Table of Content

15 April 2026 Volume 44 Issue 4

  

Commentary

Interpretation of the Expert consensus on the clinical diagnosis and treatment of lymphadenopathy in children (2026) and rethinking of clinical practice

HUANG Lisu, LI Yan, YANG Huazhen, LIU Hanmin

Journal of Clinical Pediatrics. 2026, 44(4):  277-282.  doi:10.12372/jcp.2026.26e0203

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Lymphadenopathy, one of the most common clinical signs in pediatrics, encompasses a broad etiological spectrum, posing significant challenges in differential diagnosis. The release of the Expert consensus on the clinical diagnosis and treatment of lymphadenopathy in children (2026) has sparked extensive discussion among pediatricians across China. This review aims to provide an in-depth interpretation and expansion of the core content of the consensus, focus on the difficult issues in clinical practice, and further discuss some unfinished contents. The article will thoroughly explore the definition of lymphadenopathy, refined interpretation of imaging examinations, application of "potential diagnostic clues", recognition of "alarm signals" for malignancies, and the evolving pathogen spectrum of infectious lymphadenopathy along with corresponding diagnostic and therapeutic strategies. This paper seeks to assist clinicians in better understanding and applying the consensus, thereby enhancing the diagnostic and therapeutic standards for pediatric lymphadenopathy.

Original Article

Clinical features and severe pneumonia risk factors in 708 pediatric pertussis inpatients

HUANG Tao, CAO Ke, FU Xiaoying, CHEN Yunsheng, LUO Xiaojuan

Journal of Clinical Pediatrics. 2026, 44(4):  283-290.  doi:10.12372/jcp.2026.25e0910

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Objective To analyze the clinical characteristics of pertussis in children and explore the independent risk factors for pertussis complicated by ordinary pneumonia and severe pneumonia. Methods A retrospective cohort study was conducted on the clinical data of 708 children hospitalized with pertussis in our hospital from August 2021 to June 2024. Patients were divided into three groups: pertussis without pneumonia (n=306), pertussis with ordinary pneumonia (n=316), and pertussis with severe pneumonia (n=86). Baseline clinical characteristics and laboratory indicators upon admission were compared. Multinomial logistic regression analysis (with the non-pneumonia group as the reference) was used to identify independent factors associated with ordinary and severe pneumonia. Results Among the 708 children, 400 were male (56.5%) and 308 were female (43.5%), with a median age of 4 months (1 month - 4 years), infants≤3 months accounted for 46.3%. The co-infection rate was 68.50%, with rhinovirus being the most common. Significant differences were found among the three groups in age, fever, underlying diseases, DTP vaccination status, WBC count, LYM% and Bordetella pertussis cycle threshold (BP-C_t) values (P<0.05). Post-hoc comparisons showed significant differences in these indicators for the severe pneumonia group compared to the other two groups, whereas no significant differences were observed between the ordinary pneumonia and non-pneumonia groups. Multinomial logistic regression analysis showed no statistically significant independent predictors for distinguishing ordinary pneumonia from non-pneumonia (P>0.05). However, for severe pneumonia, fever (OR=10.601, 95%CI: 5.235-21.466), underlying diseases (OR=5.576, 95%CI: 2.651-11.726), low BP-C_t value (high bacterial load) (OR=5.174, 95%CI: 1.911-14.005), and WBC>30×10⁹/L (OR=3.371, 95%CI: 1.520-7.474) were identified as independent risk factors. Conclusion Pneumonia is a common complication in hospitalized children with pertussis. While ordinary pneumonia is clinically difficult to distinguish from uncomplicated pertussis in the early stages, fever, underlying diseases, high bacterial load (low BP-C_t), and hyperleukocytosis serve as early warning indicators for the progression to severe pneumonia.

