Table of Content

15 January 2019 Volume 37 Issue 1

  

Clinical characteristics of extremely premature infants at low risk for early-onset sepsis

HUA Yuanyuan, MIAO Jingkun, ZOU Xian, LAI Xin, CHEN Na, YU Linchao, CHEN Qixiong

Journal of Clinical Pediatrics. 2019, 37(1):  1-5.  doi:10.3969/j.issn.1000-3606.2019.01.001

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Objective　To explore and analyze the clinical characteristics of extremely premature infants at low risk for early-onset sepsis (EOS), so as to avoid overuse of antibiotics. Method　The clinical data of extremely premature infants hospitalized from January 1, 2010 to December 31, 2017 were collected. Extremely premature infants born from mothers without premature rupture of membranes and without maternal clinical manifestations of chorioamnionitis during pregnancy were classified assigned into the low-risk group, and those who did not meet the low-risk conditions were regarded assigned intoas the control group. EOS was diagnosed according to the results of blood culture within 72 hours after birth. The clinical characteristics, treatment and outcome of extremely premature infants between the two groups were retrospectively analyzed. Results　A total of 245 extremely preterm infants were enrolled, including 153 (62.4%) in low-risk group. Compared with the control group, mothers in low-risk group had higher rates of gestational diabetes and hypertension, higher rates of antenatal hormone use and lower rates of antenatal antibiotics use; furthermore, neonates in low-risk group had lower rates of Apgar score < 5, higher rates of pulmonary surfactant use, respiratory support and mechanical ventilation, and lower risk of death and incidence of early-onset sepsis. The differences were statistically significant (P<0.05). Among In extremely premature infants whose having survival time > 24 hours, compared with control group, infants in low-risk group had higher incidences of respiratory distress syndrome, patent ductus arteriosus, intracranial hemorrhage and bronchopulmonary dysplasia, and lower incidence of pulmonary hemorrhage than control group, and the differences were statistically significant (all P<0.05). In low-risk group, the risks of death, distress syndrome, pulmonary hemorrhage and bronchopulmonary hemorrhage in long-term antibiotic group were higher than the short-term antibiotic group. Conclusion　Early identification of extremely preterm infants at low risk of early-onset sepsis in extremely preterm infants is of clinical significance in reducing early empirical use of antibiotics therapy. respiratory

A multicenter clinical epidemiological study of brain injury in premature infants in Jiangsu

Jiangsu Standardized Diagnosis and Treatment Research Collaborative Group on Brain Injury in Neonates

Journal of Clinical Pediatrics. 2019, 37(1):  6-10.  doi:10.3969/j.issn.1000-3606.2019.01.002

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Objective　To explore the clinical features of brain damage in premature infants. Method　The clinical data of premature infants with brain injury (including cerebral infarction, cerebral edema, intracranial hemorrhage, white matter injury and basal nerve nucleus injury) were retrospectively analyzed. The subjects were the infants admitted to the neonatal department of nine hospitals in Jiangsu Province from March 1, 2015 to February 29, 2016. Results　In 9239 preterm infants, 2515 (27.22%) met the diagnosis of brain injury, including 1406 males and 1109 females with an average gestational age at 31.2±2.8 weeks and an average birth weight being 1 825.6±819.8 g. Periventricular-intraventricular hemorrhage was the most common type of hemorrhagic brain injury in premature infants, accounting for 67.57%. Non-hemorrhagic brain injury was mainly edema (50.93%) and periventricular leukomalacia (37.94%). Periventricular-intraventricular hemorrhage (PVH-IVH) and periventricular leukomalacia (PVL) were mostly in grade Ⅰ and Ⅱ in classification. There were significant differences in gestational age, birth weight, sex, Apgar score and delivery mode among premature infants with white matter injury, basal nerve nucleus injury, cerebral infarction, brain edema and intracranial hemorrhage (all P<0.05). Among them, a higher proportion of infants having gestational age <32 weeks existed in children with white matter damage; a higher proportion of infants having birth weight <1500 g existed in children with white matter damage, cerebral infarction and intracranial hemorrhage, and a higher rate of birth weight between 1500-2500 g existed in children with basal ganglia injury and cerebral edema. The rate of Apgar score < 3 was higher in children with cerebral infarction, while it was lower in children with intracranial hemorrhage. A higher proportion of cesarean section was in Cerebral infarction children. The improvement rate of brain injury in premature infants was 89.34%. Conclusions  PVH-IVH was the most common type of hemorrhagic brain injury, while PVL was the main type of non-hemorrhagic brain injury. PVH-IVH and PVL are mostly in grade Ⅰ and Ⅱ in classification. Low Apgar score, small gestational age and low birth weight were important risk factors for brain injury in premature infants.

