Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland....Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland.During November2014 to June 2016,the prospective study was conducted in 13 hospitals.The hospitalized children under 18 years old who met the criteria for CAP were enrolled.The throat swabs or nasopharyngeal aspirates(NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay.Viral pathogens were present in 56.6%(1539/2721) of the enrolled cases,with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases.The most frequently detected virus was respiratory syncytial virus(RSV)(15.2%,414/2721).The highest detection rate of virus was in <6-month-age group(70.7%,292/413).RSV,human metapneumovirus(HMPV),human parainfluenza viruses(HPIVs) and influenza B virus(Flu B) showed the similar prevalence patterns both in north and south China,but HPIVs,Flu A,human bocavirus(HBoV),human adenovirus(HAdV) and human coronaviruses(HCoVs) showed the distinct circulating patterns in north and south China.Human enterovirus/human rhinovirus(HEV/HRV)(27.6%,27/98),HBoV(18.4%,18/98),RSV(16.3%,16/98) and HMPV(14.3%,14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection.In conclusion,viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP.RSV was the most important virus in hospitalized children with CAP in Chinese mainland.展开更多
Mycoplasma pneumoniae pneumonia (MPP) becomes one of the most important health problems in China recently. Date for MPP inChinais scarce. Although macrolides and/or cortical steroids had been reported to be effective ...Mycoplasma pneumoniae pneumonia (MPP) becomes one of the most important health problems in China recently. Date for MPP inChinais scarce. Although macrolides and/or cortical steroids had been reported to be effective treatment for MPP, the long-term outcome remained uncertain. A study on status of MPP in China was conducted via a systematic review of published studies which have the Chinese data and collected from published PubMed and core journals of China Knowledge Resource Integrated Database (CNKI). The analysis was based on epidemiology, clinical characteristics, treatment, drug resistance and prognosis. Twenty five articles concerned about MPP in Chinese children and adolescent were enrolled, including 11 studies on epidemiology/etiology, 11 studies on clinical characteristics, 7 studies on drug resistance, 5 studies on treatment from China's Mainland respectively. The overall incidence of MPP ranged from 7.1% to 54.4%. Fever and cough were most frequently identified in manifestations. Drug resistance to macrolides ranged from 18.9% to 90%. The outcome of treatment in patients who received combined treatment of macrolides, cephalosporin antibiotics and/or cortical steroid seems to be better than those who received macrolides only. Macrolide combined with cephalosporin or cortical steroid both may decrease the severity of MPP in the past decade. There was not enough evidence to suggest that cortical steroid can decrease the mortality of MPP in children. And a multi-center, randomized double blind research on the effect of cortical steroid was encouraged.展开更多
Mycoplasma pneumoniae pneumonia(MPP)is the most common atypical pneumonia among children,with non-specific clinical manifestations.Despite various laboratory diagnostic methods,the diagnostic criteria remain inconsist...Mycoplasma pneumoniae pneumonia(MPP)is the most common atypical pneumonia among children,with non-specific clinical manifestations.Despite various laboratory diagnostic methods,the diagnostic criteria remain inconsistent,potentially leading to missed or overdiagnosis.The incidence of severe and refractory cases of MPP is increasing,and there are issues with non-standard treatment in clinical practice.To standardize the diagnosis and treatment of MPP in Chinese children,the Subspecialty Group of Respiratory,the Society of Pediatrics,Chinese Medical Association,China National Clinical Research Center of Respiratory Diseases and the Editorial Board of Chinese Journal of Pediatrics jointly established a guideline expert group to formulate the"Evidence-Based Guideline for the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children(2023)"based on both domestic and international research findings.展开更多
INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 mil...INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 million hospitalizations,and>100000 deaths in children under 5 years globally,with a mortality rate of up to 9%in low-resource countries,which have 99%of the global RSV mortality.1 RSV infection is associated with an increased risk of respiratory failure,admission to the ICU,mechanical ventilation,use of oxygen therapy,and death.2,3 Severe RSV-LRTI in early childhood increases the risk of long-term respiratory disorders such as repeated wheezing or asthma.展开更多
Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in ...Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in China.Among the confirmed cases,1527 were severe cases,171 had recovered and been discharged at home,and 213 died.And among these cases,a total of 28 children aged from 1 month to 17 years have been reported in China.For standardizing prevention and management of 2019-nCoV infections in children,we called up an experts' committee to formulate this experts' consensus statement.This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections.The present consensus statement summarizes current strategies on diagnosis,treatment,and prevention of 2019-nCoV infection in children.展开更多
