Oxazolidinone antibiotics, due to their high antimicrobial activity against Gram-positive bacteria and Mycobacterium tuberculosis, are increasingly used in clinical practice, leading to a rise in off-label use. While substantial clinical research data exist in adult populations, pediatric evidence remains limited, with significant physiological and pharmacokinetic differences compared to adults. Addressing the rational use of these agents in pediatric patients has emerged as a critical clinical challenge. To address this, a multidisciplinary working group comprising experts in pediatric infectious diseases, critical care, hematology-oncology, and clinical pharmacy from 34 hospitals nationwide developed this consensus. The primary objectives are to standardize linezolid use in pediatric infections, emphasize therapeutic drug monitoring for precise administration, and provide recommendations for special populations (e.g., children with hepatic/renal dysfunction or ECMO therapy) as well as adverse event monitoring. This consensus aims to offer evidence-based decision support for clinicians and promote rational medication use in pediatric patients.

Objective To investigate the clinical features, therapeutic strategies, and outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by intracardiac thrombosis. Methods A retrospective analysis was performed on the clinical records of 19 children diagnosed with SMPP and concurrent intracardiac thrombosis admitted between January 2020 and May 2024. Results Among the 19 children, 13 were boys and 6 were girls, with a median age of 8 (7-10) years. All children presented with fever and cough, and 11 (57.89%) exhibited additional extracardiac thrombotic events. Laboratory findings revealed elevated levels of C-reactive protein 58.91 (25.62-98.19) mg/L, lactate dehydrogenase 559 (442-791) U/L, and D - dimer 6.06 (3.44-7.52) mg/L. The median time from symptom onset to diagnosis was 12 (10-17) days, with all thrombi identified via echocardiography; the majority (n=14, 73.69%) were located in the right ventricle. Six patients underwent immediate surgical intervention due to hemodynamic instability (shock), large thrombus size (diameter>30 mm), or presence of multiple mobile thrombi with high embolic risk. Thirteen patients initially received anticoagulation therapy; seven showed marked reduction in thrombus burden, while one experienced embolization during early treatment and five required conversion to surgical thrombectomy due to inadequate response. During follow-up (3-5 months), none of the 11 surgically treated patients developed new thromboses or cardiac complications. Among the 8 non-surgical cases, 6 achieved complete thrombus resolution within 3 months, while one patient was lost to follow-up and one experienced embolization.Conclusion Pediatric SMPP with intracardiac thrombosis presents with nonspecific symptoms and carries a significant risk of systemic embolization. Dynamic monitoring of echocardiography and D-dimer levels during the first 1-2 weeks of illness is recommended for early detection. Prompt anticoagulant or surgical management is associated with favorable outcomes; however, therapeutic decisions should be individualized based on thrombus morphology, hemodynamic status, and embolic risk.

Objective To investigate the clinical features, diagnosis, treatment, and prognosis of the rare complication of infectious endocarditis (IE) in children with Mycoplasma pneumoniae pneumonia (MPP), aiming to enhance clinicians' understanding and facilitate early diagnosis of this condition. Methods A retrospective analysis was conducted on the clinical data of 5 children with MPP complicated by IE admitted to our hospital from January 2023 to November 2024. The analysis included clinical manifestations, laboratory tests, imaging findings, etiological test results, treatment, and follow-up information. Results The median age of onset was 9 years (5-9.5) years, with a male-to-female ratio of 3:2. All patients presented with fever and cough; only one exhibited concomitant subxiphoid pain. Median duration of fever was 12 (9.5-15) days, and vegetations were detected on echocardiography at a median of 10 (8-12) days after disease onset. Elevated D-dimer levels 5.09 (4.35-7.9) μg/mL and fibrin degradation products 10.56 (7.2-24.71) mg/L indicated marked hypercoagulability, while increased IL-6 55.45 (33.02-95.56) pg/mL and lactate dehydrogenase 746 (568.45-838.9) U/L suggested significant systemic inflammation and tissue injury. All children tested positive for MP nucleic acid in respiratory specimens; however, only one had MP DNA detected in blood via metagenomic next-generation sequencing (mNGS). All underwent surgical excision of vegetations, with histopathological examination confirming the diagnosis of IE. Postoperatively, all received antimicrobial therapy and anticoagulation. Among them, three patients with confirmed pulmonary embolism continued long-term anticoagulation for 1-6 months post-discharge. Follow-up echocardiography revealed no vegetation recurrence, and no patient reported symptoms such as dyspnea, chest pain, or wheezing during the monitoring period. Conclusion MPP-related IE presents with nonspecific and often insidious early manifestations, posing challenges for timely diagnosis. In pediatric patients with MPP and evidence of hypercoagulability, routine echocardiographic screening is strongly recommended to enable early detection of IE and prevent diagnostic delays. With prompt diagnosis and comprehensive management, the prognosis is favorable.

