In May 2023, a series of thematic articles published in The Lancet introduced a novel concept—small vulnerable neonates (SVN) which categorizes preterm, small for gestational age (SGA), and low birth weight (LBW) neonates under a unified framework. Preterm birth, SGA, and LBW have their respective definitions and have long been considered distinct populations in different clinical practices. However, there is considerable overlap among these three categories, and their pathophysiological mechanisms interact. Isolated definitions fail to capture the full picture of these neonates, potentially leading to an underestimation of the number of high-risk newborns and affecting clinical decision-making. The introduction of the SVN concept aims to increase attention to this group through a new perspective, comprehensively reflect the overall issues of high-risk newborns, and promote the health and sustainable development of perinatal medicine, neonatology, pediatrics, and even society as a whole. In the future, SVN is poised to become a core concept in disciplinary advancement and clinical practice. Therefore, this review elaborates on the background of the SVN concept, its implications for epidemiological research, as well as prevention and intervention strategies, to help clinicians and medical researchers understand this new concept and appreciate the rationale behind SVN and its significance for future development.

Objective To explore the changing trend of the incidence of singleton small vulnerable neonates (SVN) and its influencing factors, and to analyze the association between parental factors and SVN. Methods A retrospective cohort study was conducted, recruiting 13,020 pregnant women who established prenatal records before 14 weeks of gestation between January 2019 and December 2023 and received standardized antenatal care until delivery. Based on neonatal outcomes, those meeting the SVN criteria were assigned to the SVN group, with the remaining assigned to the control group. SVN encompassed three phenotypes: preterm birth (PT), small for gestational age (SGA), and low birth weight (LBW). Baseline maternal characteristics, pregnancy complications, paternal anthropometric parameters, and pregnancy outcomes were compared between the two groups. Logistic regression analysis was employed to identify parental influencing factors for SVN. Results During the study period, the overall SVN incidence was 12.73% (1658/13020), comprising PT (3.16%, 412/13020), LBW (2.53%, 329/13020), and SGA (9.57%, 1246/13020). The incidence rates of PT and LBW decreased by 49.12% and 29.73% respectively in 2023 compared with 2019, but the incidence rate of SGA increased by 37.04% in 2023 compared with 2019. Among all pregnant women, the Zhuang ethnic group accounted for 37.55% of all ethnic groups, those with a bachelor's degree or above accounted for 82.33%, and multiparous women accounted for 48.21%. A total of 719 pregnant women (5.52%) had a history of diseases before pregnancy, and abnormal thyroid function was the most common (4.21%, 548/13020). A total of 3,582 pregnant women underwent pre-pregnancy genetic testing related to thalassemia, and 1,864 cases were detected positive (detection rate 52.04%), among which the detection rate of alpha thalassemia minor was the highest (674 cases, 18.82%). The proportion of fathers aged 35 or above was 37.08%, while the proportion of those who were overweight or obese (BMI ≥ 24 kg/m²) was 50.53%, and the proportion of those who were underweight was only 2.73%. Multivariate logistic regression analysis revealed that maternal pre-pregnancy overweight, multiparity, and AB blood type were protective factors for SVN (P<0.05); whereas maternal pre-pregnancy underweight, pregnancy complicated by polycystic ovarian syndrome (PCOS), and gestational hypertensive disorders (HDP) were identified as risk factors for SVN (P<0.05). Neonates in the SVN group exhibited significantly smaller gestational age, shorter body length, lower birth weight, and higher rates of neonatal asphyxia and mortality, with statistically significant differences (P<0.05). Conclusions The three phenotypic subtypes of SVN exhibited divergent incidence trends over the five-year period, with the incidence of SGA demonstrating an upward trajectory warranting focused attention. The occurrence of SVN showed strong associations with maternal pre-pregnancy nutritional status, comorbid PCOS, and HDP, highlighting the necessity for enhancing antenatal care and preventing HDP during pregnancy. This study did not identify significant impacts of paternal age or BMI on SVN.

