Table of Content

15 June 2026 Volume 44 Issue 6

  

Academic Viewpoint

Identification and management of faltering growth in children: insights from the 13th International Conference on Nutrition and Growth

HU Yan, YANG Fan, LIANG Aimin, MAO Meng

Journal of Clinical Pediatrics. 2026, 44(6):  485-488.  doi:10.12372/jcp.2026.26e0555

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The 13th International Conference on Nutrition and Growth (N&G 2026) was held in Prague, Czech Republic, from April 9 to 11, 2026. The conference brought together leading pediatricians, nutritionists, neonatologists, child development specialists, and researchers from related disciplines worldwide to discuss key and emerging topics in pediatric nutrition, growth, and development. Faltering growth (FG) and its management remain major challenges in pediatric practice globally. This article aims to systematically summarize and interpret the latest discussions presented at the conference regarding the evolving definitions of faltering growth, its identification and assessment, and evidence-based management strategies. It is intended to provide clinicians with up-to-date, authoritative, and practical guidance for the management of children with faltering growth.

Original Article

Early differentiation of Kawasaki disease with joint symptoms and systemic juvenile idiopathic arthritis with Kawasaki disease-like symptoms: a single-center retrospective study

LIU Ziyao, WANG Congying, WANG Hongmao, ZHANG Mingming, XU Yingjie, LAI Jianming, NIU Wenquan, LI Xiaohui

Journal of Clinical Pediatrics. 2026, 44(6):  489-498.  doi:10.12372/jcp.2026.26e0076

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Objective Children with Kawasaki disease (KD) may have joint symptoms, and some children with systemic juvenile idiopathic arthritis (sJIA) present with Kawasaki disease-like symptoms at the onset, with similar manifestations in the early stage to KD. The early differentiation between these two groups of children is very difficult. This study aims to analyze the differences in early clinical features between the two types of children, and to explore the early warning signs of children who present with KD-like symptoms accompanied by joint manifestations but are actually diagnosed with sJIA. Methods A retrospective analysis was conducted on the clinical data of children who visited the Capital Institute of Pediatrics-Peking University Teaching Hospital from January 2021 to August 2025 and whose early symptoms met the diagnostic criteria for Kawasaki Disease (KD) with joint symptoms. All children completed at least 6 months of clinical follow-up. According to follow-up outcomes, patients were divided into the sJIA group (revised diagnosis of sJIA during the follow-up) and the KD group (maintaining KD diagnosis during the follow-up). Differences in fever characteristics, joint involvement patterns, inflammatory indicators, coronary artery lesions, and treatment response were compared between the two groups. Results Among 71 children with KD and joint symptoms, there were 46 boys and 25 girls, with a median onset age of 4.3 (2.5-5.1) years, a median fever duration of 9.0 (7.5-12.5) days, and a median interval from onset to joint symptoms appearance of 9.0 (6.5-12.0) days. Fifty-five children (77.5%) had oligoarthritis, 56 (78.9%) had large joint arthritis, only 2 had small joint arthritis, and 13 had mixed arthritis. The incidence of coronary artery aneurysm was 12.7% (9/71). One patient developed macrophage activation syndrome (MAS) during follow-up. All children received intravenous immunoglobulin (IVIg) treatment, and 32 children showed no response to initial IVIg treatment. After 6 months of follow-up, 8 children were finally diagnosed with sJIA (sJIA group) and 63 maintained the diagnosis of KD (KD group). The median duration of fever in the sJIA group was 24.5 days, which was significantly longer than 8.0 days in the KD group (P<0.01). There was no significant difference in CRP level at onset between the sJIA group and the KD group (P>0.05); the median CRP level in the KD group was significantly lower than that in the sJIA group after the first IVIg treatment (12.9 mg/L vs. 61.0 mg/L), and both ΔCRP and CRP reduction rate in the sJIA group were significantly lower than those in the KD group (all P<0.05). At 1-month follow-up, CRP level in the sJIA group was significantly higher than that in the KD group (P<0.001), while there was no significant difference in CRP level between the two groups at 6-month follow-up (P>0.05).At initial diagnosis, the median number of affected joints in the sJIA group was significantly higher than that in the KD group; The proportions of polyarthritis and mixed arthritis, the rates of wrist and interphalangeal joint involvement, and the incidence of synovial membrane thickening in the sJIA group were higher than those in the KD group, with statistically significant differences (all P<0.05). At 1-month and 6-month follow-up, the number of affected joints in the sJIA group was significantly higher than that in the KD group (both P<0.001). When duration of fever and number of affected joints were used as indicators to distinguish the sJIA group from the KD group, the AUC was 0.89 and 0.81, respectively. All sJIA children (100%, 8/8) showed no response to initial IVIg treatment, while the IVIg non-response rate in the KD group was 38.1% (24/63), with a statistically significant difference (P<0.05). There was no significant difference in the incidence of coronary artery lesions between the two groups (P>0.05). Conclusions Prolonged fever duration, polyarthritis or mixed arthritis, involvement of wrist and interphalangeal small joints, synovial membrane thickening on imaging, persistent joint symptoms, and no response to IVIg treatment are early clinical warning indicators for the final diagnosis of sJIA in KD children with joint symptoms.