Objective To understand the influenza vaccination situation of children under 16 years old in Shanghai and parents' awareness of influenza and influenza vaccines, analyze the influencing factors of influenza vaccination, and provide a reference basis for improving the influenza vaccination rate and preventing the prevalence of influenza among children. Methods A total of 527 subjects from Yangpu District and Baoshan District in Shanghai were selected from September 2024 to February 2025, by convenience sampling for a questionnaire survey. The questionnaire included an influenza vaccination status survey and a self-made survey on knowledge about influenza and the influenza vaccine. Multivariate logistic regression was used to analyze factors associated with childhood influenza vaccination. Results A total of 527 questionnaires were distributed, 525 were collected, and 506 were valid, yielding an effective rate of 96.4%. Among the 506 children, 244 (48.2%) were boys and 262 (51.8%) were girls, with a median age of 8 (5-11) years. A total of 287 children (56.7%) had been vaccinated against influenza, of whom 133 had received at least one dose, 76 were vaccinated only during the flu season, and 78 were vaccinated annually; 219 children (43.3%) had never been vaccinated. The main reason why parents are willing to have their children vaccinated against the flu is to prevent flu infection, while concerns about vaccine safety were the main reasons parents were unwilling to vaccinate their children or reluctant to vaccinate again. Multivariate logistic regression showed that history of preterm birth (OR=0.38, 95% CI: 0.18-0.83), parents working in government agencies, enterprises, or institutions (OR=2.03, 95% CI: 1.06-3.86), parents engaged in social production and living services (OR=3.22, 95% CI: 1.40-7.40), and the influenza knowledge (OR=1.24, 95% CI: 1.08-1.44) were all correlated with childhood influenza vaccination status (P<0.05). Conclusions The childhood influenza vaccination rate still needs improvement, especially for special groups such as preterm infants; vaccine safety remains a major concern for parents.

Objective White-Sutton syndrome (WHSUS) is a monogenic genetic disorder with significant phenotypic differences. This study aims to further expand the clinical phenotypic spectrum of WHSUS and explore potential treatment methods for improving symptoms. Methods A retrospective analysis was conducted on the clinical data of four WHSUS patients who visited Children's Medical Center from July 2018 to February 2023. Results The age range of the first diagnosis of the 4 patients was 1-9 years old, 2 boys and 2 girls, all of whom had delayed language and motor development. Patient 1, a girl, exhibited a previously unreported clinical phenotype, tethered cord syndrome (TCS), and concurrent insulin resistance. Patient 2, a girl, visited the doctor due to short stature and poor academic performance. She received growth hormone treatment for 3.5 years. At the age of 12 years and 1 month during the follow-up, her height was 152 cm (P₅₀), and her menstruation was normal. Patient 3, a boy, was treated for delayed language development. Patient 4 was a boy with delayed language development and autistic tendency. All four patients had de novo mutations in the POGZ gene and were diagnosed with WHSUS. Conclusions This study detailedly reported the clinical features of 4 patients with WHSUS, expanding the phenotypic spectrum of WHSUS. Meanwhile, it was the first to report the treatment attempt of growth hormone for a child with WHSUS and short stature, providing a new idea for the symptomatic treatment of this kind of disease.

Objective To explore the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) combined with chemotherapy in children with myeloid sarcoma (MS). Methods A retrospective analysis was conducted on the clinical diagnosis, treatment and follow-up data of 7 children with MS who were diagnosed and treated at the hematology and oncology center from January 1, 2020 to December 31, 2023. Results There were 3 male and 4 female patients included in this study. The median age of diagnosis was 62 months (10 months - 14 years). Of the 7 patients, only 1 was initially presented with a "local mass," while the remaining 6 were diagnosed with acute myeloid leukemia (AML) and subsequently discovered to have extramedullary involvement, including 4 in the head and face, 2 in the mediastinum, and 1 in the ilium. All 7 patients received CCLG-AML-2019 protocol-based chemotherapy and bridging allo-HSCT. All children received a myeloablative pretreatment regimen prior to transplantation. Five of the 7 children were treated with post-infusion cyclophosphamide (PTCY), and 2 with busulfan combined with cyclophosphamide (BUCY). The median number of mononuclear cells infused was 19.87 (7.4-24.28)×10⁸/kg, and the median number of CD34⁺ cells infused was 12.87 (7.1-14.7)×10⁶/kg. The median time of neutrophil engraftment was +15(13-15) days, and the median time of platelet engraftment was +12(11-17) days. As of June 30, 2025, The median follow-up time was 1008 (371-1814) d. Five patients were alive, and 2 died. There was no death related to allo-HSCT. The estimated 3-year OS rate was 71%. Conclusion There are still challenges in the early diagnosis of MS in children, and the standard chemotherapy bridging allo-HSCT in the treatment of MS in children can obtain better efficacy.

