Objective Based on the body mass index (BMI) classification of Chinese population and the latest recommended range of gestational weight gain by the Chinese Nutrition Society, this study aims to evaluate the pre-pregnancy BMI and gestational weight gain status of pregnant women and further explored explore their influence on neonatal birth outcomes. Methods A total of 26 422 pregnant women who received regular prenatal examination were selected from January 2018 to December 2019 were included. The pre-pregnancy BMI, gestational weight gain of the study subjects, and their demographic characteristics among subgroups were described. Univariate and multivariate binary logistic regression analyses were employed to investigate the relationships between pre-pregnancy BMI and gestational weight gain and various neonatal outcomes (such as macrosomia, low birth weight, preterm birth, and asphyxia). Finally, a heatmap was utilized to explore the combined effect of pre-pregnancy BMI and gestational weight gain on fetal weight. Result The study found that the proportions of underweight and overweight/obese pregnant women were 13.8% and 14.7%, respectively, indicating a similar distribution. More than 50% of the participants experienced abnormal gestational weight gain. Insufficient gestational weight gain was associated with an increased risk of preterm birth. A low pre-pregnancy BMI or insufficient gestational weight gain elevated the risk of small for gestational age (SGA), whereas a high pre-pregnancy BMI or excessive gestational weight gain increased the risk of large for gestational age (LGA) and dystocia (cesarean section, forceps/vacuum extraction) (P<0.05). Multivariate analysis did not reveal a significant association between pre-pregnancy BMI, gestational weight gain, and neonatal asphyxia (P>0.05). Conclusion Abnormal gestational weight gain remains a significant issue among pregnant women, suggesting that obstetric healthcare providers and society need to strengthen the dissemination of pregnancy knowledge and weight management for pregnant women. In clinical practice, heatmaps can be utilized to assess individual risks of abnormal fetal weight and dystocia, thereby reducing adverse outcomes.

Objective To explore the impact of gestational diabetes mellitus (GDM) on lipid metabolism in pregnant women and neonates at different gestational weeks, as well as the expression of placental lipid transport enzymes. Methods A retrospective analysis was conducted on clinical data from pregnant women and their neonates who delivered between January 2022 and December 2022. Placentas were collected from women who delivered between August 2023 and October 2023. Participants were divided into a GDM group and a control group based on the presence or absence of GDM. The serum lipids were compared between the two groups for both pregnant women and neonates. Additionally, differences in the expression of endothelial lipase (EL) and lipoprotein lipase (LPL) in placental tissue were compared between the two groups. Results A total of 541 full-term pregnant women were included, with 123 in the GDM group and 418 in the control group. There were 203 pregnant women with premature delivery, with 110 in the GDM group and 93 in the control group. Among full-term pregnant women, compared with the control group, the GDM pregnancies had greater weight gain and a higher rate of cesarean section, and the differences were statistically significant (P<0.05). However, the premature pregnant women with GDM had a smaller gestational age at delivery and less weight gain during pregnancy than those in the control group (P<0.05). Both in full-term and premature pregnancies, compared with the control group, triacylglycerol (TG) was higher and high-density lipoprotein cholesterol (HDL) was lower in the GDM group before delivery, and the difference was statistically significant (P<0.05). In GDM group, 77 full-term newborns were admitted to NICU, and 77 newborns were matched according to gestation week and birth date at a 1:1 ratio as control group; Total cholesterol (TC) and TG in the GDM group were higher than those in the control group, while HDL was lower than that in the control group, and the difference was statistically significant (P<0.05). In the placentas of full-term pregnant women, the expression of EL in the GDM group was significantly increased (P<0.05), but there was no difference in LPL expression between the two groups (P>0.05). In pregnant women with premature delivery, both EL and LPL had no differences in expression between the two groups (P>0.05). Conclusions GDM was associated with lipid metabolism disorders during pregnancy, but only in full-term newborns. Placental EL may be involved in the occurrence of lipid metabolism disorders in full-term newborns delivered by GDM mothers.

Objective To investigate the effect of multisensory stimulation on the brain function development of hospitalized preterm infants and provide references for clinical practice. Methods preterm infants with a gestational age of 30 to 33⁺⁶ weeks were randomly divided into two groups. The control group was only given routine care for preterm infants, including close observation, creating a suitable environment, maintaining warmth, and preventing infections. The intervention group received multi-sensory stimulation daily on the basis of routine care, including playing the mother's voice, touching, red ball visual stimulation, and droplet feeding of breast milk on the anterior part of the tongue. The intervention period was 14 days. Results There was no statistically significant difference between the baseline data of preterm infants and mothers in the two groups (P >0.05), and the comparison of the NBNA scores and aEEG results before and after the intervention showed statistically significant differences (P<0.05). Conclusion Multisensory stimulation for preterm infants can effectively improve the brain function development of the infants.