Clinical characteristics, treatment， and prognosis of bronchopulmonary dysplasia in extremely preterm infants

YU Yanliang, ZOU Xinying, YANG Chuanzhong

Journal of Clinical Pediatrics. 2019, 37(1):  11-15.  doi:10.3969/j.issn.1000-3606.2019.01.003

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　Objective　To explore the clinical characteristics, treatment and prognosis of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Method　The clinical data of extremely preterm infants with gestational age < 28 weeks hospitalized between August 2014 and August 2017 were retrospectively analyzed. According to oxygen inhalation and BPD clinical grading at 28 days after the birth, extremely preterm infants were divided into non-BPD group, mild, moderate and severe BPD groups, and their clinical characteristics, treatment and prognosis were discussed. Results　A total of 205 extremely preterm infants were enrolled, with an average gestational age of (26.2±1.2) weeks and an average birth weight of (0.87±0.19) kg. Among them, 46 infants were gave up treatment, 15 died, and 144 (70.3%) were discharged eventually. There were statistically significant differences in the rates of patent ductus arteriosus (PDA) and infection among groups with different degrees of BPD (P<0.01). The incidence of PDA was higher in the moderate and severe BPD groups, and the infection rate was higher in the severe BPD group. The oxygen use time, length of stay, hospitalization cost, glucocorticoid treatment rate and incidence of pulmonary sequelae among groups with different degrees of BPD were significantly different (P<0.01). With oxygen use time, length of hospital stay and hospitalization cost increased gradually over the aggravation of BPD. Glucocorticoids were used in all moderate and severe children, and the incidence of pulmonary sequelae was higher. Conclusion　BPD still is an important complication affecting the prognosis of extremely preterm infants. Early prevention and systematic treatment can alleviate severe sequela.

Neonatal Budd-Chiari syndrome: a case report

ZHOU Meijuan, ZHAO Xiaoyun, LI Hong

Journal of Clinical Pediatrics. 2019, 37(1):  16-18.  doi:10.3969/j.issn.1000-3606.2019.01.004

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Objective　To explore the clinical manifestation, diagnosis and treatment of Budd-Chiari syndrome in neonates. Method　The clinical data of Budd-Chiari syndrome in a neonate were retrospectively reviewed and relevant literature was reviewed. Results　The 21-day-old girl was born through vaginal delivery with gestational age of 39 weeks and birth weight of 3150 g. Her clinical manifestations included abdominal distention, hepatosplenomegaly, ascites, repeated hypoproteinemia and low platelet count, similar to sepsis. Imaging examination indicated hepatic segment stenosis of the inferior vena cava (the stenosis segment was about 24 mm in length and 1.59 mm in diameter at the narrowest place). The girl was diagnosed with BuddChiari syndrome and died after abandoning treatment. Conclusion　Neonatal Budd-Chiari syndrome is rare, easily misdiagnosed and has a high mortality.

The clinical analysis of pleural effusion associated with peripherally inserted central catheters in two neonates

ZHANG Chengqiang, LU Chengqiu, QIAN Beiqian, HOU Jinyi, WANG Jimei

Journal of Clinical Pediatrics. 2019, 37(1):  19-21.  doi:10.3969/j.issn.1000-3606.2019.01.005

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　Objective　To explore the clinical characteristics of pleural effusion associated with peripherally inserted central catheters (PICCs) in neonates. Method　The clinical data of pleural effusion caused by PICCs in two neonates were retrospectively analyzed. Results　Both 2 cases were preterm female infants. Case 1 was delivered at 26+5 weeks, with a birth weight of 800 g. Dyspnea aggravated 8 hours after the PICC placement. Bedside chest radiograph indicated a large amount of pleural effusion on the right side. PICC was removed, puncture and drainage were performed, and pleural effusion was cured after 6 days of closed thoracic drainage. Case 2 was delivered at 29+3 weeks with a birth weight of 1240 g. Three days after placement of PICC, dyspnea became worse. Bedside chest radiograph showed bilateral pleural effusion, which was cured after PICC removal, puncture and drainage. According to the routine and biochemical indexes of pleural effusion, combined with the medical history, case 1 was consistent with the diagnosis of chylothorax and case 2 was considered as fluid exudation. Conclusion　Neonatal PICC - associated pleural effusion is rare, but the etiology is varied and progress is rapid. Vigilance and active treatment is needed in clinic.

