Table of Content

15 July 2025 Volume 43 Issue 7

  

Standard · Protocol · Guideline

Chinese expert consensus on management of nocturnal enuresis in children

Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association

Journal of Clinical Pediatrics. 2025, 43(7):  483-499.  doi:10.12372/jcp.2025.25e0564

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Nocturnal enuresis is a common disease in childhood, which can be harmful to the children’s physical and psychological well-being. Standardized diagnosis and therapeutic approaches are very important for the efficacy and prognosis of enuresis. In recent years, with the accumulation of domestic and foreign clinical research evidence and the application of new diagnostic and therapeutic concepts, it is of great clinical significance to update and improve the consensus on the diagnosis and treatment of enuresis. Therefore, Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association has revised and updated the 2014 version of the "Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children" based on the latest domestic and international evidence-based rationales and combined with clinical experience. The definition has been revised in accordance with international authoritative guidelines, and the diagnosis process and standardized terminology has been enhanced. The content of medical history collection has been updated to emphasize the differentiation of other diseases and comorbidities, and the recording method of the voiding diary has been revised to improve compliance. For monosymptomatic enuresis, the dosage adjustment and discontinuation plan of desmopressin have been added, and the specific dosage recommendations for second-line drug treatment have been refined. Additionally, a new section on non-monosymptomatic enuresis has been introduced, including treatment strategies and pharmacologic interventions. This consensus recommendations in a problem-oriented manner, delivering more comprehensive and structured guidance for the management of nocturnal enuresis.

Commentary

Leveraging digital intelligence to enhance the diagnosis, treatment, and management of pediatric bronchial asthma

WANG Yingshuo, CHEN Zhimin

Journal of Clinical Pediatrics. 2025, 43(7):  500-504.  doi:10.12372/jcp.2025.25e0503

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Numerous children in China are affected by asthma, with less-than-ideal disease control. In April this year, the "Guidelines for the Diagnosis and Management of Pediatric Bronchial Asthma (2025)" was released, offering new guidance for pediatric asthma management. In recent years, digital and intelligent technologies have developed rapidly, and the state also encourages the medical system to adopt digital and intelligent technologies to improve the quality of medical services. Taking this opportunity, in response to the challenges currently faced in the prevention and control of childhood asthma, this article summarizes the application of digital intelligence technology in the diagnosis of childhood asthma, quality control and intelligent interpretation of children's lung function, and the full-course management of asthma. It also puts forward specific suggestions for the problems that need to be solved in promoting the prevention and control of asthma through digital intelligence technology and the future construction work.

Original Article

Analysis of the efficacy and prognosis of hematopoietic stem cell transplantation for inherited bone marrow failure syndrome in children

ZHAO Linchao, WANG Yingjie, JING Zhaohe, MAI Yumiao, SUN Pan, QIU Simin, NIU Hongyun, CHEN Zhiwei, DONG Pengpeng, LIU Jian

Journal of Clinical Pediatrics. 2025, 43(7):  505-510.  doi:10.12372/jcp.2025.24e0699

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Objective To observe the efficacy and prognosis of hematopoietic stem cell transplantation (HSCT) in the treatment of inherited bone marrow failure syndromes (IBMFs) in children. Methods The clinical data of children with IBMFs who underwent HSCT in the First Affiliated Hospital of Zhengzhou University from January 2019 to November 2023 were collected, and their clinical characteristics, transplantation preconditioning regimen, hematopoietic reconstruction, and prognosis were analyzed. Results A total of 18 children with IBMFs were enrolled, including 7 cases of Fanconi anemia (FA), 5 cases of dyskeratosis congenita (DKC), 3 cases of Diamond-Blackfan anemia (DBA), 2 cases of congenital amegakaryocytic thrombocytopenia (CAMT) and 1 case of severe congenital neutropenia (SCN). There were 10 boys and 8 girls, with a median age of 8.2 (1.2-14.0) years. The median time of neutrophil engraftment was 11 (9-21) days, and the median time of platelet engraftment was 13 (10-30) days. During the median follow-up of 10.6 （1.0-62.9） months, the bone marrow of 18 patients was completely chimeric. A total of 8 patients developed acute graft-versus-host disease (GVHD), including 2 cases of grade Ⅳ, 2 cases of grade Ⅲ, 1 case of grade Ⅱ, and 3 cases of grade Ⅰ. Two children suffered from mild chronic GVHD. Fifteen patients survived and 3 died. Two children with FA developed transplant-related thrombotic microangiopathy, and they were treated with plasma exchange or defibrotide with poor results, and all died of multiple organ failure. One CAMT patient developed a severe pulmonary infection 28 days after transplantation, and his condition progressed rapidly, ultimately leading to respiratory failure. Conclusions HSCT is an effective method for the treatment of IBMFs in children. According to the different diseases of children with IBMFS, the appropriate preconditioning regimen can be selected to obtain a better curative effect and prognosis.