A retrospective analysis of 50 cases of malignant rhabdoid tumor in children: clinical features, treatment response and prognostic factors

LI Jian, LI Tao, HE Lulu, WU Lei, HU Tianjiao, HUANG Yixuan, LIN Xinrong, SHEN Qiyang, PAN Sirui, XIE Nan, ZHOU Jianfeng, ZHOU Chunlei, ZHOU Li

Journal of Clinical Pediatrics. 2026, 44(6):  499-507.  doi:10.12372/jcp.2026.25e1054

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Objective Large-scale clinical studies on malignant rhabdoid tumor (MRT) in Chinese pediatric populations remain limited, with existing literature predominantly restricted to single anatomic subtypes. Systematic comparative analyses encompassing all three subtypes—malignant rhabdoid tumor of the kidney (MRTK), atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system, and extrarenal extracranial rhabdoid tumor (EERT)—are notably lacking, and prognostic stratification systems await further refinement. This retrospective study aims to characterize the clinicopathological features and treatment responses of these three anatomic subtypes (AT/RT, MRTK, and EERT) in children with MRT, and to identify independent prognostic factors, thereby providing evidence-based insights for clinical risk stratification and individualized therapeutic decision-making. Methods A retrospective analysis was conducted on the clinical data of children with MRT admitted to the hospital from July 2017 to July 2024, including gender, age at onset, serum lactate dehydrogenase (LDH) level at initial diagnosis, tumor location, metastasis status at initial diagnosis, immunohistochemical test results of tumor tissue, treatment methods, and follow-up outcomes. The Kaplan-Meier method was used to calculate the overall survival (OS) rate and progression-free survival (PFS) rate, and the COX regression model was used to analyze the impact of different factors on OS. Results A total of 50 pediatric patients with MRT were enrolled, comprising 18 with AT/RT, 17 with MRTK, and 15 with EERT. The male-to-female ratio was 21:29. The median onset age of 50 patients was 27.0 (14.25-52.25) months, among whom 38 patients (76.0%) developed the disease before the age of 3. At the time of initial diagnosis, 26 children (52.0%) presented with local or distant metastasis, and 15 (30.0%) had abnormally elevated LDH levels. The immunohistochemical results of tumor tissues indicated that all 50 children had a loss of SMARCB1 (INI1) protein. Forty-nine children (98.0%) received surgical treatment before chemotherapy, among whom 34 children had complete resection, 15 had partial resection, and 1 only underwent fine-needle aspiration biopsy. All 50 children received multi-drug combined chemotherapy, and 27 (54.0%) received radiotherapy. There was a statistically significant difference in the radiotherapy rate among the AT/RT group, MRTK group, and EERT group (P<0.05), with the ATRT group having a higher radiotherapy rate. Thirty-two (64.0%) children achieved partial remission or complete remission after the induction chemotherapy, while the remaining 18 children showed stable disease or progression of disease. The main adverse reactions during chemotherapy included bone marrow suppression, infection, and abnormal liver function. The follow-up was conducted until December 2024, with a median follow-up time of 24 months (ranging from 3 to 84 months). Kaplan-Meier survival analysis showed that the 3-year OS rate of all children was 51.5% (95%CI: 35.2%-67.8%), and the 3-year PFS rate was 50.6% (95%CI: 33.4%-67.8%). There was no statistically significant difference in the 3-year OS rate and PFS rate among the AT/RT, MRTK and EERT groups of children (P>0.05). Multivariate COX regression analysis showed that concurrent metastasis at the initial diagnosis, abnormally elevated LDH levels, and incomplete surgical resection were independent risk factors for poor prognosis (P<0.05). Conclusions The overall prognosis of pediatric MRT remains poor. No significant differences were observed in clinical characteristics or survival outcomes among the three subtypes, although a higher proportion of patients with AT/RT received radiotherapy. Complete surgical resection, normal baseline LDH level, and absence of metastasis at initial diagnosis were identified as independent favorable prognostic factors. These findings underscore the necessity of implementing multidisciplinary comprehensive treatment based on early risk stratification to improve clinical outcomes.