Analysis of clinical characteristics and long-term prognosis of Chromobacterium violaceum infection in children

SUI Mingze, SONG Dan, CHEN Zefu

Journal of Clinical Pediatrics. 2026, 44(4):  291-295.  doi:10.12372/jcp.2026.25e0703

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Objective Chromobacterium violaceum (C. violaceum) infection presents with non-specific clinical manifestations, posing challenges for early identification—particularly in pediatric populations, where cases are extremely rare. This study aims to enhance clinicians’ awareness of pediatric C. violaceum infection and expand the global repository of case data. Methods A retrospective analysis and report were conducted on the relevant data of 4 children with C. violaceum infection admitted from January 2012 to December 2021. Results All 4 patients were male native residents of Hainan Province. The mean age at onset was (2.50±3.07) years, with all cases occurring during the tropical summer season. The median length of hospital stay was 41.00 (12.00-50.16) days. Fever was the predominant systemic symptom in all patients, 3 cases presented with pneumonia complicated by cellulitis/abscess formation, while 1 case manifested as enteritis. Elevated inflammatory markers were observed in all 4 patients. Etiological diagnosis was confirmed via bacterial culture and high-throughput sequencing. Antimicrobial susceptibility testing demonstrated susceptibility to carbapenems, aminoglycosides, and quinolones, but resistance to penicillins and most cephalosporins. During follow-up, 1 patient died of septic shock 10 months post-discharge, and another experienced late recurrence, suggesting the potential for chronic latent infection. Conclusion C. violaceum infection exhibits diverse clinical presentations. Pathogen culture of body fluids is critical for definitive diagnosis. While C. violaceum is universally resistant to penicillins and cephalosporins, antimicrobial susceptibility testing results are valuable for guiding treatment. Given the risks of late recurrence and mortality, clinicians should maintain vigilance and implement rigorous long-term follow-up for affected pediatric patients.

Clinical study of 65 cases of Chikungunya fever in children

LONG Xiaohui, LIAO Yinglan, JIA Jinrong

Journal of Clinical Pediatrics. 2026, 44(4):  296-301.  doi:10.12372/jcp.2026.25e1660

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Objective To summarize the clinical characteristics, treatment, and prognosis of 65 pediatric cases of Chikungunya fever. Methods Clinical data from 65 pediatric patients with Chikungunya fever at the department of pediatrics between August 2025 and October 2025, were retrospectively analyzed. Results Pediatric Chikungunya cases accounted for 15.9% (65/408) of all hospitalized Chikungunya patients during the study period. The male-to-female ratio was 1:0.80. Age distribution: 0-3 years: 8 cases (12.3%); 3-6 years: 11 cases (16.9%); 6-11 years: 36 cases (55.4%); and 10 cases (15.4%) aged >11 years. The mean age at onset was (7.9±3.4) years, with all cases presenting as mild. Fever was present in 58 cases (89.2%), with a fever peak of (38.8±0.67) °C and fever duration of (3.5±2.2) days. Rashes were present in 59 cases (90.8%), including generalized rashes in 38 cases (64.4%). Skin itching occurred in 35 cases (59.3%), with rashes resolving in (5.5±2.0) days. Arthralgia was reported in 32 cases (49.2%), with pain locations including: ankles in 24 cases (75.0%), knees in 11 cases (34.3%), wrists in 7 cases (21.9%), fingers in 7 cases (21.9%), and heels in 1 case (3.1%). The duration of joint pain was (3.19±1.65) days, with joint swelling occurring in 2 cases (6.2%). Twenty-nine cases (44.6%) concurrently presented with fever, rash, and joint pain. Other clinical manifestations included headache, dizziness, cough, producing sputum, sore throat, and decreased appetite, with one case (1.5%) that developed pneumonia. All children tested negative for dengue virus antigen DEVN-NS1, and a few had elevated inflammatory markers; 2 cases (3.1%) had elevated alanine aminotransferase, and 19 cases (29.2%) had elevated creatine kinase isoenzyme. Most children received symptomatic treatment, and the medications didn’t really affect how long the symptoms lasted. All cases improved or were discharged in good condition during the isolation period. Conclusion Most kids with Chikungunya showed unusual clinical symptoms, with very few severe cases.

