Table of Content

15 June 2024 Volume 42 Issue 6

  

Expert Review

The impact of infectious disease outbreaks on the pediatric healthcare system and countermeasures

KANG Li, HUANG Jiaoling

Journal of Clinical Pediatrics. 2024, 42(6):  475-479.  doi:10.12372/jcp.2024.24e0432

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In recent years, due to the infectious disease pandemic, the healthcare systems in various regions of China have been impacted to varying degrees, especially the pediatric healthcare system. The short-term surge in pediatric outpatient demand has exacerbated the conflict with limited pediatric medical resources, highlighting the shortcomings in the development of pediatric care in China. This article mainly discusses the current situation of our country's pediatric medical care system when facing the impact of large-scale infections, analyzes the reasons behind it, and puts forward targeted policy recommendations, including improving the development and service capabilities of pediatric disciplines, optimizing the layout of pediatric medical resources, and strengthening pediatric diagnosis and treatment ability in primary healthcare and promote orderly hierarchical diagnosis and treatment behavior.

New insights into the pathogen of pertussis and strategies for antibacterial infection

HUA Chunzhen, WANG Chuanqing, YANG Zhangnyu, HUANG Lisu

Journal of Clinical Pediatrics. 2024, 42(6):  480-484.  doi:10.12372/jcp.2024.24e0513

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Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis, which has a long history and can affect people of all ages. The re-emergence of pertussis has become a global issue of great concern, including in China. Since 2022, the number of whooping cough cases reported in China has increased rapidly. The genotype of the main antigen (pertussis toxin) of the current Bordetella pertussis epidemic strain has changed, and the corresponding antigen is different from the vaccine strain, resulting in immune escape, which is one of the important reasons for the recurrence of pertussis. At present, the resistance of Bordetella pertussis to macrolide antibiotics is an important reason for clinical treatment failure, so it is no longer recommended as the first choice for anti-infection treatment of pertussis. For children over 2 months of age with no contraindications to sulfanilamide, trimethoprim-sulfamethoxazole oral administration is recommended as the preferred anti-infection regimen for pertussis catarrhal stage and spasmodic cough stage. Piperacillin or cefoperazone-sulbactam are recommended for children under 2 months of age or with critical symptoms. The improvement or development of a new generation of pertussis vaccine with the same antigen as the prevalent strain will be a long-term strategy to enhance the immune protection of the susceptible population and control the epidemic of the disease.

Original Article

Epidemiological characteristics of Mycoplasma pneumoniae in children with acute respiratory infections from 2019 to 2023: a single-center retrospective study

LI Mingyi, SHEN Yuanheng, CHEN Feng, LI Yuanrui, ZHANG Minhua, WANG Juanjuan, SHEN Lisong, JIANG Limin

Journal of Clinical Pediatrics. 2024, 42(6):  485-490.  doi:10.12372/jcp.2024.24e0242

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Objective To investigate the positive rates of Mycoplasma pneumoniae (MP) and other pathogens in children with acute respiratory infection (ARTI) before, during and after COVID-19 pandemic in Shanghai. Methods The clinical data of children with ARTI who underwent respiratory 5-plex and influenza 3 plex tests in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2019 to December 30, 2023 were retrospectively analyzed. Results A total of 91825 ARTI cases were included, including 48729 male cases and 43096 female cases, and the median age was 5 (3-8) years old. Before the epidemic, there were 14096 cases, with 5126 positive cases of respiratory pathogens (36.4%); during the epidemic, there were 13366 cases, with 2963 positive cases (22.2%); and after the epidemic, there were 64363 cases, with 33510 positive cases (52.1%). There were significant differences in male proportion, age distribution, and positive rates of various pathogens among the pre-epidemic, epidemic, and post-epidemic groups of ARTI patients (P<0.05). The proportion of children>6 years old was higher in the pre-epidemic and post-epidemic groups, while the proportion of 0-3 years old was higher in the epidemic group (P<0.014). The positive rates of MP in various years and months between 2019 and 2023 showed statistical significance (P<0.05). The positive rate of MP was higher in January, February, and December 2019 (20.3%-37.7%), as well as in January to March 2020 (21.5%-35.3%). In 2021, only the positive rate of MP in December (25.8%) exceeded 20.0%, while all rates in 2022 were below this threshold. From April to June and August to December 2023, the positive rate ranged from 21.5% to 37.2%. The number of MP-positive cases was 23247, and there were statistically significant differences in gender and age distribution among the groups before, during, and after the epidemic (P<0.05). The proportion of MP-positive children>6 years old was higher in the pre- and post-epidemic groups, and the proportion of 0-3 years old in the epidemic group was higher (P<0.014). Conclusions During the period from 2019 to 2023, there have been certain alterations in the epidemiological characteristics of various pathogens associated with ARTI, particularly MP. Moreover, significant changes have occurred in both age distribution and seasonal epidemiological patterns of MP.