Objective To investigate the factors influencing weight catch-up growth in very preterm infants (VPIs) from discharge to corrected age 6 months. Methods A retrospective analysis was conducted on 124 VPIs (gestational age <32 weeks) admitted to the Department of Neonatology between August 2019 and June 2022. Catch-up growth was defined as Z-score of weight-for-age (WAZ) increase of ≥0.67 from discharge to corrected age 6 months. Infants were divided into catch-up and non-catch-up groups on this criterion. A forward stepwise logistic regression model was used to identify independent predictive factors. Results Among the 124 VPIS, there were 70 males (56.5%), with a median gestational age of 30.14 (28.86-31.11) weeks, birth weight of 1330.0 (1170-1607) g, birth WAZ of 0.10 ± 0.61, and a catch-up growth rate of 62.1% (77/124) at corrected 6 months. Compared to the non-catch-up infants, the catch-up group exhibited significantly lower birth weight, WAZ at day 7, day 14 and discharge, and serum alkaline phosphatase (ALP) at corrected 40 weeks (P<0.05), while showing longer hospital stay, greater postmenstrual age at discharge, and higher daily weight gain post-discharge (P<0.05). Multivariate regression analysis identified multiple pregnancy (OR=0.294, 95%CI: 0.088-0.982), hospital stay (OR=1.082, 95% CI: 1.032-1.134), WAZ at discharge (OR=0.385, 95%CI: 0.167-0.890), daily weight gain post-discharge (OR=1.928, 95% CI: 1.483-2.506), and ALP at corrected 40 weeks (OR=0.995, 95% CI: 0.990-0.999) as independent influencing factors for post-discharge catch-up growth. Conclusion Post-discharge weight catch-up growth in VPIs is synergistically modulated by multiple pregnancy, WAZ at discharge, growth rate post-discharge, hospital stay duration and ALP at corrected 40 weeks.

Objective This study aimed to analyze the risk factors for extrauterine growth restriction (EUGR) in premature infants with necrotizing enterocolitis (NEC) after surgery and to explore preventive measures. Methods A total of 72 premature infants with NEC who underwent surgical treatment and were hospitalized in the neonatal department from 2018 to 2024 were selected. They were divided into EUGR and non-EUGR groups based on the relationship between their weight at discharge and the average growth indicators for corrected gestational age. Results The incidence of EUGR in NEC premature infants after surgery was 65.28%, with a severe EUGR incidence of 33.33%. Univariate analysis found that birth gestational age, birth weight, 1-minute Apgar score, weight at the onset of NEC, proportion of oxygen therapy methods, length of intestine resected during surgery, duration of postoperative intravenous nutrition, and the maximum amount of amino acids in intravenous nutrition within one week after surgery were statistically significant factors associated with the occurrence of EUGR. Multivariate logistic regression analysis showed that a high 1-minute Apgar score and a larger weight at the onset of NEC were protective factors for EUGR, while a longer length of intestine resected during surgery was a risk factor for EUGR. Conclusion Clinical physicians should pay attention to premature infants with low Apgar scores at birth and low weight at the onset of NEC, reduce the length of intestine resected during surgery, strengthen perioperative nutritional assessment, and adjust nutritional support plans individually to reduce the incidence of EUGR.

Objective To investigate the application of drug-induced sleep endoscopy (DISE) in pediatric obstructive sleep apnea (OSA). Methods The clinical data of children diagnosed with OSA by polysomnography (PSG) and DISE examination were retrospectively analyzed from June 1, 2023 to June 1, 2024 in the Department of Otorhinolaryngology. The NAVOTEL scoring system was used to score DISE, and the correlation between DISE score and apnea-hypopnea index (AHI) and minimum arterial oxygen saturation (SaO₂) was analyzed. Results DISE tests were performed in 163 children (114 boys and 49 girls), and the median age was 7.0 (5.0-9.0) years. The most common obstructive site was the velopharynx (137 cases, 84.0%), followed by the lateral oropharynx (124 cases, 76.1%), nasal cavity (95 cases, 58.3%), adenoid (92 cases, 56.4%), base of the tongue (52 cases, 31.9%), epiglottis (30 cases, 18.4%), and larynx (3 cases, 1.8%). The most common obstruction site in children of different age groups (≤5 years old, 6~10 years old and 11~18 years old) was velopharynx, accounting for 81.0%, 86.2% and 83.3%, respectively. Spearman rank correlation analysis showed that the total NAVOTEL score of 163 children was significantly positively correlated with AHI (r_s=0.48, P<0.01), and significantly negatively correlated with the lowest SaO₂ (r_s=-0.35, P<0.01). The NAVOTEL score of palatopharyngeal obstruction was positively correlated with AHI (r_s=0.33, P<0.01) and negatively correlated with the lowest SaO₂ (r_s=-0.48, P<0.01). Conclusions DISE can be used to evaluate the site and severity of upper airway obstruction in children with OSA, and its score is correlated with AHI and minimum SaO₂, which can cooperate with PSG to improve the diagnosis and treatment level of OSA in children.