Clinical characteristics, genetic variations and prognostic analysis of left ventricular noncompaction in children

ZHAO Xiaopei, SONG Sirui, XIAO Tinging

Journal of Clinical Pediatrics. 2026, 44(4):  302-307.  doi:10.12372/jcp.2026.25e1205

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Objective Clinical manifestations of left ventricular noncompaction (LVNC) in children lack specificity. At present, there are relatively few systematic studies on the prognostic risk factors of LVNC, and clear evidence for risk stratification is still lacking in clinical practice. This study aimed to analyze the clinical characteristics, genetic variations, and prognostic factors of LVNC in children. Methods Clinical data of 42 children diagnosed with LVNC from June 2018 to June 2024 were retrospectively analyzed. According to the occurrence of adverse cardiovascular events during follow-up, they were divided into an adverse event group (15 cases) and a non-adverse event group (27 cases). Clinical and laboratory indicators were compared between the two groups, and multivariate Logistic regression was used to analyze prognostic risk factors. Results Among the 42 children, 24 were males (57.1%), with a median age of 92.5 months at diagnosis. The common initial symptoms were poor appetite accompanied by shortness of breath (19.0%), chest tightness or chest pain (19.0%), and palpitations (16.7%). At the initial diagnosis,children with cardiac function class III/IV accounted for 35.7% (15/42).92.9% (39/42) of the children had abnormal electrocardiograms (ECG), with tachyarrhythmia being the most common (14/42). Echocardiography revealed left atrial and left ventricular enlargement in 71.4% (30/42) and 80.9% (34/42) of patients, respectively. The median left ventricular ejection fraction (LVEF) was 52.0% (41.8-62.0), and the median non-compacted to compacted (NC/C) ratio was 2.5 (2.1-3.0). Four children had a family history of sudden death or cardiomyopathy in first-degree relatives. 16 children underwent genetic testing, and pathogenic gene mutations were detected in 10 cases. The median follow-up duration was 30 months, the fatality rate was 9.5%, and symptoms improved in 45.2% (19/42) of children. The group with adverse events exhibited a significantly higher incidence of tachyarrhythmia, a greater proportion of patients with cardiac function class III/IV, and higher NC/C ratios compared to the group without adverse events (P<0.05). Multivariate logistic regression analysis demonstrated that cardiac function class Ⅲ/IV (OR=13.55, 95% CI: 1.87~98.39, P= 0.01), tachyarrhythmia (OR=19.73, 95% CI: 2.28~170.47, P=0.007), and an elevated NC/C ratio (OR=5.19, 95% CI: 1.20~22.40, P=0.027) as independent risk factors for an unfavorable prognosis. Conclusions Children with LVNC exhibit strong heterogeneity in clinical manifestations and are often associated with a genetic background. Poor cardiac function, tachyarrhythmia, and a high NC/C ratio are independent risk factors for poor prognosis, so intensive monitoring and intervention for highrisk children are required in clinical practice.

Follow-up study on clinical manifestations and neurological recovery in children with Guillain-Barré syndrome accompanied by autonomic dysfunction

LI Heting, SUN Ruidi, JIANG Jun

Journal of Clinical Pediatrics. 2026, 44(4):  308-313.  doi:10.12372/jcp.2026.25e1362