Clinical and cyto-molecular genetics analysis of trisomy 12p in neonates: a case report

LIU Furong, HAO Shengju, WANG Xing, ZHENG Lei, ZHANG Chuan, LIANG Jici, ZHOU Bingbo

Journal of Clinical Pediatrics. 2019, 37(1):  22-25.  doi:10.3969/j.issn.1000-3606.2019.01.006

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Objective　To explore the clinical features, cytogenetic and molecular genetics characteristics of trisomy 12p in neonates. Method　The clinical data were reviewed in a neonate with trisomy 12p confirmed by routine G-banding chromosome karyotype analysis, high throughput sequencing chromosome copy number variation analysis (CNV) and lymphocyte interphase fluorescence in situ hybridization (FISH). Results　The chromosome karyotype in peripheral blood of the neonate was 47,XX,+mar, and the karyotypes of her parents were normal. CNV detected a regional duplication of 12 p13.33-p11.1 (16000134860000) with a fragment size of 34.7 Mb. Peripheral blood lymphocyte interphase FISH showed that there were 3 signals in the short arm of chromosome 12 in all interphase nuclei of the neonate, and no chimera existed. It was finally confirmed to be trisomy 12p. Conclusion　The combination of clinical features, peripheral blood karyotype analysis, CNV and FISH techniques can effectively confirm the diaganosis of trisomy 12p .

Clinical diagnosis and treatment of bronchial foreign bodies in 147 children

　CHEN Shanjia, GU Haoxiang, LU Min, WU Beirong, TANG Rong

Journal of Clinical Pediatrics. 2019, 37(1):  26-29.  doi:10.3969/j.issn.1000-3606.2019.01.007

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Objective　To explore the clinical characteristics of bronchial foreign bodies in children. Method　The clinical data of 147 children with exogenous bronchial foreign body admitted between 2014 and 2016 were retrospectively analyzed, and the applications of rigid bronchoscopy and flexible bronchoscopy for foreign body extraction were compared. Results　All 147 cases were diagnosed with bronchial foreign bodies by chest CT, chest X-ray or respiratory endoscopy. In these cases (104 boys and 43 girls), 87.8% of whom were aged 1-3 years, the most common types of bronchial foreign body were nuts. The common complications were bronchial mucosal granulation tissue hyperplasia (88 cases, 59.86%), pneumonia (56 cases, 38.1%), atelectasis (15 cases, 10.2%), respiratory failure (14 cases, 9.52%) and bronchiectasis (4 cases, 2.72%) respectively. The foreign bodies were removed by soft bronchoscopy in 106 cases which were successfully removed at one time in 100 cases. Respiratory endoscopy was undergone in 141 cases to remove foreign bodies, and flexible bronchoscope was applied in 106 (72.11%) cases and foreign bodies were successfully removed in first attempt in 100 cases (94.34%). Rigid bronchoscope was used in 35 cases (23.81%) and foreign bodies were successfully removed in first attempt in 28 cases (80.0%). Conclusion　The majority of children with bronchial foreign body are male. Both flexible and rigid bronchoscopes can remove exogenous foreign bodies in the lower respiratory tract.

Clinical characteristics of necrotizing pneumonia caused by Mycoplasma pneumoniae infection in children

　SHUAI Jinfeng, HUANG Kunling, LIU Jianhua, YANG Huirong, NIU Bo, LU Sukun, CAO Lijie, JI Lili

Journal of Clinical Pediatrics. 2019, 37(1):  30-33.  doi:10.3969/j.issn.1000-3606.2019.01.008