A comparative study on the efficacy of two CD19/CD22 dual-targeting CAR-T strategies in children with relapsed/refractory B-cell acute lymphoblastic leukemia with PAX5 gene variations

LI Yue, XIE Zhiwei, TANG Yanjing, LI Benshang

Journal of Clinical Pediatrics. 2026, 44(6):  508-517.  doi:10.12372/jcp.2026.26e0038

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Objective Antigen escape, particularly CD19 loss, limits the efficacy of CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy in children with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL). PAX5 gene variations have been shown to disrupt CD19 expression stability and increase relapse risk. This study aimed to compare the therapeutic efficacy of two CD19/CD22 dual-targeting CAR-T strategies, namely co-infusion versus bicistronic construct, in children with R/R B-ALL harboring PAX5 gene variations. Methods A retrospective analysis was conducted on the clinical data of R/R B-ALL children with PAX5 gene variation admitted to the hospital from November 5, 2019 to May 31, 2023. The patients were divided into a co-infusion group (Co group) and a bicistronic group (Bi group). All children received lymphodepletion conditioning followed by CAR-T cell infusion at a dose ranging from 2×10⁶ to 10×10⁶ cells/kg. The primary endpoints included the 30-day complete remission (CR) rate, minimal residual disease (MRD) negativity rate, relapse rate, survival outcomes, and treatment-related toxicity. The follow-up cutoff date was March 31, 2025. Results A total of 22 children with R/R B-ALL and PAX5 gene variations were included, including 18 cases (81.8%) of fusion variations, 2 cases (9.1%) of deletions, and 2 cases (9.1%) of missense variations. Six children (27.3%) had complex karyotypes (≥ 3 abnormalities). Among them, 8 patients received combined infusion of CAR-T treatment (Co group), and 14 received bicistronic CAR-T treatment (Bi group). The median age of the children at the time of treatment was 5.57 years (ranging from 1.31 to 14.85 years), and there were 13 boys and 9 girls. The CR rate of children in both the Co group and the Bi group was 100% 30 days after infusion, and the MRD was negative in both groups (MRD<0.01%). The median follow-up time was 26.5 months (range 5 to 66 months). Among the 22 patients, the 6-month, 12-month and 3-year overall survival (OS) rates were 95.45%, 90.91% and 63.64%, respectively. Meanwhile, the 6-month, 12-month and 3-year event-free survival (EFS) rates were 77.27%, 54.55% and 40.91%, respectively. The 6-month, 12-month, and 3-year OS rates in the Co group were 100%, 87.5%, and 50%, respectively, while those in the Bi group were 92.9%, 92.9%, and 71.4%, respectively. The 6-month, 12-month, and 3-year EFS rates in the Co group were 75%, 62.5%, and 37.5%, respectively, and those in the Bi group were 78.6%, 50%, and 42.9%, respectively. There were no statistically significant differences in OS and EFS rates between the two groups (P_OS=0.411, P_EFS=0.826). A total of 4 children received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CAR-T treatment. The 6-month, 12-month and 3-year OS rates in the transplantation group were 100%, 100% and 50.0%, respectively, while those in the non-transplantation group were 94.4%, 88.9% and 66.7%, respectively. The 6-month, 12-month and 3-year EFS rates in the transplantation group were 75.0%, 75.0% and 50.0%, respectively, while those in the non-transplantation group were 77.8%, 50.0% and 38.9%, respectively. There were no statistically significant differences in OS and EFS rates between the two groups (P_OS=0.693, P_EFS=0.553). Regarding toxicity, the incidence of grade ≥3 cytokine release syndrome (CRS) was 25.0% and 57.1% in the Co and Bi groups, respectively; the incidence of immune effector cell-associated neurotoxicity syndrome (ICANS) was 25.0% and 21.4%, respectively. All adverse events were manageable and no treatment-related death occurred. Conclusions Both co-infusion and bicistronic CD19/CD22 dual-targeting CAR-T strategies exhibit favorable short-term efficacy and comparable safety profiles in pediatric R/R B-ALL with PAX5 variations. However, the 3-year EFS rate remains at a relatively low level, suggesting that the long-term prognosis still needs further improvement.