The National Health Commission and the State Administration for Market Regulation jointly promulgated the "National Food Safety Standard: General Standard for Infant Formula for Special Medical Purposes" (GB 25596-2025, hereinafter referred to as the "New Standard") on March 16, 2025. The New Standard introduces comprehensive optimizations regarding the reference ranges, content requirements, and testing methods for macronutrients (proteins, carbohydrates, and fats), vitamins, minerals, and other optional components. Additionally, it expands the product categories from the original 6 to 13 types, with corresponding technical specifications established for each category. Currently, all approved infant formula products for special medical purposes (hereinafter referred to as "FSMP for infants") in the market are manufactured in compliance with the 2010 version of the standard (GB 25596-2010, "Old Standard"). This article will focus on analyzing the changes in mandatory and optional component requirements, while evaluating the compliance status of approved products with the New Standard. The findings aim to assist clinical pediatricians in accurately understanding the key revisions of the New Standard, thereby enabling more scientifically appropriate nutritional support plans for infants with special medical conditions.

Objective To analyze clinical trials for pediatric rare diseases registered in the Chinese Clinical Trial Registry (ChiCTR) and reveal their characteristics and development trends. Methods Based on China's first and second lists of rare diseases, pediatric rare disease clinical trials registered in ChiCTR from the establishment of the database to February 7, 2025, were retrieved. And then data organization and statistical analysis was carried out. Results A total of 225 registered clinical trials for pediatric rare diseases were included, encompassing 61 distinct disease categories. The leading units of 75.11% of the registered clinical trials were located in developed regions, and 76.00% trails were single-center studies. Fundings were primarily originated from self-raised funds and government sources (67.11%). Exploratory/pilot studies and Phase IV trials constituted 56.73% of the trails. Among interventional studies, non-randomized methods were most frequently employed (53.85%). And drug therapy was utilized in 29.33% of trials. Trials conducted between 2008-2017 were more likely to be multi-center (P=0.03) and randomized (P=0.002), while the trials conducted during 2018-2025 showed greater adoption of preregistration (P=0.002) and more tend to set up data monitoring committees (DMCs) (P<0.001). Conclusions Registered pediatric rare disease studies in China show sustained growth with getting increased attention on preregistration and data management; however, challenges still remain, such as incomplete information, methodological deficiencies, and uneven resource allocation, et al. Standardized trial management, along with high-quality and large-scale multicenter research are well recommended, which should be paid more efforts to in the future.

Objective To summarize the clinical characteristics of five children with Schimke immunoosseous dysplasia (SIOD) and analyze the variants in the SMARCAL1 gene, aiming to enhance the understanding of SIOD and underscore the significance of genetic diagnosis. Methods Clinical data and genetic testing results were retrospectively collected from five SIOD patients who presented to the Nephrology Department between 2016 and 2024. Results Patients 1, 2, and 3 died after 1 year, 1 year and 3 months, and 8 months of follow-up, respectively. Patient 4 exhibited progressive proteinuria during 9 months of follow-up but maintained normal renal function. Patient 5 was followed for 9 years; bilateral hip dislocation occurred at the age of 18, for which hip replacement surgery was performed. At 19 years of age, he presented with short stature, stable urinary protein levels, and preserved renal function. All patients underwent sequencing of the SMARCAL1 gene. No pathogenic variant was identified in patient 1. Patient 2 was compound heterozygous for the splice variants c.1334+1G>A and c.1335-2A>C. Patient 3 was homozygous for the missense variant c.2425G>A (p.G809R). Patient 4 was homozygous for the frameshift variant c.1071delT (p.F357LfsTer26). Patient 5 was compound heterozygous for the variants c.445C>T (p.Q149X) and c.1933C>T (p.R645C). Among these, c.1334+1G>A, c.2425G>A, c.445C>T, and c.1933C>T are known pathogenic or likely pathogenic variants, while c.1335-2A>C and c.1071delT represent novel variants not previously reported in the literature. Conclusions SIOD presents with characteristic multisystem clinical features, yet exhibits marked phenotypic variability. The genotype-phenotype correlation remains poorly defined. Early diagnosis enables avoidance of unnecessary immunosuppressive therapies, including corticosteroids, and supports timely symptomatic management. Despite advances in supportive care, the overall prognosis remains poor.