Clinical characteristics of extrapulmonary tuberculosis in 473 children

MA Tao, LU Jie, XU Hui, ZHAO Shunying, LI Huimin

Journal of Clinical Pediatrics. 2024, 42(6):  491-496.  doi:10.12372/jcp.2024.23e0157

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Objective To understand the clinical characteristics, diagnosis and treatment methods and prognostic factors of extrapulmonary tuberculosis in children, so as to improve the level of diagnosis and treatment of this disease. Methods The clinical data of children with confirmed and clinically diagnosed extrapulmonary tuberculosis admitted to Beijing Children's Hospital from January 2011 to December 2020 were retrospectively analyzed. Results A total of 473 children with extrapulmonary tuberculosis were hospitalized, accounting for 36.3% (473/1303) of the children with tuberculosis, including 269 boys (56.9%) and 378 rural patients (79.9%). The median age of onset was 4.1 (1.2-9.9) years, and 250 patients (52.9%) were less than 5 years old. One hundred and ten children (23.3%) were confirmed by etiology or pathology, and 363 children (76.7%) were clinically diagnosed, of whom tuberculous meningitis was the commonest (202 cases, 42.7%). In 307 children's extrapulmonary samples, the positive rates of acid-fast staining smear, Xpert MTB/RIF, Mycobacterium tuberculosis culture and pathological examination were significantly different (P<0.01), and the positive rates of pathological examination and Xpert MTB/RIF were higher. Chest imaging of 313 patients indicated active or old tuberculosis. As of June 18, 2022, a total of 336 children were followed up, of whom 211 had a good prognosis and 125 had a poor prognosis (including 23 deaths). Multivariate logistic regression analysis showed that age≤5 years old was an independent risk factor for prognosis (P<0.05), and abdominal tuberculosis, bone and joint tuberculosis (with tuberculous meningitis as reference) were independent protective factors for prognosis (P<0.05). Conclusions About one-third of hospitalized children with tuberculosis have extrapulmonary tuberculosis, and tuberculous meningitis is the commonest. Most of the patients were clinically diagnosed, and the molecular diagnostic technique of Xpert MTB/RIF was highly sensitive to extrapulmonary tuberculosis specimens. The prognosis of children under 5 years old and tuberculous meningitis is relatively poor.

Clinical differences between severe Mycoplasma pneumoniae pneumonia and severe Streptococcus pneumoniae pneumonia in children

RUAN Jinping, FU Zhou, YAN Pan, CHEN Qihui, YING Linyan

Journal of Clinical Pediatrics. 2024, 42(6):  497-502.  doi:10.12372/jcp.2024.23e0364

