prick test (SPT), serum allergen specific immunoglobin E(IgE) and peripheral eosinophil detection. Results A total of 23 cases (14 males and 9 females) were enrolled, with a median age of 7.8 (5.5-10) years. The children developed allergic symptoms after intake of buckwheat products, skin exposure of buckwheat or inhalation of buckwheat flour. Allergic symptoms occurred within 10 minutes in sixteen cases, within 10 minutes to 30 minutes in twenty-two cases, and within 30 minutes to 2 hours in six cases after exposure to buckwheat allergen. The most common clinical manifestations were skin symptom (21/23 cases, 91.3%), followed by respiratory symptom (15/23 cases, 65.2%), digestive symptom (5/23 cases, 21.7%) and neurological symptom (1/21 cases, 4.3%). 16 cases had severe anaphylaxis. 21 cases were tested positive in buckwheat SPT, and the risk of anaphylaxis was increased when the SPT level was “++++” (P<0.01). The detection level of serum total IgE in 23 cases was 120 to 1489 kU/L. All the cases had a history of allergic rhinitis, eczema and family allergies. 18 of them have diagnosed with bronchial asthma. 22 of them had a history of using buckwheat husk pillows. Conclusions Buckwheat allergy in children has lately onset in school-aged children and adolescent, with varied clinical manifestations and high rate of anaphylaxis. Buckwheat husk pillows may be an important way for buckwheat sensitization. Skin prick test is of great value in the diagnosis and evaluation of buckwheat allergy.

Predictive role of IL-17A in refractory Mycoplasma pneumoniae pneumonia in children

GAO Longfei, ZHANG Jingli, WU Xiaojie, WU Huifang, DUAN Chenchu, KANG Juncong, ZHANG Zhongping

Journal of Clinical Pediatrics. 2023, 41(5): 366-369. doi:10.12372/jcp.2023.22e0032

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Objective To explore the predictive value of blood interleukin (IL)-17A in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Clinical data of children with Mycoplasma pneumoniae pneumonia (MPP) admitted from January 2019 to October 2021 were retrospectively analyzed. The enrolled children were divided into the MPP and the RMPP group. The differences of infection-related indexes between the two groups were compared, and the value of these indicators in predicting RMPP was evaluated by ROC curves. Results A total of 63 children with MPP were included in the study, including 42 cases in MPP group and 21 cases in RMPP group. There were 43 males and 20 females with a median age of 4.9(1.8-12.0) years and no significant differences was found in gender and age between the two groups (P>0.05). The proportion of lobar consolidation, pleural effusion, moxifloxacin, glucocorticoid and bronchoscopy in RMPP group were higher than those in MPP group (P<0.05). Also, IL-17A, IL-18, LDH and ferritin levels in RMPP group were higher (P<0.05). The area under ROC curve (AUC) of IL-18 and IL-17A in predicting RMPP were 0.85, 0.81, 0.80 and 0.69 in the RMPP group, respectively, with corresponding cut-off values of 472.0 pg/mL, 13.4 pg/mL,389.0 UI/mL, and 251.0 pg/mL, respectively. Conclusions Serum IL-17A≥13.4 pg/mL and IL-18≥472 pg/mL were relatively accurate predictors of refractory mycoplasma pneumonia in children, and IL-18 has higher predictive efficacy.

Household questionnaire survey on the prevalence and influencing factors of chronic cough in children in Shandong Province

DAI Fangfang, YANG Juan, LIU Fengqin, GUO Chunyan, CHEN Xing

Journal of Clinical Pediatrics. 2023, 41(5): 370-375. doi:10.12372/jcp.2023.22e0128

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Objective To clarify the prevalence of chronic cough in children and related influencing factors in Shandong province. Methods A self-designed questionnaire was used to conduct a cross-sectional survey of people aged 0-14 years in various cities in Shandong Province, which was completed and submitted by the participants on mobile phones or computer terminals. Results A total of 10186 children were surveyed, including 5480 boys and 4706 girls, with the questionnaire completed by parents. Among them, 829 children (8.1%) had a previous history of chronic cough, of which 697(84.1%) had a cough lasting an average of 4-8 weeks. Parents identified the presence of allergic diseases as the dominant factor for chronic cough in children (83.4%). Associated respiratory disease factors included upper respiratory tract infections (90.8%), trachea-bronchitis (87.5%), bronchopneumonia (70.5%) and bronchial asthma (62.9%). The influence of climate change in the surrounding environment was most evident (91.6%). 608 children (73.3%) sought medical attention within one week of coughing. Routine blood tests and chest radiographs were performed in 89.1% and 56.3% of the children respectively during the consultation. Parents were generally more receptive to Chinese herbal medicine in their choice of treatment, with 647 cases (78.0%) receiving Chinese medicine or a combination of Chinese and Western medicine, and only 173 cases (20.9%) receiving mainly Western medicine. Antibiotics and hormones were mostly used in accordance with medical advice, with 661 and 622 cases respectively, and 89.6% of parents accepting hormone therapy. The proportion of severe psychological impact on children and parents was 22.2% and 67.3%, respectively. Conclusions The prevalence of chronic cough in Shandong province is high, with diverse influencing factors, and auxiliary examination needs to be further popularized. Chronic cough has varying degrees of psychological impact on both children and their families.