Objective To characterize the clinical and radiological features and prognosis of children with bocavirus pneumonia complicated by plastic bronchitis. Methods A retrospective analysis was conducted on the clinical data and follow-up results of 13 children diagnosed with bocavirus pneumonia complicated with plastic bronchitis in our hospital from January 2022 to January 2024. Results A total of 13 cases were included, including 7 males and 6 females, with a median age of 3.0 (1.0-5.0) years. Eight cases (61.5%) were hospitalized during summer. All patients presented with fever and cough; 7 (53.8%) had wheezing, and 3 exhibited tachypnea. The mean duration of fever was 3.92±1.26 days, with a peak temperature of 39.24±0.40 °C. Extrapolmonary complications included one case of toxic encephalopathy and one of erythema multiforme; no other organ dysfunction was observed. Laboratory findings revealed mild elevations in C-reactive protein (CRP) in 9 patients, with PCT and LDH were slightly elevated. Chest CT predominantly showed inflammatory consolidation, with atelectasis in 9 cases (69.2%) and small pleural effusions in 4 (30.8%). Bronchoalveolar lavage fluid analysis demonstrated marked eosinophilia. All patients underwent bronchoscopic removal of intraluminal casts and improved clinically, with a median hospital stay of 5.0 (4.5-6.5) days. During follow-up, one child developed recurrent wheezing and was subsequently diagnosed with asthma; the remaining patients had favorable outcomes. Conclusion Bocavirus pneumonia complicated by plastic bronchitis in children are more frequently observed during the summer months. The disease commonly presents with high fever, cough, and wheezing, with minimal elevation in inflammatory markers such as CRP, PCT, and LDH. Radiologically, consolidation and atelectasis are the predominant findings. The disease course is relatively short, and severe multi-organ involvement is uncommon. Overall, the prognosis is favorable.

Objective To investigate the clinical characteristics of Chlamydia pneumoniae pneumonia in children and enhance awareness, diagnostic accuracy, and therapeutic management of this condition. Methods A retrospective analysis was performed on clinical data from children diagnosed with Chlamydia pneumoniae pneumonia admitted to the Department of Respiratory Medicine between July 2024 and May 2025. Results A total of 39 patients were included, comprising 20 males and 19 females, with a median onset age of 10.9 years (interquartile range: 7.8-12.5). The mean duration of illness prior to admission was (11±5) days, and the median hospital stay was 6 days (range: 4-6). All patients presented with cough; fever, chest pain, and chest tightness were observed in some, while only a few exhibited abnormal pulmonary auscultation findings. Chest CT revealed round high-density opacities or patchy consolidations, predominantly subpleural in distribution. Air bronchograms and halo signs were noted in a subset of cases. Unilateral lung involvement occurred in 34 patients, bilateral in 5. Laboratory findings showed normal white blood cell count, neutrophil percentage, procalcitonin, and IL-6 levels. Elevated C-reactive protein was present in 12.8% of patients, increased erythrocyte sedimentation rate in 50%, and elevated IL-10 in 73.7%. All 39 patients had positive serum IgM antibodies against Chlamydia pneumoniae; among them, 7 had positive Chlamydia pneumoniae nucleic acid detected by next-generation sequencing in bronchoalveolar lavage fluid, and 1 had a positive nucleic acid test in sputum obtained from an outside institution. Most patients received azithromycin monotherapy, followed by doxycycline; 5 patients additionally received glucocorticoids. Clinical recovery was achieved in all 36 follow-up cases. Conclusions Pediatric Chlamydia pneumoniae pneumonia may manifest without fever, with cough as the sole presenting symptom. Characteristic imaging features include subpleural, mass-like consolidations often accompanied by peripheral air bronchograms and occasionally halo signs. Definitive diagnosis relies on serological IgM detection or nucleic acid testing. Treatment with azithromycin or doxycycline is effective.

Hypercalcemia of Infancy Type 1 (HCINF1) is a rare genetic disorder resulting from pathogenic variants in the CYP24A1 gene. The disease typically manifests during infancy or adulthood, with highly variable clinical presentations. Management is categorized into acute and long-term phases. Acute management encompasses hydration, diuretic therapy, glucocorticoids, calcitonin, bisphosphonates, and, in severe cases, dialysis. Long-term strategies primarily focus on lifestyle modifications—particularly restriction of vitamin D and calcium intake—and pharmacological interventions that bypass impaired metabolic pathways. However, the durability, efficacy, and safety profile of these long-term therapies remain to be fully established and warrant further investigation. Currently, there is a lack of clinical management guidelines or consensus for HCINF1. This review summarizes current advances in therapeutic approaches with the aim of informing and improving clinical decision-making.

This review aims to systematically evaluate the therapeutic role of infliximab in patients with Kawasaki disease (KD) who are resistant to intravenous immunoglobulin (IVIG), with a focus on its mechanism of action, clinical efficacy, and safety profile. By synthesizing recent advances in both domestic and international research, we provide a comprehensive assessment of the benefits and current limitations of infliximab therapy. Evidence indicates that infliximab significantly shortens fever duration, reduces levels of inflammatory biomarkers, and lowers the risk of coronary artery lesions. As understanding of the etiology and immunopathogenesis of KD continues to evolve, infliximab is emerging as a promising therapeutic option for IVIG-resistant cases. This review highlights its potential to inform optimized clinical management strategies and improve long-term outcomes in affected patients.