Objective To investigate the phenotypic impact of dual variations in GABRG2 and SCN1A on genetic epilepsy with febrile seizures plus (GEFS+). Methods The clinical data of a 3-year-old girl and her three generations of family members who visited the Pediatric Internal Medicine Department due to "repeated convulsions" in May 2023 were collected. The genetic variations of this family were verified by whole exome sequencing (WES) and Sanger sequencing, and the genotype-phenotypic association was analyzed in combination with the literature. Results Among the 6 members of this family, 3 patients with SCN1A (c.5621G>A) mutations presented with febrile seizures (FS) or late-onset antiseizure medication-responsive epilepsy. Two individuals with isolated GABRG2 mutations presented with FS or incomplete penetrance. The proband, carrying dual mutations, manifested early-onset refractory epilepsy and status epilepticus. Two patients with the same single variant reported in the literature also showed FS. Protein interaction analysis revealed co-expression and functional synergy between SCN1A and GABRG2 in regulating neuronal excitability. Conclusions Dual mutations in SCN1A and GABRG2 may exacerbate epilepsy phenotypes through additive functional effects and genetic modifying mechanisms. Clinicians should be vigilant for synergistic interactions of dual variations in families with heterogeneous phenotypes, and timely genetic testing is critical to guide precision therapy and genetic counseling.

Systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are chronic systemic autoimmune conditions marked by aberrant immune activation. The pathogenesis of both diseases is multifactorial, involving a complex interplay between genetic susceptibility and environmental influences. Although the simultaneous presence of SLE and IBD is uncommon in clinical practice, this report describes a pediatric female patient who presented with abdominal pain as the primary manifestation and was ultimately diagnosed with both SLE and ulcerative colitis. Treatment with infliximab (IFX), a tumor necrosis factor-α inhibitor, in combination with immunosuppressive therapy led to significant alleviation of her autoimmune and gastrointestinal symptoms. This case highlights the importance of maintaining a high index of suspicion for underlying IBD when evaluating SLE patients with unexplained gastrointestinal complaints—particularly abdominal pain or diarrhea—that do not correlate with typical disease flares.

Inflammatory bowel disease (IBD) is a chronic, recurrent inflammatory disease involving the entire gastrointestinal tract. Nutrient deficiencies are common in IBD patients, and zinc, as an important nutrient for the body to maintain the physiological cellular functions, is widely recognized as beneficial in the treatment of many gastrointestinal diseases. In recent years, research on the mechanism of zinc and IBD has been emerging continuously. More and more studies have revealed that zinc deficiency is common among children with IBD. Zinc deficiency is associated with disease recurrence in children with IBD, as well as the occurrence of complications such as malnutrition, growth retardation, and anemia. This article will review the progress of basic and clinical researches related to zinc and IBD, providing references for the mechanism research and optimized treatment of IBD.

Neonatal acute kidney injury (AKI) predominantly occurs in critically ill infants, with an incidence rate of approximately 30% in neonatal intensive care units. It is associated with a significantly increased risk of mortality and a high propensity to progress to chronic kidney disease. This review mainly summarizes recent advances in the risk factors and emerging biomarkers for neonatal AKI. Besides, this review summarizes the clinical characteristics associated with different risk factors and the sensitivity and specificity of corresponding biomarkers. The occurrence of neonatal acute kidney injury is characterized by multifactorial interactions, and the pathological mechanisms vary depending on the underlying risk factors. The use of specific biomarkers facilitates early diagnosis and precise intervention. Combined monitoring of risk factors and biomarker levels enables early identification of acute kidney injury, guiding individualized treatment and prognosis assessment.

Takotsubo cardiomyopathy in children is an acute, reversible form of cardiomyopathy characterized by transient left ventricular systolic dysfunction. It exhibits distinct epidemiological, etiological, and clinical features compared to the adult population, with differences also evident in management strategies and prognostic outcomes. Although the incidence in pediatric patients is low, the condition is associated with substantial mortality. Neurological disorders are frequently identified as precipitating factors in this age group. Catecholamine excess is considered a central mechanism in the pathophysiology of the disease. Clinical presentation may mimic that of fulminant myocarditis, dilated cardiomyopathy, or sepsis-induced myocardial dysfunction, posing significant diagnostic challenges. Accurate differentiation among these entities is critical for optimizing patient outcomes. Echocardiography serves as a pivotal diagnostic tool, enabling real-time evaluation of regional wall motion abnormalities and ventricular morphology essential for differential diagnosis. This article aims to review key aspects of Takotsubo cardiomyopathy in children, clarify current understanding of its clinical spectrum, and enhance awareness and diagnostic precision among pediatric clinicians.

Vancomycin is a key glycopeptide antibiotic for the treatment of Gram-positive bacterial infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). However, significant pharmacokinetic (PK) heterogeneity in pediatric patients makes it difficult for traditional dosing regimens to balance efficacy and nephrotoxicity risk. Model-Informed precision dosing (MIPD) strategies provide a novel approach for individualized, AUC_0-24h/MIC-guided therapy by integrating quantitative pharmacological models (such as PPK, PBPK, and machine learning models) with individual patient data. Compared to conventional TDM, MIPD strategies significantly enhance the attainment rate of pharmacokinetic/pharmacodynamic (PK/PD) target concentrations (e.g., AUC), shorten the time to target attainment, especially in neonates and critically ill patients, and effectively reduce the risk of nephrotoxicity. This review summarizes the clinical value of MIPD-guided vancomycin application in neonates, critically ill children, and children with special disease conditions, intending to provide a reference for clinical practice.