Analysis of survival prognosis and related risk factors of pediatric head and neck rhabdomyosarcoma

LI Yanhua, ZHANG Huanhuan, YANG Jingwei, LIAO Xuelian, SHAO Jingbo, JIAO Yangyang, ZHANG Ting, HUANG Can, JIANG Shayi

Journal of Clinical Pediatrics. 2026, 44(6):  518-523.  doi:10.12372/jcp.2026.26e0156

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Objective To explore the clinical characteristics and prognostic factors of head and neck rhabdomyosarcoma (HNRMS) in children. Methods A retrospective analysis was conducted on the clinical data of children with HNRMS treated in Shanghai Children's Hospital from January 2011 to December 2025. Patients were stratified into different groups according to the following criteria: presence or absence of resectable tumor on imaging following neoadjuvant chemotherapy, presence or absence of viable tumor tissue on histopathology of the delayed primary tumor resection, and presence or absence of residual disease on imaging at the completion of multimodal therapy. The 5-year overall survival (OS) rates were compared between groups. Results A total of 32 pediatric patients with HNRMS were enrolled, including 20 boys and 12 girls. The median age at diagnosis was 48 (36.0-94.0)months. Tumor diameter was >5 cm in 14 patients and ≤5 cm in 18 patients. Distant metastasis occurred in 5 patients (15.6%). The primary tumors were located in the parameningeal region in 15 patients (46.9%), among whom 11 exhibited signs of meningeal involvement; in the orbit in 4 patients (12.5%); and in non-orbital, non-parameningeal sites in 13 patients (40.6%). According to risk stratification, 3 patients (9.4%) were classified as low-risk, 22 (68.7%) as intermediate-risk, and 7 (21.9%) as high-risk. Histopathological subtypes included embryonal in 24 patients, alveolar in 6 patients, and other types in 2 patients. The median follow-up duration for all 32 patients was 62.5 (34.8-82.0) months. The 5-year event-free survival (EFS) and overall survival (OS) rates were both 78.1%±7.8%. The 5-year OS rate for patients with non-metastatic HNRMS was significantly higher than that for patients with metastatic HNRMS (85.2% vs. 40.0%, P=0.020). The 5-year OS rate for PM-RMS was slightly lower than that for RMS in non-parameningeal sites (66.7% vs. 88.2%, P=0.077). PM-RMS with signs of meningeal involvement (11 patients) demonstrated a significantly lower 5-year OS rate compared with RMS in non-parameningeal sites (54.5% vs. 88.2%, P=0.016). Twelve patients with residual disease following neoadjuvant chemotherapy (the residual tumor group) had a significantly lower 5-year OS rate compared with nine patients without residual disease following neoadjuvant chemotherapy (the no residual tumor group) (50.0% vs. 100.0%, P=0.028). Patients without residual disease on imaging at the completion of multimodal therapy had a significantly higher 5-year OS rate than those with residual disease (96.2% vs. 0.0%, P<0.001). Conclusions Children with HNRMS have a favorable overall survival, but those with metastasis or parameningeal site (especially accompanied by signs of meningeal involvement) still have poor prognosis, and new treatment methods need to be explored. Maximal tumor eradication with radiotherapy, chemotherapy, and surgery is critical for successful treatment.

Rubinstein-Taybi syndrome caused by truncating variants in the last exon of CREBBP gene: clinical phenotypic characteristics and comparative analysis

WANG Yanrui, SHI Yijie, ZHANG Kaichuang, WANG Xiaoqiang, XIAO Bing, SUN Yu

Journal of Clinical Pediatrics. 2026, 44(6):  524-531.  doi:10.12372/jcp.2026.26e0297

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Objective To analyze the clinical characteristics of children carrying truncating variants in the last exon of CREBBP and to explore their phenotypic features in comparison with the classical Rubinstein-Taybi syndrome (RSTS). Methods The clinical and genetic data of three patients carrying truncating variants in the last exon of CREBBP (NM_004380.3) were retrospectively reviewed. Their phenotypic features were compared with previously reported cases involving last exon variants and with the classical RSTS phenotype. Results All three patients harbored heterozygous nonsense variants in the last exon of CREBBP. All three variants arose de novo. Two variants had been previously reported, and one was novel. According to ACMG/AMP guidelines, the variants were classified as pathogenic or likely pathogenic. All patients exhibited features within the RSTS spectrum, while the core manifestations varied. One patient showed broad thumbs/halluces and several characteristic facial features of RSTS, whereas the other two displayed only partial RSTS-related features and did not fully meet the classical phenotype. A review of the literature indicated that patients with CREBBP last exon variants demonstrated heterogeneity in the expression of core features and disease severity. Conclusions Patients with nonsense variants in the last exon of CREBBP generally fall within the RSTS phenotypic spectrum, although their clinical manifestations may be atypical or incomplete. Comprehensive evaluation integrating detailed phenotypic assessment with molecular findings is important for accurate diagnosis and genetic counseling.