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Objective Comorbid autonomic nervous system dysfunction affects the overall prognosis of children with Guillain-Barré syndrome (GBS), whereas systematic research on the course of autonomic nervous system dysfunction and the process of neurological function recovery in these children remains scarce. This study aims to investigate the clinical characteristics and neurological function recovery of GBS children complicated with autonomic nervous system dysfunction. Methods A retrospective analysis was conducted on the clinical data of children with GBS who visited Wuhan Children’s Hospital, Tongji Medical College from May 2017 to August 2023. The children were divided into two groups, with and without autonomic dysfunction, and a comparative analysis of key clinical indicators between the two groups were conducted. Results A total of 92 children with GBS were enrolled, including 58 boys (63.0%), with a median age of 5.0 (3.4-8.4) years. None of the children presented with autonomic nervous system dysfunction as the initial symptom. Autonomic nervous system dysfunction developed in 40 cases (43.5%) during the disease course, with the median time from disease onset to the occurrence of autonomic nervous system dysfunction being 9 (4-13) days. Cardiovascular complications were the most common autonomic symptoms, including 16 cases of tachycardia, 12 cases of arrhythmia, 5 cases of hypertension, 4 cases of atrioventricular block, 3 cases of orthostatic hypotension, and 2 cases of bradycardia. Other symptoms included 4 cases of diarrhea, 2 cases of constipation, 7 cases of urinary retention, and 3 cases of hyperhidrosis. Compared with GBS children without autonomic nervous system dysfunction, those with this complication had significantly higher proportions of assisted ventilation requirement and combined immunotherapy plus plasma exchange, longer hospital stays, and longer time to recovery of independent ambulation (P<0.05). Autonomic nervous system function recovered within 3 months in all children. At the 3-month follow-up, among all children with abnormal nerve conduction, only 39.0% (30/77) achieved recovery of nerve conduction velocity, while the recovery rate of clinical symptoms was 67.5% (52/77). Conclusions Autonomic nervous system dysfunction affects the treatment and prognosis of children with Guillain-Barré syndrome (GBS). However, autonomic nervous system dysfunction in these children achieves a favorable recovery, and its recovery time precedes that of nerve conduction impairment.

Application and comparison of three modified percutaneous catheterization techniques in pediatric peritoneal dialysis: an 8-year retrospective single-center study

CHEN Qiuxia, ZHU Chunhua, ZHAO Fei, WU Hongmei, ZHANG Aihua

Journal of Clinical Pediatrics. 2026, 44(4):  314-322.  doi:10.12372/jcp.2026.25e1432

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Objective To evaluate the efficacy and safety of modified percutaneous peritoneal dialysis (PD) catheterization techniques in pediatric uremic patients, and to compare the clinical advantages and limitations of three distinct modified approaches. Methods A single-center retrospective cohort study was conducted, enrolling pediatric patients who underwent their first percutaneous PD catheterization for uremia at the department of nephrology between January 1, 2017 and December 31, 2024. Patients were stratified into three groups based on the catheterization technique: Group A (puncture cannula combined with rigid guidewire-guided technique), Group B (peel-away sheath combined with rigid guidewire-guided technique), and Group C (pneumoperitoneum-assisted trocar combined with rigid guidewire-guided technique). Baseline characteristics, procedural duration, incidence of intraoperative incision bleeding, time to initiation of dialysis, and incidences of catheter dysfunction and PD-related infections within 1 year of regular PD initiation were collected and analyzed statistically. Results A total of 98 patients were included, with well-balanced baseline characteristics across groups. All patients received regular PD for≥1 month; 75 completed≥6 months of PD, and 53 completed≥12 months. Procedural duration differed significantly among the three groups (P<0.05), with Group C having the shortest duration (significantly shorter than Group A, P<0.01). Cross-sectional analyses at postoperative time points revealed no significant differences in incision bleeding, time to dialysis initiation, poor drainage, leakage, or PD-related infections (P>0.05). Kaplan-Meier survival analysis showed 1-year catheter survival rates of 0.89, 0.79, and 0.96 in Groups A, B, and C, respectively. However, Cox proportional hazards regression demonstrated no significant difference in 1-year catheter survival among the three techniques. Further survival analyses for key catheter-related adverse events showed no significant intergroup differences in 1-year tunnel infection or peritonitis rates. Notably, Group C had a significantly higher incidence of poor drainage than Group A (P=0.034). Conclusion Modified percutaneous PD catheterization is a safe, effective, and technically feasible approach suitable for dissemination among pediatric nephrologists. The peel-away sheath combined with rigid guidewire technique exhibits the most balanced performance in terms of procedural efficiency and complication control. While the pneumoperitoneum-assisted trocar technique significantly shortens procedural duration, it may increase the risk of postoperative poor drainage, warranting selective application in centers with proficient technical expertise.

