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Journal Information
Journal of Clinical Pediatrics
(Monthly, founded in 1983)
Governed by:Shanghai Jiao Tong University
Sponsored by:Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
   
Published by:Editorial Office of Journal of Clinical Pediatrics
Editor-in-Chief:SUN Kun
Address:1665 Kongjiang Road, Yangpu District, Shanghai.
Postal Code:200092
Phone:(021)25076489
E-mail: jcperke@126.com

Table of Content

    15 September 2025 Volume 43 Issue 9
      
    Standard · Protocol · Guideline
    Expert consensus on pre-symptomatic treatment for pediatric spinal muscular atrophy (2025 edition)
    Journal of Clinical Pediatrics. 2025, 43(9):  643-651.  doi:10.12372/jcp.2025.25e0953
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    Spinal muscular atrophy (SMA) is a common fatal and disabling neuromuscular disease in infants and young children, caused by the degeneration of spinal anterior horn motor neurons, leading to progressive muscle weakness and atrophy in the limbs. In recent years, the emergence and application of disease-modifying therapies are gradually changing the natural history of SMA. However, the efficacy of these therapies is closely related to factors such as the age at treatment initiation and the pre-treatment disease course. Pre-symptomatic treatment is more promising to enable the affected children to survive and achieve near-normal motor milestones. This consensus was developed by experts from relevant fields, focusing on the following themes: pre-symptomatic SMA diagnosis, treatment decision-making, follow-up management, and key points for parental communication, with the aim of providing standards and guidance for clinical practices of pre-symptomatic treatment of pediatric SMA.

    Original Article
    Therapeutic efficacy of surfactant supplementation after pulmonary hemorrhage in improving clinical outcomes of preterm infants with gestational age <34 weeks
    LIU Yun, PAN Jingjing, SHEN Jinxin, ZOU Yunsu, CHENG Rui, FENG Yun, YANG Yang
    Journal of Clinical Pediatrics. 2025, 43(9):  652-660.  doi:10.12372/jcp.2025.25e0126
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    Objective Whether exogenous pulmonary surfactant (PS) administration could prolong the survival time of preterm infants after pulmonary hemorrhage is currently a lack of sufficient evidence. This study was conducted to evaluate the effect of surfactant administration after pulmonary hemorrhage on the survival prognosis of preterm infants. Methods The study participants were preterm babies, gestational age (GA) <34 weeks, with pulmonary hemorrhage admitted from January 1, 2017 to December 31, 2022. After pulmonary hemorrhage, infants would be given an additional dose of PS if the parents agreed. The timing of administration is usually 2-4 hours after the pulmonary hemorrhage stabilizes. Accordingly, the participants were retrospectively divided into the PS administration group after pulmonary hemorrhage (n=16) and the non-PS administration group after pulmonary hemorrhage (n=40) according to the records from hospital information system. Results It was found that the blood gas was better after PS administration. Moreover, the survival time, duration of caffeine administration, and duration of invasive ventilation were significantly longer in the PS administration group (P<0.05). The intergroup comparison showed that the application of PS after pulmonary hemorrhage could reduce the short-term all-cause mortality within 72 hours and 168 hours (P<0.05), but for the all-cause mortality within 702 hours and during the complete hospitalization period, there was no significant difference between the two groups. The Log-rank test of the survival curve showed that the application of PS after pulmonary hemorrhage could reduce the risk of death within 72 hours, within 168 hours, and during the full hospitalization period (P<0.05), except for the risk of death within 702 hours. The Breslow test showed that the application of PS after pulmonary hemorrhage could significantly prolong the survival time from 72 hours after pulmonary hemorrhage to discharge (P<0.05). Conclusion Administering PS to preterm infants with gestational age <34 weeks after pulmonary hemorrhage may have potential benefits, further clinical studies are needed to explore whether this treatment can improve the long-term outcomes.