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Objective To compare the differences of clinical features between severe Mycoplasma pneumoniae pneumonia (MPP) and severe Streptococcus pneumoniae pneumonia (SPP). Methods Seventy-seven patients with severe MPP and 40 patients with severe SPP admitted to the respiratory ward of Children's Hospital Affiliated to Chongqing Medical University from January 2015 to January 2020 were retrospectively analyzed, and the general conditions, clinical manifestations, auxiliary examinations and other data of the two groups were compared. Results There were 48 boys (62.3%) in the severe MPP group with a median age of 44(24-78) months. In the severe SPP group, there were 22 boys (55.0%) with a median age of 14(9-25) months. 96.1% (74/77) of children with severe MPP and 80.0% (32/40) of children with severe SPP received antibiotics before admission (P=0.007). Compared with children with severe SPP, the proportion of fever and hyperpyrexia was higher, and the proportion of wheezing and nervous system symptoms was lower in children with severe MPP (P<0.05). The children with severe SPP were more likely to have crackles and rhonchi in the lungs, and the proportion of children with signs on both sides was higher (P<0.05). Compared with children with severe SPP, children with severe MPP had lower WBC and higher LDH levels, and were more likely to have aerated bronchus signs on chest CT (all P<0.05). There was no significant difference in bronchoscopy and routine examination results of bronchoalveolar lavage fluid between the two groups (all P>0.05). Conclusions The clinical characteristics of children with severe MPP and severe SPP are often atypical. Age, fever, hyperpyrexia, wheezing, pulmonary signs, nervous system manifestations, peripheral WBC, and peripheral blood LDH levels are helpful for clinical differentiation.

Clinical characteristics and treatment outcomes of connective tissue disease-associated interstitial lung disease in children

GONG Ling, SHU Chang, RAN Haibo

Journal of Clinical Pediatrics. 2024, 42(6):  503-508.  doi:10.12372/jcp.2024.23e0277

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Objective To analyze the clinical data of connective tissue disease-associated interstitial lung disease (CTD-ILD) in children, and to improve the understanding of CTD-ILD in children. Methods The clinical data of 53 hospitalized children with CTD-ILD from January 2012 to December 2021 were retrospectively analyzed, including clinical manifestations, chest HRCT, pulmonary function, treatment and outcome, etc. Results Among the 53 children with CTD-ILD, 23 children were diagnosed as ILD by HRCT at the same time of CTD diagnosis, 4 children had ILD onset, and 26 children were diagnosed as ILD with a time span of 15 days to more than 7 years. The common symptoms of respiratory system were cough (47.2%), shortness of breath (28.3%) and rales (26.4%). But there were 21 cases without respiratory symptoms, and ILD was diagnosed according to HRCT. Chest HRCT showed patchy shadows (64.2%), striped shadows (55.6%), streak shadows (37.7%), grid/honeycomb shadows (24.5%), cystic low-density shadows (24.5%) and ground glass shadows (22.6%), etc. The main pulmonary function abnormalities were diffusion dysfunction (46.5%), restrictive ventilation dysfunction (39.5%) and small airway dysfunction (32.6%). After treatment with glucocorticoids, immunosuppressants and biological agents, 48 children showed improvement in clinical symptoms. Chest HRCT showed improvement in 20 children, no significant change in 21 children, and progress in 6 children. Pulmonary function examination showed improvement in 17 children, no significant change in 11 children, progress in 3 children, and normal in 8 children. Conclusions The clinical symptoms of CTD-ILD in children are lack of specificity, and chest HRCT and pulmonary function tests are helpful for early detection of pulmonary lesions, so relevant examinations should be actively completed and regular follow-up should be conducted. Treatment options are glucocorticoids combined with immunosuppressants and/or biological agents, but the use of biological agents in children needs further study.

Clinical features of adenovirus pneumonia complicated with plastic bronchitis in 11 children

GAO Weiwei, ZHAI Jia, GUO Yongsheng, ZOU Yingxue

Journal of Clinical Pediatrics. 2024, 42(6):  509-514.  doi:10.12372/jcp.2024.23e0777