Construction of risk prediction model for primary graft failure after umbilical cord blood transplantation in pediatric leukemia

ZHANG Zhiqi, XIONG Ruolan, LI Bohan, JI Qi, WANG Qingwei, LU Jun, LI Jie, XIAO Peifang, HU Shaoyan

Journal of Clinical Pediatrics. 2025, 43(7):  511-518.  doi:10.12372/jcp.2025.24e0304

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Objective To build a risk prediction model for primary graft failure (PGF) after umbilical cord blood transplantation (UCBT) in pediatric leukemia based on over-sampling. Methods Patients with leukemia who received umbilical cord blood transplantation from January 2017 to December 2022 were retrospectively analyzed. According to the presence or absence of PGF, the patients were divided into graft failure group and graft success group. Based on the over-sampling algorithm to expand the positive group data, the random forest, neural network and logistic regression were used to construct the mode. The stability of the algorithm was evaluated by using the 5-fold cross-validation method. The model was evaluated by using AUC, precision, recall and F1-score. Results A total of 92 leukemia patients were enrolled, PGF occurred in 10 patients (10.9%). ROSE and SMOTE algorithm demonstrate good stability in 5-fold cross-validation method. In the data set processed by ROSE algorithm, all models have good prediction effect, and the best performance is the neural network model. Juvenile myelomonocytic leukemia, HLA matching<9/10, RIC, no Periengraftment syndrome and EBV infection within 42 days were independent risk factors for PGF. Conclusion Multiple factors may cause PGF after umbilical cord blood transplantation in pediatric leukemia. ROSE-Neural Network model has good predictive ability, which can help doctors to identify patients at high risk of PGF early, provide personalized treatment, and improve the prognosis of children.

Analysis on risk factors associated with false-negative results of interferon-gamma release assay in children with pulmonary tuberculosis

JIANG Wenwen, LI Sitong, XU Yongsheng

Journal of Clinical Pediatrics. 2025, 43(7):  519-524.  doi:10.12372/jcp.2025.24e0168

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Objective To investigate the diagnostic value of interferon-gamma release assay (IGRA) in pediatric pulmonary tuberculosis (PTB) and analyze the risk factors of negative IGRA results. Method A total of 77 children with confirmed PTB who were hospitalized in our hospital from January 2018 to June 2023 were included in the study. Based on IGRA results, they were categorized into positive and false-negative groups. The sensitivity of IGRA for diagnosing pediatric PTB was evaluated, and the factors contributing to false-negative results were analyzed. Result The sensitivity of Tuberculin skin test (TST) for diagnosing pediatric PTB was 67.53% (52/77), while that of IGRA was 77.92% (60/77). The agreement rate between TST and IGRA was 79.22%, with a Kappa value of 0.48, indicating moderate consistency. Multivariate analysis revealed that the induration reaction of TST (moderate positive OR=0.066, 95%CI:0.009-0.471, P=0.007, strong positive OR=0.023, 95%CI: 0.002-0.275, P=0.003) and albumin-to-globulin ratio (OR=17.193,95%CI: 2.379-124.247, P=0.005) were independent predictors of false-negative IGRA results. Conclusion Due to the immature development of the immune system, children should be vigilant against the possibility of false negative results of IGRA. Emphasis on molecular biological and pathological examinations is crucial for achieving an early and accurate diagnosis, thereby preventing delayed treatment and missed opportunities for optimal care.

Study on the role and mechanism of caffeine citrate in the treatment of bronchopulmonary dysplasia in preterm infants

SHI Hui, WANG Yiwen

Journal of Clinical Pediatrics. 2025, 43(7):  525-531.  doi:10.12372/jcp.2025.25e0298