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　Objectives　To analyze the clinical characteristics, treatment and prognosis of necrotizing pneumonia caused by Mycoplasma pneumoniae (MP) infection in children. Method　The clinical data of children with necrotizing pneumonia cause by MP infection from October 2016 to October 2017 were retrospectively analyzed. Results　A total of 26 children (10 males and 16 females) with an average age of (5.76±2.60) years, were enrolled in the study. All children were characterized by fever and cough. High fever (≥39.0 ℃) was seen in 23 cases (88.5%) and the total duration of fever was (16.88±7.42) days. Pulmonary auscultation showed a reduction in respiratory sounds in all children. The range of peripheral blood leukocytes were (9.0~36.8)×109/L, mean peak neutrophil ratio was (69.2±13.2) %, and the range of C-reactive protein (CRP) was (1~202.5) mg/ L. The mean value of lactic dehydrogenase (LDH) was (448±247) U/L. At the beginning of the disease, the chest images showed homogeneous solid high-density images over the whole lung lobe and 20 cases (76.9%) were complicated with pleural effusion. At the later stage, lung CT showed thin-walled cavities or multiple air-containing cysts on the basis of lung consolidation. Fiberoptic bronchoscopy showed lumen obstruction caused by mucus plugs in 23 cases (88.5%). All the children were treated with methylprednisolone. The dose of 2 mg/ (kg·d) was effective in 21 cases and the fever was relieved in 5 cases after the dose was adjusted to 4 mg/ (kg·d), and the average hormone application time was (13.08 ± 8.38) d. The median length of hospital stay was [16.5 (7~32)] d. Two cases were lost to follow-up and 24 cases finished 6-month follow-up. Lung CT showed almost complete recovery of the lungs in 16 cases, residual pleural hypertrophy in 5 cases, and bronchiectasis in 1 case and bronchiolitis obliterans in 2 cases. Conclusion　Necrotic pneumonia in children caused by MP infection is characterized by persistent high fever, decreased respiratory sounds, lung consolidation and mucus plugs induced lumen obstruction. The prognosis is relatively good after active anti-infection and hormone therapy.

Mycoplasma pneumoniae pneumonia complicated with top of the basilar syndrome in children: a case report

WANG Xin, YANG Huafang, WANG Weiyi, ZHENG Huacheng

Journal of Clinical Pediatrics. 2019, 37(1):  34-38.  doi:10.3969/j.issn.1000-3606.2019.01.009

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Objective　To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) complicated with “top of the basilar” syndrome (TOBS) in children. Method　The clinical data of MPP complicated with TOBS in a child were retrospectively analyzed, and the related literature was reviewed. Results　A 6-year-old girl developed fever and inflexible movement in unilateral limb, and serum Mycoplasma pneumoniae antibody increased gradually. Lung CT showed a large area of inflammatory consolidation. Brain magnetic resonance imaging (MRI) showed multiple cerebral infarctions. After the symptomatic treatment of anti-infection, anticoagulation, thrombolysis and intracranial pressure reduction, the girl’s condition continued to worsen and she presented with coma, cough weakness, dysphagia, facial nerve paralysis and bilateral pupillary inequality. Although the vital signs of the child were stable, she could not take care of herself and was still recovering. Conclusion　MPP is often accompanied by hypercoagulative state and autoimmune abnormalities, and the prognosis of patients combined with TOBS is poor.

Analysis of the etiology and clinical characteristics of short stature

　HAN Xiaowei, DONG Zhiya, ZHANG Wanyu, MA Xiaoyu, AN Jingjing, XIAO Yuan, LU Wenli, WANG Wei, NI Jihong, WANG Defen

Journal of Clinical Pediatrics. 2019, 37(1):  39-42.  doi:10.3969/j.issn.1000-3606.2019.01.010

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Abstract:　Objective　To explore the etiology and clinical characteristics of short stature. Method　Clinical data of 2075 children with short stature treated from May 1995 to July 2017 were retrospectively analyzed. The etiology and morbidity of pathological short stature and normal variant short stature were analyzed. The clinical characteristics of growth hormone deficiency (GHD), idiopathic short stature (ISS), constitutional delay in growth (CDG) and familial short stature (FSS) were analyzed. The etiological differences between severe short stature [height standard deviation score (SDS) ≤－3] and general short stature (height SDS >－3) were analyzed. Results　Among 2075 children diagnosed with short stature, 1719 (82.84%) were pathological short stature, among which GHD (38.60%) and ISS (22.02%) were more common. Normal variant short stature was found in 356 children (17.16%), with FSS and CDG accounting for 10.70% and 6.46% respectively. There were statistically significant differences in the sex ratio, age at initial diagnosis, height SDS, body mass index (BMI), bone age and bone age delay among children with four common childhood short stature (GHD, ISS, CDG and FSS) (all P<0.01). Boys were more than girls in four kinds of childhood short stature. The height SDS was the lowest in GHD group and the highest in CDG group; BMI was highest in GHD group, but lower in CDG and ISS group. Bone age delay was highest in GHD group and lowest in CDG group. In severe short stature group, the rates of complete GHD, multiple pituitary hormone deficiency, small for gestational age infant, Turner syndrome, hypothyroidism and Russell-Silver syndrome were higher than those in general short stature group, but the rates of partial GHD, ISS, FSS and CDG was lower than those in general short stature group. Conclusion　The etiology of short stature is complex. Analysis of the etiology and clinical features is helpful for clinical diagnosis and treatment.