Objective To summarize the clinical characteristics of gastrointestinal foreign bodies in children, analyze the diagnosis, treatment, and outcomes of different types of foreign bodies, and provide references for clinical management and risk prevention of pediatric foreign body ingestion. Methods Clinical data of 614 pediatric patients with gastrointestinal foreign bodies from July 2021 to July 2024 were retrospectively collected and analyzed. Results A total of 614 cases were included, with a male-to-female ratio of 1.7:1. The mean age was 4.12 ± 3.07 years, and the highest incidence was among children aged 1-3 years (52.34%). Blunt foreign bodies with smooth and round surfaces were the most common (60.58%), followed by corrosive foreign bodies (8.47%) and other unclassifiable objects (2.12%). Among the cases, 153 (24.92%) were managed conservatively and excreted spontaneously, 442 (71.99%) were removed via endoscopy or surgical exploration, and 19 (3.09%) involved liquid ingestion. The esophagus was the most common site of impaction (48.05%). Complications occurred in 152 (24.76%) children, with mild gastrointestinal mucosal injury being the most common, followed by peptic ulcers (4.72%), gastrointestinal perforations (6.19%), corrosive injuries (1.95%), and esophageal strictures (0.65%). The occurrence of complications was not associated with gender or age (P>0.05), but was significantly related to factors such as admission interval, sharp or corrosive nature of the foreign body, location (upper vs. lower gastrointestinal tract), presence of underlying diseases, habitual residence, and symptoms at presentation (P<0.05). Risk factors for complications included sharp or corrosive foreign bodies, retention time >24 hours, location in the lower gastrointestinal tract, and symptoms at diagnosis (P<0.05). Conclusion Timely removal of gastrointestinal foreign bodies can reduce the incidence of complications. The type of foreign body significantly influences clinical management and prognosis, with particular attention needed for novel or special types of foreign bodies. Strengthening preventive care and avoiding foreign body ingestion are crucial in reducing the incidence of such cases.

Objective To investigate the clinical characteristics and prognostic factors of children with relapsed acute lymphoblastic leukemia (ALL). Methods A total of 458 newly diagnosed ALL children who treated with the Chinese Children's Leukemia Group (CCLG) protocol at hospital between February 2006 and December 2019 were selected. Results The overall relapse rate of childhod ALL in this center was 16.6% (76/458). The mortality rate among relapsed ALL children was 57.9% (44/76), and the 5-year overall survival (OS) rate for relapsed ALL children was 38.6% ± 5.9%. Grouped by time to relapse, the cohort included 26 cases of very early relapse, 30 cases of early relapse, and 20 cases of late relapse. There was a statistically significant difference in the 5-year overall survival rate (OS) among the three groups(P<0.001). When categorized by relapse site, 57 cases involved isolated bone marrow relapse, 12 cases had extramedullary relapse, and 7 cases exhibited combined medullary/extramedullary relapse. There was a statistically significant difference in the 5-year OS rate among the three groups (P<0.05). Among the 76 relapsed children, 11 discontinued treatment, while 65 received retreatment. Among them, 14 failed to achieve a second complete remission (CR2), whereas 51 attained CR2. There was a statistically significant difference in the 5-year OS rate between the two groups (P<0.001). Based on post-relapse treatment modalities,the patients were divided into allogeneic hematopoietic stem cell transplantation (Allo-HSCT) group (22 cases, 33.8%), chimeric antigen receptor T-cell immunotherapy (CART) group (8 cases, 12.3%), CAR-T combined with Allo-HSCT group (14 cases, 21.5%), and chemotherapy and/or targeted therapy group (21 cases, 32.2%). There was a statistically significant difference in the 5-year OS rate among the groups (P<0.001). Univariate prognostic analysis revealed that initial white blood cell count>100×10⁹/L, initial risk stratification, relapse time, relapse site, post-relapse risk stratification, post-relapse treatment modality, and failure to achieve CR2 were independent risk factors affecting the prognosis of relapsed ALL children (P<0.05). Multivariate analysis using the Cox regression model identified very early relapse and failure to attain CR2 after relapse as independent risk factors for poor prognosis in relapsed ALL children (P<0.05), while post-relapse treatment with CAR-T bridging to allogeneic hematopoietic stem cell transplantation (Allo-HSCT) was a protective prognostic factor. Conclusions The predominant relapse pattern in our center was early recurrence, with bone marrow being the main relapse site. Multivariate analysis revealed that very early relapse and failure to achieve CR2 were independent adverse prognostic factors (P<0.05). CART combined with Allo-HSCT significantly improved outcomes in children with relapsed ALL.