Clinical characteristics and prognosis analysis of autoimmune encephalitis with movement disorders in children: A single-center retrospective study

SHI Yongyuan, YANG Lijuan, LEI Wenting, XIONG Yurong, PAN Shujing, LI Yuelin, ZHANG Jiali, TIAN Maoqiang

Journal of Clinical Pediatrics. 2026, 44(6):  532-539.  doi:10.12372/jcp.2026.25e0962

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Objective Movement disorders are not uncommon clinical manifestations in children with autoimmune encephalitis (AE). The characteristics of movement disorders in children with AE and their impact on the clinical prognosis of AE remain to be systematically clarified. This study aims to investigate these issues through a systematic review of patients accumulated over 10 years in a single center. Methods A retrospective analysis was conducted on the data of 82 children diagnosed with AE from January 2014 to December 2023. Information on their general conditions, clinical manifestations, laboratory tests, treatments, and prognoses was collected. The modified Rankin Scale (mRS) was used to assess the severity of the disease, and differences between different age groups were compared. Results The median age of onset was 9 (1.2 - 17) years, and 46.3% were positive for anti-neuronal antibodies, with anti-NMDAR encephalitis accounting for 39.0%. The most common symptoms were behavioral abnormalities, movement disorders, and epileptic seizures. The incidence of movement disorders was 68.3%, mainly characterized by stereotyped movements and orofacial movement disorders. The incidence of movement disorders was higher in children with anti-NMDAR encephalitis (81.3%). Age stratification showed that movement disorders were more common in the <12-year-old group (P<0.05), and orofacial movement disorders were particularly prominent in this group (P=0.027), and were only observed in children with anti-NMDAR encephalitis in this group (P=0.004). The proportion of autonomic dysfunction, sleep disorders, anti-NMDAR antibody positivity, and mRS scores in the movement disorder group were all higher than those in the non-movement disorder group (P<0.05). The overall good prognosis rate was 70.7%, and the recurrence rate was 11.0%. Except for the mRS score at discharge being higher in the movement disorder group than in the non-movement disorder group (P=0.027), no differences were observed in other long-term prognosis indicators between the two groups. Conclusion The antibody positivity rate in children with AE is less than 50%, and the clinical manifestations are mainly behavioral abnormalities, movement disorders, and epileptic seizures. Movement disorders are more common in children under 12 years old and those with anti-NMDAR encephalitis. Patients with autonomic dysfunction and sleep disorders are more likely to have movement disorders. Movement disorders are not a risk factor for poor prognosis in children with AE.

Comparison of efficacy and safety between robotic-assisted and laparoscopically assisted anorectoplasty for intermediate and high anorectal malformations in children

CHI Yijie, HAN Yijiang, HU Shuqi, MA Dong, ZHAO Xiaoxia, WANG Peng, LAI Dengming, CHEN Rui, LYU Chengjie, HUANG Shoujiang, TOU Jinfa

Journal of Clinical Pediatrics. 2026, 44(6):  540-545.  doi:10.12372/jcp.2026.25e1254

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Objective Robotic-assisted anorectoplasty (RAARP) has been reported for the treatment of anorectal malformation (ARM) in children; however, the number of reported cases remains limited, and a systematic evaluation is lacking. This study aims to compare the efficacy and safety of RAARP with those of conventional laparoscopically assisted anorectoplasty (LAARP) in the treatment of intermediate and high ARM, and to evaluate the suitability of RAARP for this condition. Methods Clinical data of 50 children with intermediate or high ARM treated between July 2019 and January 2024 were retrospectively analyzed. Patients were divided into RAARP group and LAARP group. Postoperative follow-up ranged from 12 to 60 months. Operative time (total duration and setup time), intraoperative blood loss, postoperative hospital stay, complications (rectal mucosal prolapse), and defecation function (Kelly score) were compared between the two groups. Statistical analysis was performed using SPSS 21.0, with t -test and chi-square test, and P<0.05 was considered statistically significant. Results The RAARP group and LAARP group consisted of 32 and 18 patients, respectively. No statistically significant differences were observed between the two groups in terms of sex distribution (30/32, 93.75% vs. 18/18, 100%, P=0.530), body weight at surgery (5.90 ± 0.98 kg vs. 6.06 ± 1.30 kg, P=0.645), total operative time (148.94 ± 28.43 min vs. 149.28 ± 43.97 min, P=0.974), postoperative hospital stay (8.27 ± 1.89 d vs. 7.84 ± 1.74 d, P=0.425), incidence of poor defecation function (Kelly score grade “poor”) (6.25% vs. 11.11%, P=0.540), and complication rate (9.38% vs. 11.11%, P=1.000). Compared with the LAARP group, the RAARP group had a younger surgical age (77.45 ± 29.77 d vs. 101.92 ±45.64 d, P=0.026), lower intraoperative blood loss (3.09 ± 1.87 mL vs. 4.83 ± 3.26 mL, P=0.020), but a longer setup time (17.91 ± 5.64 min vs. 1.83 ± 0.84 min, P<0.001). Conclusion RAARP demonstrates comparable perioperative safety and short-term efficacy to LAARP in the treatment of intermediate and high ARM, with long-term functional outcomes requiring further validation. The reduced intraoperative blood loss associated with RAARP suggests its potential advantage for delicate dissection in the narrow pelvic space, and younger infants with ARM may particularly benefit from this approach.