    The association between influenza vaccination during pregnancy from 2012 to 2022 and demographic characteristics and preterm birth outcomes in Shanghai
    NING Xinan, MA Zhonghui, WANG Chunfang, HUANG Zhuoying, JIANG Hong, YU Huiting, XIA Tian
    Journal of Clinical Pediatrics. 2025, 43(9):  661-669.  doi:10.12372/jcp.2025.25e0371
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    Objective This study aimed to investigate the influenza vaccination coverage among pregnant women in Shanghai, analyze the main demographic factors influencing vaccination behavior, and further assess the potential association between influenza vaccination during pregnancy and the occurrence of preterm birth, providing empirical evidence for influenza vaccination strategies in China. Methods All the information of the mothers and their newborns from January 1, 2012 to December 31, 2022 in the Shanghai Birth Medical Information System was collected. A multivariate logistic regression model was used to analyze the main demographic factors influencing influenza vaccination among pregnant women and to evaluate the association between influenza vaccination during pregnancy and preterm birth outcomes. Results During the study period, 2209 pregnant women received influenza vaccination. Multivariate logistic regression analysis revealed that maternal residency, age, education, spouse’s age and education, history of miscarriage, and offspring birth year were significant factors influencing influenza vaccination during pregnancy (all P<0.001). Compared with pregnant women registered in Shanghai, those with residency outside Shanghai had a lower likelihood of vaccination (adjusted OR=0.83, 95% CI: 0.76-0.91). Compared to women aged < 25 years, those aged 25-34 years (adjusted OR=2.65, 95% CI: 1.75-4.00) and ≥ 35 years (adjusted OR=3.35, 95% CI: 2.19-5.14) had higher likelihoods of vaccination. Women whose spouses were ≥ 35 years old were more likely to be vaccinated compared with those whose spouses were < 25 years old (adjusted OR=2.74, 95% CI: 1.57-4.78). Women with a college degree or above had a higher likelihood of vaccination than those with less than college education (adjusted OR=5.63, 95% CI: 4.30-7.38), and similarly, women whose spouses had a college degree or above were more likely to be vaccinated compared to those whose spouses had lower education (adjusted OR=2.19, 95% CI: 1.78-2.69). Women with a history of miscarriage were less likely to be vaccinated compared with those without (adjusted OR=0.76, 95% CI: 0.70-0.84). Compared to offspring born between 2012 and 2015, women with offspring born between 2016 and 2019 (adjusted OR=8.70, 95% CI: 6.45-11.75) and between 2020 and 2022 (adjusted OR=54.56, 95% CI: 40.79-72.97) were significantly more likely to receive influenza vaccination during pregnancy. After adjusting for maternal residency, age, education, spouse’s age and education, single/multiple pregnancies, history of miscarriage, gestational hypertension, gestational diabetes, and offspring birth year, influenza vaccination during pregnancy was associated with a 35% reduction in the risk of preterm birth compared to that of no vaccination during pregnancy (adjusted OR=0.65, 95% CI: 0.53-0.81). Conclusions Multiple sociodemographic factors are significantly associated with influenza vaccination behavior among pregnant women in Shanghai between 2012 and 2022, and influenza vaccination during pregnancy may be related to a reduced risk of preterm birth. It is recommended to further strengthen public education and service support, continuously promote vaccination efforts, and effectively safeguard maternal and infant health.

    International comparison of disease burden of neonatal sepsis (1990-2021) and implications for China
    ZENG Shicheng, FENG Kun, ZHOU Xianlu, HUA Ziyu
    Journal of Clinical Pediatrics. 2025, 43(9):  670-679.  doi:10.12372/jcp.2025.25e0179
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    Objective Neonatal sepsis (NS) is the third cause of neonatal deaths in the world, with significant differences in disease burden between developing and developed countries. The disease burden of NS in developed and developing countries was compared to provide an evidence-based basis for China to formulate more effective prevention to reduce the disease burden of NS. Methods The NS data of prevalence, incidence, and deaths including number,rate and age standard rate,were extracted from the Global Burden of Diseases 2021 (GBD 2021) database for 1990-2021 in the global, America, China, and India. The Joinpoint regression model was used to analyze the trend, and annual percentage change (APC) and average annual percentage change (AAPC) were calculated. To forecast trends in NS age standard prevalence, incidence, and deaths in the global, America, China, and India from 2021 to 2035. Results As of 2021, the global number of NS prevalence was 9661523, and the number of deaths was 232656. In 2021, compared with 1990, the global age standard prevalence of NS increased by 34.5%,while age standard incidence and deaths respectively decreased 20.6% and 21.2%. From 1990 to 2021, the age standard prevalence, incidence and deaths in India were all higher than the global average. Age standard prevalence in China is increased, while in America it has remained stable. China showed the largest decline in age standard incidence and deaths of NS (35.7% and 65.8%, respectively). Conclusion From 1990 to 2021, the global disease burden of NS showed a downward trend. It is suggested to further optimize the balanced allocation of medical resources to promote the reduction of NS disease burden.