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Objective To explore the role and mechanism of caffeine citrate in the treatment of bronchopulmonary dysplasia (BPD) in premature infants. Methods Hyperoxic BPD models of neonatal rats and MLE-12 lung epithelial cells were constructed, and the control group, hyperoxic group, and low, medium, and high dose of caffeine citrate intervention groups were set up respectively. The effects of caffeine citrate were evaluated using H&E staining, immunofluorescence staining, CCK8 apoptosis assay, and flow cytometry apoptosis detection. The occurrence of mitochondrial stress and apoptosis was further detected by reactive oxygen species (ROS) immunofluorescence assay, electron microscopy observation, and western blot assay. Results Caffeine citrate intervention increased the survival rate, promoted the body weight gain, and ameliorated the lung tissue injury in neonatal rats after hyperoxia exposure. Caffeine citrate intervention increased the survival rate of MLE-12 cells, reduced the loss of surfactant protein C (SPC), and inhibited apoptosis. In terms of mechanism of action, caffeine citrate reduced the level of reactive oxygen species (ROS), repaired mitochondrial structure, and regulated the expression of proteins related to mitochondrial stress pathways (eIF2α-ATF4-CHOP) and mitochondrial apoptotic pathways (Bax, Bcl2 and Cleaved caspase-3). Conclusions Caffeine citrate ameliorates hyperoxia-induced lung injury by repairing mitochondrial function and inhibiting oxidative stress and apoptosis, which plays an active role in the treatment of BPD in preterm infants.

Tocilizumab treatment for febrile infection-related epilepsy syndrome in children: 2 cases report and literature review

LI Fan, HUANG Xianjie, FAN Yazhen, ZHAO Jianchuang, CUI Chenhang, GUO Qiliang, QIAO Junying

Journal of Clinical Pediatrics. 2025, 43(7):  532-538.  doi:10.12372/jcp.2025.24e0426

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Objective To report the use of tocilizumab in 2 cases of children with febrile infection-ralated epilepsy syndrome (FIRES), and provide a reference for its therapeutic application. Methods A retrospective analysis was conducted on the clinical manifestations, diagnostic and treatment processes, and therapeutic responses to tocilizumab in two FIRES patients admitted to the pediatric intensive care unit of our hospital in 2023, and the relevant literatures were reviewed. Results Neither patient responded to multiple antiepileptic drugs, anesthetics, ketogenic diet therapy, or first-line immunotherapy (high-dose methylprednisolone and high-dose intravenous immunoglobulin). Following second-line immunotherapy with tocilizumab, epileptic seizures were effectively controlled without adverse reactions. After 4-6 months of follow-up, one patient experienced recurrence of epileptic seizures. Conclusions Tocilizumab demonstrates efficacy as a second-line immunotherapy for FIRES, with good tolerability, and represents a promising treatment option.

Clinical Report

A report of two cases of bronchiolitis obliterans organizing pneumonia secondary to toxic epidermal necrolysis/Stevens-Johnson syndrome in lung transplantation treatment

LIANG Jialong, CHEN Yuan, XU Jian, YE Shugao

Journal of Clinical Pediatrics. 2025, 43(7):  539-542.  doi:10.12372/jcp.2025.24e1052

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Objective To assess the efficacy of lung transplantation in managing bronchiolitis obliterans resulting from toxic epidermal necrolysis/Stevens-Johnson syndrome. Methods The medical records of 2 children with toxic epidermal necrolysis/Stevens-Johnson syndrome secondary bronchiolitis obliterans were retrospectively analyzed. Results Two patients successfully underwent lung transplantation and experienced no recurrence of their condition postoperatively. Tragically, one of these patients succumbed to an infection 16 months following the procedure. Additionally, we extracted data on six patients from the literature who fulfilled the criteria, and at the time of publication, all were reported to be alive and free from disease recurrence. Conclusions Lung transplantation emerges as a potentially effective therapeutic option for patients with toxic epidermal necrolysis/Stevens-Johnson syndrome who develop secondary bronchiolitis obliterans, suggesting a favorable prognosis. However, the crux of success lies in meticulous management of perioperative pulmonary infections.

Clinical efficacy analysis of disease-modifying therapies for spinal muscular atrophy with SMN1 gene compound heterozygous variants

DUAN Haolin, ZHANG Ciliu, XIONG Juan, PANG Nan, YIN Fei, PENG Jing

Journal of Clinical Pediatrics. 2025, 43(7):  543-548.  doi:10.12372/jcp.2025.24e1371