Correlation between splanchnic tissue oxygen saturation and superior mesenteric artery hemodynamics during red blood cell transfusion in neonates: a prospective cohort study

HUANG Haiting, ZHANG Hui, TUOHETI Aerziguli, SU Yajie, LI Long

Journal of Clinical Pediatrics. 2026, 44(4):  323-330.  doi:10.12372/jcp.2026.25e1436

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Objective To investigate the dynamic changes and correlation between splanchnic tissue oxygen saturation (SrSO₂) and superior mesenteric artery (SMA) hemodynamic parameters in neonates during red blood cell (RBC) transfusion. Methods A total of neonates who required RBC transfusion and were admitted to the neonatal intensive care unit between October 2024 and October 2025 were enrolled in this study. Synchronous monitoring of SrSO₂ and SMA hemodynamic parameters — including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) — was performed at eight predefined time points: 1 hour before transfusion (t_-1h), mid-transfusion (t_m), end of transfusion (t_e), and 2, 4, 12, 24, and 48 hours after transfusion completion (t_2h, t_4h, t_12h, t_24h, and t_48h). Spearman correlation, generalized estimating equations (GEE), and cross-lagged correlation analyses were used to examine the associations among the indicators. Results A total of 43 neonates were included, with 26 boys (60.5%). The median gestational age was 31.1 (29.0-36.0) weeks and the median birth weight was 1750 (1255-2600) g. During the observation period, the median PSV ranged from 33.4 to 46.9 cm/s, median EDV from 9.6 to 11.5 cm/s, median RI from 0.73 to 0.77, and median SrSO₂ from 49.8% to 56.5%. Correlation analysis revealed a significant negative correlation only at t4h between RI and SrSO₂ (r_s=-0.52, P_adjusted=0.048); no significant correlations were found at other time points (all P>0.05). GEE showed that time had no significant effect on PSV (β=0.003, P=0.992), EDV (β=-0.073, P=0.449), or RI (β=0.002, P=0.324), but had a statistically significant positive effect on SrSO₂ (β=0.776, P=0.004). The absolute values of the mean cross-correlation function (CCF) between PSV, EDV, RI and SrSO₂ were all small (the highest was 0.151 for PSV at lag-1), indicating no clear lagged relationship. Conclusions During RBC transfusion in neonates, the SMA hemodynamic parameters remain relatively stable, whereas the SrSO₂ shows an overall increasing trend. There is no significantly synchronous or lagged correlation between the changes in these two measures, suggesting that macrohemodynamics and microcirculatory oxygenation may be regulated by different mechanisms.

TRIT1-associated combined oxidative phosphorylation deficiency type 35: a report of 3 cases

LIU Hui, SUN Yingying, LIU Miao, ZHANG Jun, WANG Ying, ZHANG Wenqian, FENG Mingcai, LIU Xiaoke, WANG Yuan, MA Yanli

Journal of Clinical Pediatrics. 2026, 44(4):  331-336.  doi:10.12372/jcp.2026.25e0487

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Objective To investigate the clinical characteristics of patients with combined oxidative phosphorylation deficiency type 35(COXPD35) caused by TRIT1 gene mutations, in order to enhance clinicians' understanding of this disease. Methods A retrospective analysis was conducted on three patients diagnosed with COXPD35 resulting from compound heterozygous variants in the TRIT1 gene. Clinical data, auxiliary examinations results, genetic findings, and diagnostic courses were summarized and reviewed alongside relevant literature. Results All three patients were male children, with onset ages ranging from 5 months to 2 years and 3 months. They all presented initially with febrile seizures, which were later followed by myoclonic seizures and eventually progressed to refractory epilepsy. Common clinical features included microcephaly, intellectual disability, and pyramidal tract signs. Blood lactate levels were not significantly elevated. Genetic testing identified three TRIT1 mutation sites, among which c.172-2A>T and c.741G>A have not been previously reported in the literature. Conclusions COXPD35 caused by TRIT1 mutations typically begins with febrile seizures, followed by various seizure types, predominantly difficult-to-control myoclonic seizures. Patients may achieve normal developmental milestones during infancy, but experience psychomotor regression after seizure onset. Microcephaly and pyramidal tract signs are common, while lactate levels often remain normal.