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Objective To study the clinical features and prognosis of adenovirus pneumonia complicated with plastic bronchitis in children. Methods The clinical data and follow-up results of 11 children with adenovirus pneumonia complicated with plastic bronchitis diagnosed in hospital from January 2018 to December 2022 were retrospectively analyzed. Results The median age of the 11 patients (7 boys and 4 girls) was 6.0 years old. All of them had fever and cough, 3 children were accompanied by wheezing, 6 had shortness of breath, and 7 had decreased breathing sounds. The mean duration of fever was (7.55±3.59) days, the mean peak of temperature was (39.95±0.79) ℃. There were 7 children with toxic encephalopathy and 8 with liver function impairment. The LDH, IL-6 and PCT levels were increased to different degrees in all patients, and CRP>30mg/L was found in 7 patients. Chest CT+3D reconstruction showed that lung consolidation was the main lesion, including atelectasis in 6 cases and pleural effusion in 4 cases. Six patients were administered with intravenous immunoglobulin, and 9 patients received methylprednisolone. Five patients received facial mask oxygen inhalation. One child received mechanical ventilation, and then changed to V-V-ECMO. All children underwent bronchoscopy and plastic body removal. Among them, 7 patients received bronchoscopy once and 4 received bronchoscopy twice. One child died and the others were discharged after improvement. During follow-up, 1 child had recurrent cough and wheezing, and the others had good prognosis. Conclusions Adenovirus pneumonia with plastic bronchitis is usually characterized by persistent high fever, shortness of breath, hypoxia, reduced breath sound, and significantly increased levels of CRP, PCT and LDH. Most of the imaging findings show atelectasis and lung consolidation, which are easy to combine with other organ injuries. Active anti-inflammatory therapy and bronchoscopy should be performed as soon as possible. Most of patients have a well prognosis, while a few may have poor prognosis such as recurrent cough and wheezing.

Analysis of the effect of optimized quality control system and evaluation indicators on the screening efficiency of neonatal genetic metabolic diseases

LI Qiang, CHEN Chi, ZHOU Ying, MAO Huaqing, XU Yihong, XU Yanhua

Journal of Clinical Pediatrics. 2024, 42(6):  515-519.  doi:10.12372/jcp.2024.24e0307

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Objective To analyze the effect of optimized quality control system and evaluation indicators on the screening efficiency of neonatal genetic metabolic diseases. Methods By utilizing 13 evaluation indices across three dimensions, namely management quality, blood film quality, and diagnosis and treatment quality, the study analyzed the variations in the quality of screening work before the establishment of Zhejiang Quality Control Monitoring and Evaluation Indicators in 2013, after its establishment in 2015, as well as in 2020 and 2023 following subsequent revisions. This analysis aimed to comprehend the actual impact of assessment and management indices on the screening work. Results The screening rate and recall rate of genetic metabolic diseases in newborns in Zhejiang Province between 2013, 2015, 2020 and 2023 were statistically significant by Chi-square test (P<0.05), but there was no statistically significant difference by linear regression test (P>0.05). There were statistically significant differences in the rate of unqualified blood samples, the rate of incomplete collection of unqualified blood samples, the rate of delayed delivery for blood samples and the rate of missing and incorrect blood samples in neonatal genetic metabolic diseases in Zhejiang Province among different years (P<0.05). In 2023, the above indicators all reached the lowest value. After the linear regression test, the rate of unqualified blood samples, the rate of incomplete collection of unqualified blood samples, and the rate of missing and incorrect blood samples showed a downward trend (P<0.05). Chi-square test showed significant differences in diagnosis and treatment rates of congenital hypothyroidism (CH) and phenylketonuria/tetrahydrobiopterin deficiency (PKU/BH4D) at 2, 3 and 4 weeks after birth among different years (P<0.05). After the trend test by linear regression, the 2-week and 4-week diagnostic rates (treatment rates) of CH and the 3-week diagnostic rates (treatment rates) of PKU/BH4D showed an upward trend (P<0.05). Conclusions Establishing and optimizing quantifiable "indicators" can effectively evaluate and improve the efficiency of screening for genetic metabolic diseases in newborns in Zhejiang Province, so as to further strengthen the prevention and control ability of birth defects.

Analysis of risk factors for early-onset sepsis associated acute kidney injury in neonates

WANG Man, LI Luquan, LI Xiaowen

Journal of Clinical Pediatrics. 2024, 42(6):  520-525.  doi:10.12372/jcp.2024.23e1250