Burden of urinary system diseases in children and adolescents in China, 1990-2023

GU Xinjia, ZHENG Zhihui, MEI Lingli, ZHENG Jinxin, LIU Taixiang, ZHU Jihua

Journal of Clinical Pediatrics. 2026, 44(6):  546-555.  doi:10.12372/jcp.2026.25e1478

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Objective To assess the disease burden and long-term trends of six major urinary system diseases among children and adolescents under 20 years in China from 1990 to 2023, and to quantify the driving effects of demographic and epidemiological factors. Methods Data on the number of incident cases, incidence rates, disability-adjusted life years (DALYs), and DALY rates for the Chinese population under 20 years old from 1990 to 2023 were extracted from the Global Burden of Disease Study (GBD) 2023. Descriptive statistics and the average annual percentage change (AAPC) derived from Joinpoint regression models were employed to analyze temporal trends. A demographic decomposition method was applied to quantify the contributions of changes in age structure, population size, and age-specific rates to the changes in DALYs. Results From 1990 to 2023, the overall incidence rate of urinary system diseases in China's population under 20 years declined from 384.70 to 285.38 per 100,000, and the overall DALY rate decreased from 160.82 to 39.81 per 100,000. Significant shifts were observed in the disease spectrum. Urinary tract infections and interstitial nephritis remained the most common conditions (accounting for 68.70% of incidence in 2023), whereas chronic kidney disease (48.61%) and kidney cancer (26.03%) constituted the primary sources of DALY burden. The distribution of diseases exhibited distinct age and sex patterns. Decomposition analysis indicated that for all diseases except congenital genitourinary anomalies, the reduction in DALYs was predominantly attributable to improvements in epidemiological factors, with contribution rates ranging from 58.10% to 83.94%. Conclusions The burden of urinary system diseases among children and adolescents in China decreased markedly between 1990 and 2023, largely driven by public health initiatives and advances in clinical diagnosis and treatment. Future prevention and control strategies should prioritize the evolving disease spectrum and implement precise interventions targeting key populations, such as adolescent females, adolescent males, and infants.

A study on the latent profile analysis of psychological resilience and coping styles of parents of children with asthma and its influencing factors

CHEN Xumei, AIERKEN Aibibai, YUE Xueyan, RU Liang, ZHANG Li

Journal of Clinical Pediatrics. 2026, 44(6):  556-563.  doi:10.12372/jcp.2026.25e1127

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Objective The caregiving ability and coping level of parents are key factors influencing the control effect of childhood asthma, and parents' psychological resilience significantly affects their coping styles, which in turn has a significant impact on the control of childhood asthma. This study focuses on the potential subtypes and influencing factors of psychological resilience and coping styles of parents of children with asthma, and explores possible paths to further improve asthma control by improving parents' psychological resilience and coping styles. Methods A cross-sectional survey was conducted between February and June 2025, enrolling 236 parents of children with asthma via convenience sampling from a pediatric outpatient department. Data were collected using a general demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Simplified Coping Style Questionnaire (SCSQ). Latent profile analysis (LPA) was employed to empirically derive homogeneous subgroups based on resilience and coping scores. Multinomial logistic regression was then used to identify factors associated with subgroup membership, with the low resilience-negative coping subtype as the reference category. Results The psychological resilience and coping styles of parents of children with asthma can be classified into three types: low resilience - negative coping (22.0%), medium resilience - mixed coping (41.5%), and high resilience - positive coping (36.4%). The logistic regression analysis results showed that the significant influencing factors for the medium resilience - mixed coping type were parents' educational level (OR=1.791, 95%CI: 1.074-2.986), family monthly income (OR=2.420, 95%CI:1.256-4.663), whether they were the main caregivers (OR=2.001, 95%CI:1.074-3.586), and the frequency of attacks (OR=0.346, 95%CI:0.158-0.761). In the high resilience - positive coping type, the significant influencing factors were the age of the child (OR=4.088, 95%CI:1.320-12.662), parents' educational level (OR=1.712, 95%CI:1.051-2.789), family monthly income (OR=3.025, 95%CI:1.156-9.236), whether they were the main caregivers (OR=3.304, 95%CI:1.049-10.372), and the duration of asthma (OR=0.331, 95%CI:0.163-0.673) and the frequency of attacks (OR=0.232, 95%CI:0.105-0.513). Conclusions Parental psychological resilience and coping styles exhibit substantial heterogeneity among families of children with asthma. Targeted interventions—tailored to parental education level, household resources, caregiving role, and disease burden (exacerbation frequency, duration)—may enhance parental adaptive coping and resilience, thereby improving asthma control in children.