Clinical Report

A case of severe acute necrotizing pancreatitis in children treated by continuous regional arterial infusion

XIE Shiyu, ZHENG Minne, LIU Chunhua, WANG Yanli

Journal of Clinical Pediatrics. 2026, 44(4):  337-340.  doi:10.12372/jcp.2026.25e0518

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The incidence of acute pancreatitis (AP) in children has shown a yearly increasing trend. Currently, standardized and definitive diagnosis and treatment protocols for severe acute necrotizing pancreatitis in children are lacking, and clinical practice often relies on adapting adult guidelines. Continuous regional arterial infusion of medication has been applied in the treatment of early-stage acute necrotizing pancreatitis in adults. However, the etiology, pathophysiological processes, and pharmacokinetics of AP differ in children compared to adults, with certain individual variations also present. Consequently, reports on its application specifically in children with AP are scarce. This article presents a case of severe acute necrotizing pancreatitis in a child treated via continuous regional arterial infusion, where medication was administered to a specified site through an indwelling catheter. Furthermore, the applicability of continuous regional arterial infusion therapy in pediatric AP is discussed, aiming to contribute to advancements in the diagnosis and management of AP in children.

Literature Review

Development and assessment of children's pragmatic competence and its application in the diagnosis of neurodevelopmental disorders

LI Xuewei, LIU Xiao

Journal of Clinical Pediatrics. 2026, 44(4):  341-347.  doi:10.12372/jcp.2026.25e1439

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Pragmatic competence refers to the ability to accurately understand and appropriately use language in a specific context.There is a relatively close correlation between the development of children's pragmatic competence and neurodevelopmental disorders. Some neurodevelopmental disorders are often accompanied by pragmatic communication disorders of varying degrees, and patients mostly seek medical attention due to language or pragmatics-related problems, which leads to their final diagnosis. In-depth research on the development patterns of pragmatic competence in normal children and their standardized assessment tools is of great guiding significance for the early identification of behavioral problems and developmental disorders risks in children. Most of the currently used standardized assessment tools for pragmatic competence are developed by foreign scholars, including the children's communication checklist, the test of pragmatic language, and the language use inventory. However, these tools have such limitations as insufficient cultural adaptability and lack of targeted assessment dimensions. Localized, standardized assessment tools in China are still relatively scarce and have limited application.This article reviews the development trajectory of normal children's pragmatic competence, the research progress in existing standardized assessment tools for pragmatic competence, and the relationship between pragmatic competence and neurodevelopmental disorders.It also discusses the future research directions and challenges, thus providing a reference for the development of standardized assessment tools for pragmatic competence in China.

Research advances on the intestinal microbiome in pediatric short bowel syndrome

LIU Shiyi, WANG Ying

Journal of Clinical Pediatrics. 2026, 44(4):  348-354.  doi:10.12372/jcp.2026.25e0381

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Pediatric short bowel syndrome (SBS) is defined as a clinical condition characterized by impaired intestinal absorptive capacity resulting from extensive small bowel resection, bypass, or congenital short bowel, which fails to meet the nutritional requirements for normal growth and development, necessitating parenteral nutrition (PN) support for a duration exceeding 42 days. Owing to significant structural and functional abnormalities of the small intestine, pediatric SBS patients exhibit intestinal microecological dysbiosis, as evidenced by reduced microbial diversity and aberrant metabolic pathways. Key factors influencing the intestinal microbiota profiles in these patients include nutritional support modalities, prophylactic antibiotic administration, anatomical configuration, and growth and developmental status. Maintenance of intestinal microbiota diversity and stability is of paramount importance for enhancing intestinal barrier function, facilitating intestinal adaptation, and mitigating complications in pediatric SBS patients.