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Objective The clinical data of neonates with early-onset sepsis (EOS) were analyzed in order to explore the risk factors affecting neonatal early-onset sepsis associated acute kidney injury (AKI). Methods The clinical data of EOS neonates hospitalized in the neonatal ward from January 2018 to April 2022 were retrospectively analyzed. The neonates meeting the revised KDIGO AKI diagnostic criteria were assigned to AKI group, and the neonates without AKI were assigned to NAKI group according to 1:2 matching method. The clinical data between the two groups were compared to analyze the risk factors of neonatal early-onset sepsis complicated with acute kidney injury (ESA-AKI). Results A total of 70 neonates in the AKI group and 140 in the NAKI group were included in the study. A univariate conditional logistic regression analysis revealed that older admission age, maternal hypertension during pregnancy, asphyxia, high levels of serum urea nitrogen and creatinine at admission, coexisting with moderate to severe anemia, pulmonary hemorrhage, patent ductus arteriosus, septic shock, exposure to small doses of dopamine and meropenem, and surgery were risk factors for the development of AKI. The AKI group had a higher rate of death or abandonment (P<0.05). Conclusions AKI should be closely monitored in the group of neonates with EOS who were treated with dopamine, meropenem, and surgery and who had higher admission ages, asphyxia, maternal hypertension during pregnancy, high serum urea nitrogen and creatinine levels at admission, complicated by moderate to severe anemia, pulmonary hemorrhage, patent ductus arteriosus, and septic shock.

Study on the application value of the new Lake Louise criteria in children with myocarditis

LIANG Jiawei, MA Xiaohui, JIA Xuan

Journal of Clinical Pediatrics. 2024, 42(6):  526-532.  doi:10.12372/jcp.2024.23e0289

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Objective To explore the application value of new Lake Louise criteria (LLC) in the diagnosis of myocarditis in children. Methods The clinical data of children diagnosed with myocarditis (myocarditis group) in Children's Hospital Affiliated to Zhejiang University School of Medicine from May 2019 to December 2020 were retrospectively analyzed. In addition, children who were clinically excluded from myocarditis during the same period were included as non-myocarditis group. Receiver operating characteristic (ROC) curve analysis and calculation of Kappa value were used to compare the diagnostic efficacy of LLC and new LLC in children with myocarditis. Results In the myocarditis group, there were 29 children (16 boys and 13 girls) with a median age of 8.8 (4.2-13.4) years. There were 50 patients (27 boys and 23 girls) in the non-myocarditis group, and the median age was 9.7 (6.2-13.2) years. The T2 mapping value, T1 native value and ECV value of myocarditis group were higher than those of non-myocarditis group, the T1 enhanced value was lower than that of non-myocarditis group, and the difference was statistically significant (P<0.05). The area under ROC curves (AUCs) of LLC, T2 mapping, T1 native, T1 enhanced and ECV for diagnosing myocarditis were 0.75, 0.86, 0.92, 0.70 and 0.93, respectively. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of LLC in diagnosing myocarditis were 81.0%, 51.7%, 98.0%, 93.8%, 77.8%, 25.85 and 0.49 respectively. The consistency between LLC and the clinical diagnosis of myocarditis was moderate (Kappa=0.55, P<0.001). The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of new LLC in diagnosing myocarditis were 92.4%, 89.7%, 94.0%, 89.7%, 94.0%, 14.95 and 0.11 respectively. The consistency between new LLC and the clinical diagnosis of myocarditis was good (Kappa=0.84, P<0.001). Conclusions The new LLC has good application value in the diagnosis of myocarditis in children and can effectively improve the diagnostic efficiency.

Correlation between functional constipation and the formation of appendiceal fecaliths in children with acute appendicitis

FAN Na, WANG Chunhui, ZHANG Anding, ZENG Lingchao, LI Yuanxia, LIN Yan, SHANG Lei, ZHANG Xinhui, HE Xiaobao, QI Ke, JIANG Xun

Journal of Clinical Pediatrics. 2024, 42(6):  533-537.  doi:10.12372/jcp.2024.23e0844