Analysis of clinical characteristics of children with pneumonia complicated with plastic bronchitis and establishment and validation of risk prediction model

LUO Zihao, LI Shaojun, REN Peizhen, WANG Yanhong, GENG Gang

Journal of Clinical Pediatrics. 2026, 44(6):  564-572.  doi:10.12372/jcp.2026.25e0439

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Objective To characterize the clinical features and independent risk factors for plastic bronchitis (PB) in children with pneumonia, and to develop and validate a clinically applicable nomogram for early risk stratification. Methods A retrospective analysis was conducted on the data of children hospitalized from January 2018 to January 2025, who were diagnosed with pneumonia and underwent bronchoscopy. Stratified sampling was used to divide the data into a training set and a test set at a ratio of 7∶3, ensuring that the PB incidence rate in both sets was approximately 7.0%. After collinearity analysis, variables were selected using LASSO combined with logistic regression, and then included in weighted logistic regression to establish a prediction model. A nomogram was constructed, and the model was validated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves. Results Among 2697 eligible children, 190 (7.0%) developed PB. Bootstrap aralysis of the weighted cogistic regression model identified nine independent predictors: asthma history (OR=1.67, 95% CI: 1.24-2.15, P<0.001), tachypnea (OR=2.01, 95% CI: 1.54-2.64, P<0.001), fever duration (OR=4.00, 95% CI: 3.24-5.83, P<0.001), pleural effusion (OR=1.53, 95% CI: 1.19-1.94, P<0.001), airway obstruction on CT reconstruction (OR=2.42, 95% CI: 1.77-3.87, P<0.001), neutrophil-to-lymphocyte ratio (NLR) (OR=1.63, 95% CI: 1.28-2.25, P<0.001), platelet count (OR=0.54, 95% CI: 0.33-0.72, P<0.001), fibrinogen (OR=1.48, 95% CI: 1.12-2.08, P=0.004), and D-dimer (OR=1.46, 95% CI: 1.20-1.80, P=0.006). The nomogram demonstrated good predictive performance in the test set with an AUC of =0.921,（95% CI: 0.88-0.96; P<0.05). Conclusion PB is a rare but severe complication of pediatric pneumonia, associated with distinct and quantifiable clinical and laboratory features. The validated nomogram provides a practical, interpretable, and statistically robust tool for early identification of high-risk children—enabling timely bronchoscopic evaluation and intervention.

Clinical Report

Neonatal-onset hereditary thrombotic thrombocytopenic purpura: a report of two cases

ZHU Linmin, KANG Lili, LIU Chen, HAN Yujie, YAN Beibei, XU Qun, LI Xiaomei, LI Xiaoying

Journal of Clinical Pediatrics. 2026, 44(6):  573-578.  doi:10.12372/jcp.2026.25e1558

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To delineate the clinical and genetic profile of congenital thrombotic thrombocytopenic purpura (cTTP) with neonatal onset, aiming to enhance its early recognition and management. A retrospective analysis was conducted on two cTTP neonates diagnosed at our center, combined with a systematic review of 17 previously reported neonatal-onset cases in China. Both index patients presented with thrombocytopenia, jaundice, and anemia postnatally; one required surgical intervention for intracranial hemorrhage. Genetic analysis revealed compound heterozygous ADAMTS13 Mutations (Case 1: c.330+1G>A and c.929del; Case 2: c.2185C>T and c.2017A>T). Among the total 19 neonates (including our two cases), the core clinical manifestations were a triad of jaundice (94.7%), thrombocytopenia (89.5%), and anemia (89.5%). Biallelic pathogenic ADAMTS13 gene mutations were identified in all patients, predominantly loss-of-function types (57.9%). Notably, the splice-site mutation c.330+1G>A was recurrently found in four unrelated patients. Fourteen neonates (73.7%) underwent exchange transfusion, and the overall survival rate was 89.5% (17/19). cTTP should be highly suspected in neonates presenting with the triad of thrombocytopenia, jaundice, and anemia, particularly those requiring exchange transfusion or with a history of sibling death in the neonatal period. ADAMTS13 gene analysis is pivotal for definitive diagnosis. Early initiation and consistent maintenance of plasma-based therapy or targeted recombinant ADAMTS13 replacement are fundamental for improving outcomes.