Clinical andgenetic characteristics of dopamine-responsive dystonia in 3 children

　ZHOU Hao, LONG Shasha, LI Chunpei, WANG Tianqi, WU Bingbing, WANG Yi

Journal of Clinical Pediatrics. 2019, 37(1):  43-46.  doi:10.3969/j.issn.1000-3606.2019.01.011

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Objective　To explore the clinical and genetic characteristics, treatment。 and prognosis of dopamine responsive dystonia (DRD) in children. Method　The clinical data of DRD in 3 children admitted to neurology clinic from January 2014 to August 2017 were retrospectively analyzed. Results　Two male children, 20-month-old and 2-year-old respectively, and one 4-year-old female child suffered from hypotonia after birth or one year after birth. Genetic testing found that case 1 had heterozygous mutations in tyrosine hydroxylase (TH) gene, C. G943A (p. G315S) from his mother (PMID 20056467) and C. G739A (p. G247S) from his father (PMID 18554280, 24753243). Case 2 had a heterozygous mutation, c.454-2A>G, in GCH-1 gene, which was identified to be from his father (PMID 10732814). Case 3 had two mutations in TH1 gene, c.580+2T>C from her mother (novel mutation) and c.698G>A (p.R233H) from her father (PMID 9703425). The mother of case 1 was pregnant again. Prenatal examination revealed that the fetus only carried c.G943A (p.G315S) from the mother. Three patients were treated with a small dose of madopar after diagnosis, and gradually increased to obtain the best effect. After 6-month follow-up, cases 1 and 2 recovered to normal, and case 3 showed significant improvement in dystonia, but left foot deformity. Conclusion　DRD can start in infants and young children with atypical early symptoms. Genetic testing can make a definite diagnosis. The family that has proband should undergo prenatal examination.

Anti-Caspr2 antibody-associated encephalitis in a child: a case report and literature review

　WANG Jue, LIN Xin, LIN Zhi, LIN Xinfu, MEI Ainong

Journal of Clinical Pediatrics. 2019, 37(1):  47-50.  doi:10.3969/j.issn.1000-3606.2019.01.012

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Objective　To explore the clinical features of anti-Caspr2 antibody-associated encephalitis. Method　The clinical data of anti-Caspr2 antibody-associated encephalitis in a child were retrospectively reviewed. Results　A 5-year-old girl manifested as recent memory loss, irritability, cognitive impairment, hallucination, sleep disorders, and so on. The child had positive serum Caspr2 antibody, and was diagnosed with Caspr2 antibody encephalitis after exclusion of other diseases. The literature search retrieved 50 cases of Caspr2 antibody encephalitis with complete data, including 43 male cases and 7 female cases. The minimum onset age of the disease was 5 years in this case. In addition, 1 patient developed the disease at the age of 8, while the rest developed in adulthood. There were 32 cases (62.75%) of marginal encephalitis and 19 cases (37.25%) of morvan’s syndrome. The most common clinical symptoms were impaired memory, epileptic seizures, and psychiatric symptoms such as anxiety, apathy, irritability, hallucinations or delusions, peripheral nerve hyperexcitability (PNH), cerebellar ataxia and autonomic nervous disorders. Forty-four cases (86.27%) recovered or improved, 8 cases (15.69%) were complicated with tumors and 8 cases (15.69%) relapsed. Conclusion　Caspr2 antibody encephalitis is relatively rare, especially in children. If the patient has marginal encephalitis symptoms, combining with PNH, ataxia and autonomic nerve symptoms, the possibility of Caspr2 antibody encephalitis should be considered.