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Objective To investigate the correlation between functional constipation (FC) and the formation of fecaliths in the appendix cavity in children with acute appendicitis (AA). Methods The clinical data of children diagnosed with AA from August 2022 to June 2023 were retrospectively analyzed. According to the presence or absence of fecaliths in the appendix cavity, the patients were divided into the AA group with fecaliths and the AA group without fecaliths. The clinical characteristics of FC between the two groups were compared, and the factors affecting the formation of fecaliths in the appendix cavity of children with AA were analyzed. Results A total of 192 children (114 boys and 78 girls) with AA were included and the median age was 6.0 (4.0-9.0) years old. There were 72 children in the AA group with fecaliths and 120 in the AA group without fecaliths. Compared with the AA group without fecaliths, the AA group with fecaliths had a higher incidence of fecal retention (≥ 4 years old), higher prevalence of FC, longer average constipation time, and higher incidence of dietary bias, and the difference was statistically significant (P<0.05). Binary logistic regression analysis showed that prolonged constipation duration and dietary bias were independent risk factors for the formation of fecaliths in the appendix cavity of children with AA (P<0.05). Conclusions Long-term constipation and dietary bias have a certain correlation with fecaliths formation in the appendix cavity of children with AA.

The survival predictive value of pre-treatment blood test indicators and risk factors for children with recurrent medulloblastoma

LIU Jingjing, LIU Lei, DU Shuxu, SUN Yanling, GONG Xiaojun, ZHANG Jin, WU Wanshui, SUN Liming

Journal of Clinical Pediatrics. 2024, 42(6):  538-542.  doi:10.12372/jcp.2024.23e0613

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Objective To investigate the relationship between peripheral blood platelet-lymphocyte ratio, prognostic nutritional index and prognosis in patients with medulloblastoma (MB) after recurrence and before re-treatment. Methods A retrospective study was conducted on 82 patients with MB admitted from September 2015 to September 2022. The post-recurrence OS rates were compared between high/low neutrophil-lymphocyte ratio (NLR) group, high/low platele-lymphocyte ratio (PLR) group, high/low systemic inflammation index (SII) group, and high/low prognostic nutritional index (PNI) group, and the prognostic factors were analyzed. Results The critical values of NLR, PLR, SII and PNI were 3.1, 311.7, 763.7 and 49.0, respectively. Univariate analysis suggested that high NLR, high PLR, high SII and low PNI were associated with shorter OS rate, and the differences between groups were statistically significant (P<0.05). COX regression analysis suggested that PLR was an independent risk factor and PNI was a protective factor for OS after recurrence (P<0.05). The risk of death in the high PLR group was 3.889 times that of the low PLR group, and the risk of death in the high PNI group was 0.484 times that of the low PNI group. Conclusions Relapse has a significant impact on the prognosis of children with MB. For children with recurrent MB, high PNI was a protective factor, but high PLR is a risk factor for a poor prognosis.

Clinical analysis of neonatal lupus erythematosus

ZHOU Meijuan, LI Hong, WANG Qing

Journal of Clinical Pediatrics. 2024, 42(6):  543-546.  doi:10.12372/jcp.2024.23e0274

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Objective To improve the understanding of neonatal lupus erythematosus (NLE) and avoid the missed diagnosis and misdiagnosis of the disease. Methods The clinical characteristics, treatment, discharge outcome and long-term prognosis of 19 children with NLE who were hospitalized from January 2015 to April 2022 were retrospectively analyzed. Results Among the 19 children, there were 10 boys and 9 girls. There were 14 cases of cardiac system involvement, 13 cases of blood system damage, 5 cases of liver function impairment, 4 cases of skin damage, 2 cases of nervous system involvement, as well as 5 cases with single symptom presentations and 14 with multiple symptom presentations. Eighteen children were positive for anti-SSA or SSB antibodies, and one case was positive only for anti-nuclear antibodies and anti-U1RNP antibodies. Nine mothers had a prenatal history of disease, including systemic lupus erythematosus (6 cases), Sjogren's syndrome (2 cases), and thrombocytopenia (1 case). There were 10 mothers without medical history. Four patients were treated with glucocorticoids, 4 with human immunoglobulin, 9 with glucocorticoids and human immunoglobulin, 1 with liver protection and 1 with no treatment. All the children did not have pacemakers installed. Follow-up until August 31, 2022, 4 cases were lost to follow-up, 1 case had vitiligo, 1 case had motor developmental retardation, 2 cases still had low platelet count, but no bleeding, and the rest of the children were no different from normal children. Conclusions Most of the symptoms of NLE can be relieved by treatment or observation, and there are no serious adverse outcomes. In a few children, symptoms can last for several years, and some children may develop immune diseases again. Asymptomatic pregnant mother can also cause NLE, and there is also a risk of developing autoimmune diseases after delivery, so it is necessary to strengthen prenatal testing and maternal and infant follow-up.