Clinical characteristics of bacterial meningitis/meningoencephalitis in children aged 5 years and over: an analysis of 39 cases

ZHANG Jianzhao, SUN Jing, LI Guannan, ZHENG Ping, LI Dongqing, LIU Zhao, MA Caihui, YANG Jian

Journal of Clinical Pediatrics. 2023, 41(5): 376-380. doi:10.12372/jcp.2023.22e1493

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Objective To analyze the clinical characteristics of bacterial meningitis/ meningoencephalitis in children aged 5 years and above. Methods The clinical data of hospitalized children with bacterial meningitis/meningoencephalitis in the department of neurology in the hospital were retrospectively analyzed. Results A total of 39 (7.8%) children, 28 males and 11 females, aged 5-15 years with bacterial meningitis/meningoencephalitis were enrolled. The etiology included: nasal infection in 11 cases (28.2%), ear infection in 5 cases (12.8%), trauma in 3 cases (7.7%), immunodeficiency disease in 3 cases (7.7%), facial cellulitis in 2 cases (5.1%), anatomical abnormalities (dermoid cysts) in 1 case (2.7%), central nervous system tumors (lymphoma) in 1 case (2.7%), and unknown causes in 13 cases (33.3%). Symptoms include fever, headache, vomiting, disturbance of consciousness, convulsions, paralysis, facial paralysis and convulsive persistence. Pathogens were found in cerebrospinal fluid of 15 children (38.5%), including Neisseria gonorrhoeae, Streptococcus pneumoniae, Pseudomonas aeruginosa, Ralstonia pipiensis, Micrococcus kristinae, Rosemonas, Staphylococcus aureus, Streptococcus intermedius, Streptococcus constellatus and Listeria monocytogenes. Among them, pathogens of 10 cases were found by second generation sequencing, and 6 cases were found by cerebrospinal fluid culture. There were 17 cases (43.6%) with abnormal magnetic resonance imaging of the skull. Complications or sequelae included: subdural effusion in 35 cases (89.7%), subdural pus in 6 cases (15.4%), cerebral hernia in 6 cases (15.4%), hydrocephalus in 3 cases (7.7%), speech impairment in 2 cases (5.1%), and death in 1 case (2.7%). Conclusions The etiology of bacterial meningitis/meningoencephalitis in children aged 5 years or older should be actively sought, such as intracranial endothelioid cysts, primary tumors of the central nervous system, cellulitis of the head and face, sinusitis, immunodeficiency diseases, and trauma.

Clinical and genetic analysis of early onset very long chain acyl-CoA dehydrogenase deficiency: a report of three cases

LI Yanjun, ZHANG Yonghong, CHEN Yan, QIU Wenjun, HAN Lianshu, ZHU Tianwen

Journal of Clinical Pediatrics. 2023, 41(5): 381-386. doi:10.12372/jcp.2023.22e0453

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Objective To explore the clinical features and genetic characteristics for early onset very long chain acyl-coenzyme A dehydrogenase deficiency (VLCADD) and to improve the understanding of this disease. Methods The genotypes, clinical phenotypes and prognosis of 3 neonates with early-onset VLCADD diagnosed and treated in the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to April 2020 were retrospectively analyzed. Results Three children (2 boys and 1 girl) with early onset VLCADD were diagnosed by molecular method, and none of them had a positive family history. All three patients presented with metabolic crisis or digestive tract symptoms during the neonatal period. Two children were found to have increased C14:1 during the neonatal screening, and 1 case was not screened. All three children had ACADVL gene variations, which were complex heterozygotes, and the variations were from parents, among which c.1615C > T and c.231-232insAATG were not reported. One patient was breastfed after birth and had respiratory and cardiac arrest at 2 days of age. The other two children were fed special milk powder rich in medium-chain triacylglycerol immediately after the diagnosis due to abnormalities found in the neonatal screening, and sudden death occurred at 3 and 4 months of age, respectively. Conclusions Early onset VLCADD is one of the potential sudden death diseases in neonatal period and infancy. The prognosis is still poor despite early diagnosis and treatment. Therefore, prenatal diagnosis of fetuses from families with previous birth of VLCADD is an effective way to avoid the birth of early onset VLCADD children.

Advances in the study of bedaquiline and delamanid in the treatment of drug-resistant tuberculosis in children

WANG Xiyu, XU Hongmei

Journal of Clinical Pediatrics. 2023, 41(5): 387-393. doi:10.12372/jcp.2023.22e1064

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Tuberculosis (TB) is one of the major global public health concerns, and drug-resistant TB is one of the major obstacles to achieve the goal of ending TB due to the long treatment period, complicated regimens, multiple adverse effects and poor efficacy. In recent years, bedaquiline and delamanid have gradually become promising new drugs, but there is lack of researches on the application of these drugs in children with drug-resistant tuberculosis in China. This article reviews the efficacy and safety of bedaquiline and delamanid in drug-resistant tuberculosis and the progress of their use in children, in order to help construct new and effective regimens for the treatment of drug-resistant tuberculosis in children.

Role of vascular smooth muscle cell phenotypic switching in cardiovascular diseases in children

XU Xiao, ZHAO Lin, GONG Fangqi

Journal of Clinical Pediatrics. 2023, 41(5): 394-400. doi:10.12372/jcp.2023.22e0555

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Vascular smooth muscle cells (VSMCs) are predominant constituents of the vessel walls and contribute to maintaining vascular function of the blood vessels. VSMC phenotypic switching from a quiescent contractile phenotype to a proliferative and migratory phenotype induced by several pathological stimulations, which is involved in the pathogenesis of a serious cardiovascular disease (CVDs). In recent years, cardiovascular health in children has become an increasingly prominent problem, posing a heavy burdens on economic development. In this review, we summarized the research on VSMCs phenotypic switching in pediatric CVDs such as Kawasaki disease, aneurysm, primary hypertension, pulmonary hypertension, coarctation of the aorta, and Takayasu arteritis, which is aim to provide potential targets for the prevention and treatment of CVDs in children.

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