Lower extremity arterial thrombosis as first clinical manifestation in children's systemic lupus erythematosus complicated with antiphospholipid syndrome: a two-case report

CHU Weihong, XU Liyan, PENG Shao, LAI Jianming

Journal of Clinical Pediatrics. 2026, 44(6):  579-583.  doi:10.12372/jcp.2026.25e1528

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To summarize clinical characteristics, treatment and prognosis of lower extremity arterial thrombosis caused by systemic lupus erythematosus (SLE) complicated with antiphospholipid syndrome (APS) in children, and to provide diagnostic and therapeutic experience for clinicians. Two cases of lower extremity arterial thrombosis caused by SLE complicated with APS were collected.The differences in clinical characteristics, treatment plans and prognosis were compared and analyzed between two cases. Patient 1 was treated with glucocorticoids, cyclophosphamide, belimumab, intravenous immunoglobulins, hydroxychloroquine and anticoagulation drug. However, gangrene still occurred, resulting in necrosis and eventual auto-amputation of toe bones. During a follow-up of 4 years, no thrombotic events recurred. Patient 2 was treated with glucocorticoids, rituximab, hydroxychloroquine, anticoagulation drug, balloon dilation, catheter-directed thrombolysis and thrombus aspiration. The patient had a good prognosis after 9 months of follow-up. Children with SLE complicated by APS may develop lower extremity arterial thrombosis, which carries a risk of serious adverse outcomes. Early diagnosis and active treatment are crucial.

Methylmalonic acidemia with homocystinemia causing subacute combined degeneration of the spinal cord : a case report

CHEN Liuwang, LIU Pan, XI Rongjuan, ZHANG Xianxia, ZHANG Yi, WEI Xingjiao, SU Min, YANG Yonghong, FU Yangxi

Journal of Clinical Pediatrics. 2026, 44(6):  584-588.  doi:10.12372/jcp.2026.25e0982

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Methylmalonic acidemia (MMA) is a relatively common inherited organic acid disorder. However, MMA-associated subacute combined degeneration of the spinal cord (SCD) in pediatric patients remains exceedingly rare, with insidious onset and high risk of diagnostic delay or misdiagnosis. This report presents a retrospective analysis of the clinical, neuroimaging, biochemical, and genetic features of an 8-year-old boy diagnosed with cblC-type MMA-homocysteinemia who developed SCD. The patient initially presented with progressive gait ataxia and had a documented history of global developmental delay, including language and motor milestones, and was previously diagnosed with mild intellectual disability. Neurological examination revealed bilateral lower-limb muscle strength of grade IV+, mild spasticity, impaired vibration and proprioception, reduced cortical sensation, and positive Romberg and heel-knee-shin tests. Laboratory tests showed significantly elevated levels of homocysteine, propionylcarnitine, and methylmalonic acid in the blood and urine. Whole-spine magnetic resonance imaging (MRI) demonstrated diffuse abnormal signals in the posterior columns of the thoracic spinal cord at the T5-T8 levels. Genetic testing confirmed compound heterozygous variations in the MMACHC gene, c.217C>T and c.365A>T, confirming the diagnosis of cbl C type MMA combined with homocysteinemia. After treatment with L-carnitine, vitamin B₆, betaine, and folic acid, the patient's neurological symptoms and signs completely resolved, gait returned to normal, and blood homocysteine and urine methylmalonic acid levels significantly decreased. MMA combined with homocysteinemia leading to SCD is relatively rare in children. Early diagnosis can be made by combining biochemical indicators, spinal cord MRI, and MMACHC gene testing. Timely intervention for the primary disease can significantly improve clinical manifestations, including SCD.

Literature Review

Research progress and clinical implications of isavuconazole in the treatment of pediatric mucormycosis

SHI Jiena, ZHANG Junqi, SHEN Longhui

Journal of Clinical Pediatrics. 2026, 44(6):  589-594.  doi:10.12372/jcp.2026.25e0937

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Mucormycosis is an infectious disease caused by fungi in the order Mucorales. Due to its high mortality rate and limited treatment options, treating mucormycosis in children remains challenging. Isavuconazole, a novel triazole antifungal agent, has offered a new option for treating mucormycosis. Though isavuconazole has been approved for marketing in China, data on its use in pediatric mucormycosis remain extremely limited. This article reviews the research progress of isavuconazole in treating pediatric mucormycosis, introduces its mechanism of action, pharmacokinetics, and comparison with other antifungal drugs. It also analyzes the potential efficacy and safety of isavuconazole in treating pediatric mucormycosis, and discusses its dosage and administration in children and the necessity of therapeutic drug monitoring, thus providing references for the clinical use of therapeutic drugs in pediatric mucormycosis.