Comparison of clinical features between hemophagocytic lymphohistiocytosis and sepsis

ZHONG Xiaomei, REN Hong, ZHANG Jian, LI Biru, QIAN Juan, NING Botao, GAO Yijin, WANG Ying

Journal of Clinical Pediatrics. 2024, 42(6):  547-552.  doi:10.12372/jcp.2024.22e1731

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Objective To compare the clinical features of hemophagocytic lymphohistiocytosis (HLH) and sepsis, and to find laboratory markers to help differential diagnosis. Methods The clinical data of HLH children without underlying disease or sepsis children with fever and decreased peripheral blood two cell lines or splenomegaly from January 2013 to December 2020 was retrospectively analyzed. Results A total of 106 patients were enrolled in this study. There were 72 children (46 boys and 26 girls) in the HLH group, and the median age was 26.5 (14.3-56.8) months. There were 34 children (18 boys and 16 girls) in the sepsis group, and the median age was 14.0 (3.8-89.0) months. The total length of hospital stay and PICU stay in the sepsis group were longer than those in the HLH group, and the differences were statistically significant (P<0.05). Compared with the sepsis group, the white blood cell count (WBC)-Min, absolute neutrophil count (ANC)-Min, hemoglobin (HB)-Min, platelet count (PLT)-Min, creatinine (CREA)-Max, fibrinogen (FIB)-Min, C-reactive protein (CRP)-Max, and procalcitonin (PCT)-Max were lower, and triglyceride-Max and serum ferritin (SF)-Max were higher in the HLH group. The duration of HB reduction was shorter in the HLH group, while the duration of ANC reduction was longer, and the differences between the two groups were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the decreased levels of WBC-Min, FIB-Min, CREA-Max and PCT-Max were helpful for the diagnosis of HLH (P<0.05). The AUC of SF-Max to aid in the diagnosis of HLH was 0.72 (95%CI: 0.62-0.80), according to ROC curve analysis. The combined predictors of WBC-Min, FIB-Min, CREA-Max and PCT-Max were obtained by logistic regression equation fitting, and the AUC of which in the diagnosis of HLH was 0.95 (95%CI: 0.89-0.99). The AUC of the combined predictors was significantly larger than that of SF-Max, and the difference was statistically significant (P<0.01). Conclusions The fitting of WBC-Min, FIB-Min, CREA-Max and PCT-Max may help to better distinguish HLH from sepsis.

Standard•Protocol•Guideline

From practice to consensus, from consensus to practice: interpretation of Chinese expert consensus on the diagnosis and treatment of respiratory syncytial virus infections in children (2023 edition)

HUANG Lisu, LIN Luona, ZHANG Xianli

Journal of Clinical Pediatrics. 2024, 42(6):  553-557.  doi:10.12372/jcp.2024.24e0523

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Respiratory syncytial virus (RSV) infection is a global health issue that poses a serious threat to the health of children under the age of 5. This article closely follows the “Chinese expert consensus on the clinical diagnosis and treatment of respiratory syncytial virus infection in children (2023 edition)”, and makes an in-depth interpretation of key issues such as the window period for RSV pathogenic diagnosis, late-onset severe disease of RSV, and supportive treatment of RSV.

Literature Review

Causes, outcomes and prevention measurements of neo-aortic valve regurgitation and root dilation after arterial switch operation

DAI Jieming, LU Yanan

Journal of Clinical Pediatrics. 2024, 42(6):  558-565.  doi:10.12372/jcp.2024.24e0215

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Arterial switch operation (ASO) is the preferred procedure for the treatment of transposition of great arteries (TGA) and Taussig-Bing anomaly (TBA). A large number of patients who received surgery during childhood have reached adulthood, thus the late complications have attracted more attentions. Neo-aortic valve regurgitation and neo-aortic root dilation are second common causes for reoperation lately after ASO. This article intends to review the existing research, hoping to summarize the etiologies and prognosis of NAVR and NARD and to provide references for clinical practice.