The hazards of functional constipation in children and the progress in its diagnosis and treatment

FAN Na, WANG Baoxi, LIN Yan, WANG Chunhui, ZHANG Anding, JIANG Xun

Journal of Clinical Pediatrics. 2026, 44(4):  355-361.  doi:10.12372/jcp.2026.25e1521

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Functional constipation is one of the most common digestive system diseases in children, which can cause symptoms such as reduced defecation, hard and dry stools, abdominal distension, and abdominal pain. Long-term constipation can also lead to related problems such as delayed growth and development, urinary retention, and anxiety in children, seriously affecting their quality of life. However, at present, there is a lack of evidence-based research on the long-term hazards of functional constipation in children. Some clinicians have insufficient understanding of it, and the poor compliance of children and their parents often leads to delays in diagnosis and treatment. In view of this, this article systematically reviews the potential hazards of functional constipation to children and the progress in its diagnosis and treatment, with the aim of enhancing the attention of clinical workers and families of affected children to this disease, optimizing management strategies and improving prognosis.

Kidney diseases related to COL4A3, COL4A4 and COL4A5 gene variations and their pathogenic mechanisms

LI Haomiao, ZHANG Xiaoyu, HAN Yuan, CHE Ruochen, CHEN Qiuxia, ZHAO Sanlong, DING Guixia

Journal of Clinical Pediatrics. 2026, 44(4):  362-372.  doi:10.12372/jcp.2026.25e1075

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Collagen Ⅳ is the core structural protein of the glomerular basement membrane, composed of α chains encoded by the COL4A3, COL4A4, and COL4A5 genes, which assemble into the α3α4α5 trimer. It plays a crucial role in maintaining the structural integrity and filtration function of the glomerular basement membrane. Variations in these three genes can lead to a spectrum of inherited kidney diseases, with Alport syndrome being the most representative. Clinically, Alport syndrome is characterized by hematuria, progressive renal dysfunction, sensorineural hearing loss, and ocular abnormalities, with inheritance patterns including X-linked, autosomal recessive, and autosomal dominant. Additionally, variations in the COL4A3-COL4A5 genes are closely associated with various kidney diseases, such as thin basement membrane nephropathy (TBMN), familial IgA nephropathy, focal segmental glomerulosclerosis (FSGS), steroid-resistant nephrotic syndrome (SRNS), and end-stage renal disease (ESRD) of unknown etiology. In recent years, with the widespread application of high-throughput sequencing technologies, genetic testing has increasingly demonstrated its value in disease diagnosis, prognosis assessment, and precision medicine. This article systematically reviews the clinical manifestations, molecular genetic mechanisms, and clinical management strategies of COL4A3-COL4A5-related kidney diseases, aiming to provide a theoretical foundation and practical guidance for early diagnosis and individualized treatment of these conditions.

Child growth curves: historical development, construction methodologies, and applications

GAO Yufei, QIAN Naisi, YANG Zhiyu, JIN Shan, LU Huiping, WU Cheng, SONG Hualing, YU Huiting

Journal of Clinical Pediatrics. 2026, 44(4):  373-380.  doi:10.12372/jcp.2026.25e0686

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Growth curves are indispensable for monitoring children's growth in child health care and pediatrics. In our article, we traces growth curves ranging over 200 years, from the hand-drawn charts in the early 18th century to algorithmic modeling in modern ages, highlighting their crucial role in assessing child health. China has made progress in growth curves research, with localized versions better reflecting domestic children's growth patterns, especially in detecting growth retardation in rural populations. In this article we also introduce growth curves construction methods, including non - parametric approaches (e.g., cubic spline, penalized splines, kernel estimation, LOWESS/LOESS) and parametric approaches (e.g., LMS, GAMLSS), comparing their merits, limitations, and applicability. Future research will focus on creating individualized growth curves and building localized standards to enhance assessment accuracy, thereby better supporting child health monitoring and disease prevention.