Refractory hypertension caused by renal artery fibromuscular dysplasia in one child

CHEN Naiqing1, 2, XIAO Huijie1, WANG Fang1

Journal of Clinical Pediatrics. 2019, 37(1):  51-54.  doi:10.3969/j.issn.1000-3606.2019.01.013

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　Objective　To explore the clinical characteristics, diagnosis and treatment of refractory hypertension caused by renal artery fibromuscular dysplasia (FMD) in children. Method　The clinical data of a child with refractory hypertension caused by FMD were retrospectively analyzed. Results　A boy, with onset at age of 4 years, had significantly increased blood pressure and decreased serum potassium. His renin and angiotensin levels were significantly elevated. The boy was diagnosed with renovascular hypertension by color Doppler ultrasonography, enhanced thoracoabdominal CT and vascular reconstruction. Oral administration of a variety of antihypertensive drugs is not effective. The child was finally diagnosed of refractory hypertension caused by FMD using renal angiography. The child was not suitable for surgery. After adjusting the antihypertensive drugs, the blood pressure of the child tended to be stable. The boy received continuous follow-up for 8 years. The antihypertensive regimen was adjusted annually and blood pressure fluctuations and target organ damage were dynamically assessed. Conclusion　Children with FMD caused renal vascular hypertension may have no specific manifestations in the early stage. The drug treatment is preferred, and surgical treatment may be considered.

A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children

　XU Xiaonan1, HUI Jiangjin2, CHEN Jinghua2, DU Liya3, ZHANG Ni1, MA Hanwei1

Journal of Clinical Pediatrics. 2019, 37(1):  55-62.  doi:10.3969/j.issn.1000-3606.2019.01.014

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Objective　To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods　The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results　Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95% CI :1.5~5.4; success rate: OR=3.5, 95% CI :1.7~7.5) and alarm (complete response rate: OR=2.7, 95% CI :1.1~6.6; success rate: OR=3.8, 95% CI: 1.6~9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95%CI: 1.1~3.4). The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95%CI: 0.03~0.53). The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion　The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.

Advances in the role of vascular endothelial system in the pathogenesis of vasovagal syncope in children

　Reviewer: CHEN Tingting, HUANG Min, ZHANG Guoqing, Reviser: HUANG Yujuan

Journal of Clinical Pediatrics. 2019, 37(1):  63-66.  doi:10.3969/j.issn.1000-3606.2019.01.015

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　Vasovagal syncope (VVS) is the most common cause of unexplained syncope in children. The etiology of VVS is complex, and its diagnosis is mainly based on clinical manifestations and head-up tilt test (HUT). It has been pointed out that neuroendocrine system plays an important role in the pathogenesis of syncope. HUT-induced syncope is accompanied by abnormal neurohumoral activation. The changes of plasma concentration of endothelin-1 and nitric oxide secreted by endothelial system before and after VVS syncope in children suggest that endothelial system is involved in the occurrence of VVS in children. This article reviews the research on the involvement of vascular endothelial system in the pathogenesis of VVS in children.

Advances in safety of high-flow nasal cannulae in neonates

Reviewer: HE Yue, Reviser: CHEN Chao

Journal of Clinical Pediatrics. 2019, 37(1):  67-70.  doi:10.3969/j.issn.1000-3606.2019.01.016

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In recent years, heated humidified high-flow nasal cannulae (HFNC) devices have become a popular method of non-invasive respiratory support in the neonatal intensive care units. However, the relevant evidence supporting its clinical safety has not been fully established so far. This article reviews the factors affecting the safe use of HFNC and the related complications, so as to provide reference for clinical application.

The prenatal diagnosis-postpartum treatment of the intractable tachyarrhythmia in a fetus

Journal of Clinical Pediatrics. 2019, 37(1):  71-71.  doi:10.3969/j.issn.1000-3606.2019.01.017

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Neonatal 22q13 deletion syndrome: a case report

Journal of Clinical Pediatrics. 2019, 37(1):  72-73.  doi:10.3969/j.issn.1000-3606.2019.01.018

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Postbiotics: a novel concept of micro-ecology therapy and its application prospects

Journal of Clinical Pediatrics. 2019, 37(1):  74-77.  doi:10.3969/j.issn.1000-3606.2019.01.019

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