    Analysis of clinical manifestations, ciliary structure and genetic characteristics of primary ciliary dyskinesia in 14 children
    ZHANG Wei, WANG Yang, DENG Wenhua, WU Yabin
    Journal of Clinical Pediatrics. 2025, 43(9):  680-685.  doi:10.12372/jcp.2025.25e0254
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    Objective To explore the clinical manifestations, ciliary structure and genetic variation characteristics of primary ciliary dyskinesia (PCD). Methods A retrospective analysis of the clinical data of children diagnosed with primary ciliary dyskinesia (PCD) by bronchoscopic mucosal biopsy electron microscopy or whole exome sequencing (WES) from January 2017 to December 2024 at the hospital. Results A total of 14 children (4 boys and 10 girls) were included, the median age of onset was 6.3 (1.3-7.9) years, and the median age of diagnosis was 8.0 (7.0-10.8) years. The main clinical manifestations included chronic wet cough (14 cases, 100%), rhinosinusitis (12 cases, 85.7%), bronchiectasis and atelectasis (9 cases, 64.3%), situs inversus (3 cases, 21.4%), and chronic otitis media (2 cases, 14.3%). All 14 children presented with bronchoscopic findings of purulent bronchitis (100%), 2 patients were combined with bronchial stenosis, and 1 was combined with bronchial occlusion under bronchoscopy. Nasal exhaled nitric oxide (nNO) was detected in 10 children at least 2 weeks after the acute infection was controlled. nNO was significantly decreased in 8 cases, and nNO was > 77 nL/min in 2 cases. Seven children underwent exome sequencing. Among them, 2 children were negative and 5 were detected with biallelic variations (2 cases of DNAH5 gene variation, 2 cases of CCNO gene variation, and 1 case of DNAH1 gene variation). Conclusions The clinical phenotypes of PCD are mainly chronic cough, sinusitis, and bronchiectasis, with low incidence of situs inversus and neonatal respiratory distress. Some children have nNO levels above the positive threshold and may develop bronchial obstruction. The main gene variations are DNAH5 and CCNO.

    Prognostic factors analysis of adenovirus type 3 pneumonia in children
    XIANG Linjuan, CHEN Xuexin, JIA Yanhui, WU Yuhang, CONG Xin, LI Wei, CHEN Yingying, CHEN Sun, HUANG Lisu
    Journal of Clinical Pediatrics. 2025, 43(9):  686-691.  doi:10.12372/jcp.2025.24e1412
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    Objective To analyze the clinical characteristics of children with respiratory adenovirus type 3 infection and the influencing factors of adenovirus type 3 pneumonia in children. Methods A retrospective analysis was conducted on the clinical data of children with respiratory adenovirus type 3 infection admitted to the hospital's infectious disease department from January to October 2024. The possible influencing factors of the occurrence of adenovirus type 3 pneumonia were analyzed through multivariate logistic regression. Results A total of 159 children (87 boys and 72 girls) with adenovirus type 3 infection were included, with a median age of 59.0 (41.0-81.0) months. Multivariate logistic regression analysis showed that tonsillar exudation and elevated CRP level were independent protective factors for adenovirus type 3 pneumonia in children (P<0.05), while cough, expectoration and elevated D-dimer level were independent risk factors for adenovirus type 3 pneumonia (P<0.05). Conclusions In the early course of respiratory adenovirus type 3 infection in children, tonsillar exudation may indicate mild pulmonary symptoms, suggesting that the tonsils may play an important defensive role in the immune response of acute adenovirus infection.

    Clinical Report
    Treatment of congenital myotonia: a case series of 3 pediatric patients
    CHANG Ya, ZHOU Yunqing, WANG Jiwen, WU Hongyan, YANG Fangfei, SUN Lina
    Journal of Clinical Pediatrics. 2025, 43(9):  692-697.  doi:10.12372/jcp.2025.24e1272
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    Objective To investigate the clinical characteristics, genetic profiles, and therapeutic outcomes of oxcarbazepine in children with congenital myotonia (MC). Methods A retrospective analysis was conducted on three pediatric MC cases, summarizing their clinical manifestations and treatment courses. All patients underwent next-generation sequencing (NGS) for genetic diagnosis. Results All three cases initially presented with movement disorders and were misdiagnosed as paroxysmal kinesigenic dyskinesia (PKD). Genetic testing revealed pathogenic variants in the CLCN1 gene, confirming MC diagnosis. Remarkably, all patients achieved symptomatic relief after oxcarbazepine administration. Conclusions MC patients exhibit diverse clinical features, including the "warm-up phenomenon," positive family history, and specific genotypes. While medications such as mexiletine and acetazolamide are effective, individualized treatment strategies are essential. Early diagnosis and proper intervention are crucial for improving patients' quality of life and prognosis. This study preliminary report the efficacy of oxcarbazepine in MC treatment, providing valuable insights for clinical practice.