Objective The clinical phenotype and gene variation spectrum of children with congenital long QT syndrome (LQTS) were summarized and analyzed to explore the potential correlation between LQTS genotype and clinical phenotype. Methods Fourteen unrelated LQTS families admitted to the Department of Cardiology from November 2018 to November 2023 were selected as the study objects. The clinical data of the children were collected, whole exome sequencing of family was performed, candidate variants were verified by Sanger sequencing, and the children were treated and followed up. Results The median onset age of the 14 patients (6 boys and 8 girls) was 82.5 (37.5-129.8) months. Fourteen patients started with sudden cardiac arrest, syncope or Adams-Stokes syndrome. A total of 5 genes (KCNQ1, KCNH2, SCN5A, CACNA1C, and CALM1) were detected with variations, and according to the grading standard of the American College of Medical Genetics and Genomics (ACMG), all variations were pathogenic or likely pathogenic. Among them, SCN5A (NM_198056.2) c.796C>G (p.Leu266Val) has not been reported in the literature in the past, and according to the ACMG guidelines, it is determined to be a likely pathogenic variant (PS2+PM2_Supporting+PP3). All 14 children were treated with β-blockers, 2 of whom were also treated with mexiletine. During follow-up until March 31, 2024, there were 3 deaths. One child had an episode of Adams-Stokes syndrome due to self-discontinuation of medication, and the remainder had no further syncope. Conclusions In this study, a novel variant c.796C>G (p.leu266val) of SCN5A gene was found, expanding the spectrum of SCN5A gene variants associated with congenital LQTS. There are various forms of congenital LQTS, and an electrocardiogram should be performed for children with suspected LQTS, which in combination with genetic testing can lead to a definitive diagnosis of the disease.

Objective To summarize the clinical characteristics of 9 children who underwent lung transplantation, explore the prognosis and immune profiles of these children, and furnish references for clinical diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical data and prognosis of 9 children who underwent lung transplantation and were hospitalized in our hospital from January 2019 to June 2023. Results Among the 9 children, 3 were male and 6 were female. The underlying diseases comprised pulmonary fibrosis, idiopathic pulmonary arterial hypertension, obliterative bronchiolitis, interstitial lung disease, and cystic fibrosis. All children underwent bilateral lung transplantation, with an average age of 7.83 (4.79 - 9.34) years at the time of transplantation. Four children developed bronchial stenosis, among which all 3 children were under 7 years old and 2 were diagnosed with bronchiolitis obliterans syndrome (BOS) related to chronic allograft dysfunction. Compared with the normal reference values, the proportions of CD3⁺T and CD8⁺T cells were elevated in six children, and the proportions of CD4⁺T cells and CD4⁺T/CD8⁺T were decreased in four and eight children, respectively. Immune abnormalities were more pronounced in children under 7 years old. Two children with BOS developed post-transplant lymphoproliferative disorder (PTLD), and both were diagnosed with diffuse large B-cell lymphoma through biopsy. The follow-up period was 2.67 (1.67-3.17) years. Two children with BOS died at 1.33 years and 1 year after transplantation, both succumbing to typeⅡ respiratory failure. All children over the age of seven were taking oral immunosuppressive drugs at home and were capable of performing simple physical activities and daily life. Conclusion BOS and PTLD are life-threatening complications for children under 7 years old who have undergone bilateral lung transplantation, being closely associated with abnormal T lymphocyte subsets. The survival period after lung transplantation is shorter for younger children, and their lung structure and immune status are key factors influencing prognosis. With the increasing number of children undergoing lung transplantation, it is necessary to further expand the case numbers and deepen age group studies to optimize clinical diagnosis and treatment strategies, prolong the survival period of children, and enhance their quality of life.