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Objective To investigate the clinical efficacy of disease-modifying therapies (DMTs) in spinal muscular atrophy (SMA) patients with SMN1 gene compound heterozygous variants. Methods A retrospective analysis was performed on two cases with SMN1 compound heterozygous SMA, including clinical data, treatment approaches, and prognosis. Clinical findings were contextualized through a systematic literature review of analogous cases. Results Two SMA type I patients exhibited SMN1 compound heterozygous: a 4-year-old male (Patient 1) with exon 7 heterozygous deletion and c.188C>A variation, and a 1.7-year-old female (Patient 2) with exon 7 heterozygous deletion and c.683T>A variation. Patient 1 initiated rehabilitation at 7 months of age, received nusinersen treatment at 1 year and 6 months, added risdiplam as combination therapy at 3 years, and discontinued rehabilitation at 3 years and 10 months. Following DMTs, the patient showed slow progress in motor function, acquiring the ability to roll over to the side and sit with support, and is currently able to sit with assistance. Patient 2 started rehabilitation at 4 months of age, received risdiplam at 7 months, and switched to nusinersen treatment at 1 year and 5 months due to persistent darkening of skin color. The combination of DMTs and rehabilitation resulted in significant improvement in the patient's motor function, achieving milestones such as sitting independently and standing with support. Currently, she can stand independently for 7-8 seconds and take steps. Conclusion DMTs can improve the overall prognosis of children with compound heterozygous SMA and enhance their motor function.

Leadless cardiac pacemaker implantation via the internal jugular vein: clinical practice and reflection of a 15kg child with third-degree atrioventricular block after congenital heart surgery

HE Shuang, XU Xin, ZHOU Xue, LIU Qian, ZHANG Lei, TIAN Jie, LYU Tiewei

Journal of Clinical Pediatrics. 2025, 43(7):  549-553.  doi:10.12372/jcp.2025.25e0359

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Objective To explore the safety and feasibility of implanting leadless pacemakers via the internal jugular vein in children with congenital heart disease (CHD) of small age and low weight who have developed third-degree atrioventricular block (AVB) after surgery. Methods A retrospective analysis was conducted on the clinical data of a child with grade three AVB after congenital heart disease surgery, as well as the implantation of leadless pacemaker through the internal jugular vein. Results A 6.5-year-old girl (weighing 15 kg) with syncope secondary to third-degree AVB following congenital heart defect repair underwent successful implantation of an AVEIR leadless cardiac pacemaker via the internal jugular vein after comprehensive evaluation of vascular diameter and cardiac dimensions. Postoperative pacing parameters were good, clinical symptoms were eliminated, and no pacemaker-related complications occurred. Conclusions In low-weight young children, after thorough preoperative vascular and cardiac function evaluations, the intracervical vein approach for leadless cardiac pacemaker implantation proves a safe and feasible choice.

Expert Comment

Promoting the research and application of leadless cardiac pacemakers in children

LI Fen

Journal of Clinical Pediatrics. 2025, 43(7):  554-555.  doi:10.12372/jcp.2025.25e0672

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Leadless pacemakers have gained prominence in the field of pacemaker implantation due to their small size, lack of a pouch, minimal implant trauma, and avoidance of traditional electrode lead wear and fragmentation. However, children, with their distinct physiological characteristics from adults, face unique challenges in terms of implantation pathways, cardiac chamber size, right ventricular target area conditions, pacing ratio, pacemaker lifespan, and future replacement issues. This article provides a brief review of the current status of leadless pacemaker implantation in children, discussing the problems and strategies faced in the implantation of leadless pacemakers in children, with the aim of enhancing the understanding of this cutting-edge technology among peers and promoting the standardized application of leadless cardiac pacemakers in the pediatric field.

Literature Review

Progress in pathogenesis and treatment of pediatric generalized pustular psoriasis

LYU Mingjun, LUO Wen, YANG Jinxiang, LIANG Jianying, YAO Zhirong

Journal of Clinical Pediatrics. 2025, 43(7):  556-562.  doi:10.12372/jcp.2025.24e1264

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Generalized pustular psoriasis (GPP) is a rare, recurrent systemic inflammatory skin disease. Interleukin (IL)-36RN (IL36RN) is the most common causative gene in GPP. Innate immunity mediated by IL-1/IL-36-chemokine-neutrophils plays a central role in the pathogenesis of GPP, and adaptive immunity mediated by tumor necrosis factor-α (TNF-α)/IL-23/IL-17 is also involved in GPP pathogenesis. At present, the main therapeutic agents for GPP are acitretin, methotrexate, cyclosporine and biologics. Most of the biologics are still used as over-indications in pediatric GPP. There is increasing evidence that adalimumab and secukinumab have achieved better efficacy in the treatment of GPP in children. Spesolimab, an IL-36 receptor inhibitor, is a new therapeutic target for GPP, bringing new hope for the treatment and prevention of GPP. This article reviews the pathogenesis and treatment progress of GPP in children, and provides reference for the clinical diagnosis and treatment of the disease.