    Two cases of pediatric hepatosplenic T-cell lymphoma and literature review
    WANG Jie, WU Bin, ZHANG Lannan, CHEN Kailan
    Journal of Clinical Pediatrics. 2025, 43(9):  698-704.  doi:10.12372/jcp.2025.24e1059
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    Objective To investigate the clinical characteristics, treatment outcomes, and prognosis of hepatosplenic γδ T-cell lymphoma (HSγδTCL) in pediatric patients. Methods The clinical data of two pediatric patients with HS γδ TCL admitted to the oncology department of our hospital from October 2012 to May 2023 were retrospectively analyzed. Additionally, relevant literature was systematically searched and reviewed. Results The two patients were 9- and 11-year-old boys who presented with splenomegaly and cytopenia. Both were diagnosed with HSγδTCL. Patient 1 received chemotherapy but succumbed to disease progression. Patient 2 underwent seven cycles of chemotherapy in combination with histone deacetylase inhibitor therapy. After achieving remission, the patient received allogeneic hematopoietic stem cell transplantation and remains alive to date. A total of 30 pediatric cases were reviewed from the literature. Eight patients had a history of chronic immunodeficiency diseases and had received immunosuppressive therapy. Eleven patients underwent intensive chemotherapy combined with stem cell transplantation, while five patients had splenectomy followed by chemotherapy. Overall, 22 patients died, with a median survival time of less than one year after diagnosis. Conclusion HSγδTCL in children has a poor treatment outcome. Chemotherapy combined with hematopoietic stem cell transplantation is an alternative treatment strategy worthy of consideration.

    A case report of sirolimus in the treatment of diffuse pulmonary lymphangiomatosis in children
    YE Zehui, JIANG Xiaoli
    Journal of Clinical Pediatrics. 2025, 43(9):  705-709.  doi:10.12372/jcp.2025.24e0399
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    Objective To explore the clinical characteristics and treatment strategies of diffuse pulmonary lymphangiomatosis in children, in order to improve the early diagnosis and treatment level and the prognosis of children. Methods The clinical data of a child with diffuse pulmonary lymphangiomatosis admitted to the respiratory department of our hospital were retrospectively analyzed. The clinical manifestations, diagnostic process, and treatment outcomes were systematically summarized. Furthermore, current comprehensive treatment options and prognostic factors were discussed in light of relevant literature. Results The child received sirolimus treatment for 3 years, and the clinical symptoms were significantly relieved. Chest CT showed significant improvement. Conclusion Sirolimus demonstrates promising therapeutic efficacy in the management of diffuse pulmonary lymphangiomatosis in children, with a favorable safety profile and the potential to significantly enhance long-term prognosis.

    Literature Review
    Applications of low field MRI in pediatrics and prenatal fetal diagnosis
    DONG Suzhen, CHEN Hao, ZHANG Zhiyong, JIANG Fan
    Journal of Clinical Pediatrics. 2025, 43(9):  710-715.  doi:10.12372/jcp.2025.24e1182
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    Generally, the higher the magnetic field strength of a magnetic resonance imaging (MRI) scanner, the greater the likelihood of achieving a higher signal-to-noise ratio and improved image resolution within a shorter scanning time. However, high-field-strength MRI systems are associated with significant limitations, including high acquisition costs, stringent installation requirements, and substantial maintenance expenditures, which collectively hinder their widespread adoption. In contrast, low-field-strength MRI scanners, due to their relatively lower costs and enhanced portability, have increasingly been integrated into clinical practice and related research settings. This review aims to summarize the current diagnostic applications of low-field-strength MRI in pediatric neurological disorders, neonatal intensive care, and prenatal fetal imaging, while also discussing their future potential. This article seeks to provide a comprehensive overview of the clinical value and developmental trajectory of low-field-strength MRI in fetal and pediatric diagnosis.

    Application progress of glucagon-like peptide-2 analogues in inflammatory bowel disease
    ZHOU Zhixuan, WANG Ying
    Journal of Clinical Pediatrics. 2025, 43(9):  716-722.  doi:10.12372/jcp.2025.24e1343
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    Glucagon-like peptide-2 is a polypeptide hormone secreted by intestinal L cells. It mainly exerts multiple physiological functions in the intestine, such as increasing blood flow, promoting nutrient absorption and enhancing barrier function, by binding to specific receptors. In the treatment of intestinal inflammation, GLP-2 has demonstrated multiple mechanisms including anti-inflammatory effects, promoting intestinal barrier repair and regulating the intestinal microbiota, and has achieved results in numerous animal experiments and clinical trials. This article summarizes the research progress of GLP-2 and its analogues in the treatment of inflammatory bowel disease, providing a basis for future research and clinical applications.