Objective The purpose of this study was to retrospectively analyze the main factors affecting the prognosis of pediatric intracranial embryonal tumor with multilayered rosettes (ETMR) and to provide effective suggestions for improving the prognosis of children with this condition. Methods From January 2013 to December 2023, clinical data were collected from 29 patients with ETMR who underwent surgery and were diagnosed postoperatively. Data were obtained from medical records and telephone follow-ups. A total of 17 patients who completed follow-up were included in the analysis. The clinical data of these 17 children with ETMR were retrospectively reviewed, summarizing their gender, age, tumor location, clinical manifestations, extent of surgical resection, postoperative radiotherapy and chemotherapy, recurrence and metastasis, as well as prognosis. Results Among the 17 patients, 11 were diagnosed with ETMR, 2 with embryonal tumor with abundant neuropil and true rosettes (ETANTR), and 4 with medulloepithelioma (MEPL). The median age at diagnosis was 2.5 years (range: 11 months and 20 days to 8.6 years). The study endpoint was death, with a median survival time of 8 months (range: 0 to 130.5 months). The 1-year progression-free survival (PFS) and overall survival (OS) rates were 18% and 41%, respectively, while the 3-year PFS and OS rates were 18% and 24%, respectively. Thirteen patients (76%) died due to tumor-related complications, progression, or recurrence. Survival analysis showed that gender, postoperative radiotherapy, chemotherapy, and combined chemoradiotherapy had statistically significant effects on overall survival (P<0.05). Conclusion ETMR is a highly invasive tumor with a high mortality rate. Treatment typically begins with maximum surgical resection. Gross total resection, postoperative radiotherapy, chemotherapy, or combined chemoradiotherapy are associated with better prognosis.

To preliminarily explore the feasibility and effectiveness of olfatomuzumab (OFA) in the treatment of patients with refractory neuromyelitis optica spectrum disorder (NMOSD). A 15-year-old adolescent female with seropositive AQP4-IgG and multiple relapses of refractory neuromyelitis optica spectrum disorder was given intravenous methylprednisolone, immunoglobulin, rituximab (RTX), and oral prednisone and mycophenolate mofetil for 5 years. She started to receive 4 doses of OFA (20 mg, subcutaneous injection) at intervals 9 months ago. The patient was observed for NMOSD recurrence, serum AQP4-IgG antibody titer, peripheral blood B cell level, and changes in cranial and spinal cord MRI during the 9-month period of OFA treatment. The patient's symptoms were stable without recurrence during the 9-month period of OFA treatment. The serum AQP4-IgG titer decreased, and the lesions in the cranial and spinal cord MRI decreased. There were no new lesions, and the tolerance was good without anaphylactic reactions or infectious adverse events. In addition to complete depletion of B cells, no lymphopenia or hypogammaglobulinemia was found. For patients with refractory NMOSD or other intolerant to immunotherapy, subcutaneous injection of OFA may be a safe and effective alternative treatment.

In recent years, antineoplastic therapy have been continuously improved, and the long-term survival rate of children and adolescents with tumor has been significantly increased. Therefore, the long-term quality of life has been paid more and more attention, especially for female children and adolescents. Due to fertility requirements, endocrine and reproductive problems have attracted much attention. Antineoplastic therapy may lead to ovarian insufficiency, affecting pubertal development and reproductive function. There is currently a lack of research that systematically describes the mechanisms by which antineoplastic therapy affects the ovarian function of pediatric patients. Based on the existing literature, this study summarizes the effects and mechanisms of antineoplastic therapy on ovarian function in children and adolescents, concludes the measures to reserve ovarian function, and discusses the limitations and future breakthroughs in this field. It is expected to promote the improvement of antineoplastic therapy strategies, retain children and adolescents’ reproductive function, and enhance their quality of life.

Sleep disorders are one of the most common comorbidities in children with autism spectrum disorders (ASD), which not only impair the child's daytime function, but also aggravate the symptoms of ASD, and significantly reduce the quality of life of children with ASD and their families. Therefore, timely and effective intervention and management of children with ASD with comorbid sleep disorders is of great significance to improve the health, social function and quality of life of children. This article reviews the progress in the treatment of sleep disorders in children with ASD, aiming to improve the understanding of autism among clinicians.

Pediatric acute ischemic stroke is a rare condition with a poor prognosis and significant recurrence rates. Intravenous tissue plasminogen activator (IV-TPA) has been proven to be an effective treatment for acute ischemic stroke (AIS) in adults, but it has not been licensed for use in children. The safety and efficacy of IV-TPA in children should be investigated further. This article reviews the research on IV-TPA treatment in children with pediatric acute ischemic stroke.