Importance:Recurrent respiratory tract infection(RRTI)is common in children.Inappropriate RRTI treatment will lead to asthma and other diseases,thereby seriously affecting the growth and physical health of children.Im...Importance:Recurrent respiratory tract infection(RRTI)is common in children.Inappropriate RRTI treatment will lead to asthma and other diseases,thereby seriously affecting the growth and physical health of children.Immune function modulation can prevent and alleviate childhood RRTI.Yupingfeng(YPF),a patented traditional Chinese medicine(TCM),has immunomodulatory effects and is widely used in China to treat children with RRTI.Objective:To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI.Methods:This multicenter,randomized,double-blind,double-simulation,noninferiority clinical trial was conducted from January 2015 to August 2017,with an 8-week treatment period and 52-week follow-up after the drug withdrawal.Children aged 2–6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups(2:2:1 ratio)to receive YPF,pidotimod,or placebo.The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up.The secondary outcomes were reduction in the number of RRTI recurrences,effect on clinical symptoms(in accord with TCM practice),effect per symptom,and safety.The trial was registered at the Chinese Clinical Trials Registry(www.chictr.org.cn)under the unique identifier ChiCTR-IPR-15006847.Results:Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups;124,125,and 61 children in the YPF,pidotimod,and placebo groups,respectively,had completed the trial.During the follow-up,the proportion of RRTI returning to normal standard level was 73.13%,67.15%,and 38.81%with YPF,pidotimod,and placebo,respectively(P<0.0001).The proportion of cases who returned to normal standard level in the YPF group was 34.32%higher than that in the placebo group.The safety profile did not significantly differ among the groups.Interpretation:YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children,and were superior to placebo,with a high safety profile.展开更多
Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the saf...Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.展开更多
Effective prophylactic and therapeutic interventions are urgentlyneeded to address the coronavirus disease 2019(COVID-19)pandemic.Various antiviral drugs have recently been tested.Type I interferon(IFN)is a regulatory...Effective prophylactic and therapeutic interventions are urgentlyneeded to address the coronavirus disease 2019(COVID-19)pandemic.Various antiviral drugs have recently been tested.Type I interferon(IFN)is a regulatory protein involved in the innate immune response,with broad-spectrum antiviral activities and the ability to directly block viral replication and support the immune response to eliminate virus infection.Insufficient virus-induced type I IFN production is characteristic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection,because SARS-CoV-2 suppresses the IFN response by interacting with essential IFN signaling pathways.Exogenous type I IFN is recommended for treating COVID-19.Unexpectedly however,angiotensin converting enzyme-2(ACE2)receptor,which acts as a SARS-CoV-2 receptor,was shown to be stimulated by IFN,raising doubts about the suitability of IFN use.However,further studies have excluded concerns regarding IFN administration.Type I IFNs,including IFN-α1b,have been used clinically as antiviral drugs for many years and have shown strong antiviral activity against SARS-CoV-2in vitro.Preliminary clinical studies of type I IFNs,especially when delivered via aerosol inhalation,have demonstrated efficacy for the treatment and prevention of COVID-19.Randomized controlled trials of IFN for COVID-19 treatment are ongoing.展开更多
Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced multisystem inflammatory syndrome in children(MIS-C)is a life-threatening illness that has been reported in the United States and Europe.It affects m...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced multisystem inflammatory syndrome in children(MIS-C)is a life-threatening illness that has been reported in the United States and Europe.It affects multiple organ systems and often requires patient admission to an intensive care unit.Although some features of MIS-C overlap with Kawasaki disease,MIS-C is more common among older children and adolescents,more often affects cardiovascular and gastrointestinal systems,and more frequently presents with elevated inflammatory markers.Rapid and complete clinical recovery is possible in nearly all patients following immunomodulation therapy.Thus far,MIS-C pathophysiology and long-term prognosis are not sufficiently clear;further studies are needed.展开更多
With the increasing awareness of genetics in respiratory medicine and improvements in molecular diagnostic techniques,many complicated and rare diseases in respiratory medicine can be diagnosed.Most respiratory diseas...With the increasing awareness of genetics in respiratory medicine and improvements in molecular diagnostic techniques,many complicated and rare diseases in respiratory medicine can be diagnosed.Most respiratory diseases have no specific phenotype.However,the clinical spectrum of monogenic diseases in respiratory medicine varies,from pulmonary disease to other inherited disorders that involve the lung.The genes that mediate some of these diseases have been identified.Certain monogenic diseases remain poorly characterized clinically.Because of the specificity of the phenotype of respiratory disease,a future challenge will be to correlate the phenotype and genotype and understand its phenotypic variability.With the development of precision medicine,research on monogenic disorders has been intensive and vigorous.In this article,we provide a brief clinical introduction to monogenic diseases in pediatrics.展开更多
Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal...Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).展开更多
Introduction:Congenital central hypoventilation syndrome(CCHS)is a rare disorder characterized by alveolar hypoventilation and autonomic system dysregulation secondary to mutations of the PHOX2B gene.Treatment consist...Introduction:Congenital central hypoventilation syndrome(CCHS)is a rare disorder characterized by alveolar hypoventilation and autonomic system dysregulation secondary to mutations of the PHOX2B gene.Treatment consists of assisted ventilation using positive-pressure ventilators via tracheostomy,bi-level positive airway pressure(BPAP)via a noninvasive interface,negative-pressure ventilators,or diaphragm pacing.The long-term use of BPAP in younger children at home has been less frequently reported.Case presentation:We present a case of a 2-month-old infant with CCHS who was successfully managed by BPAP without the need for tracheostomy and followed up for 7 years.Conclusion:CCHS is a rare disease that manifests as nocturnal desaturation and carbon dioxide retention in early life.Noninvasive ventilation can be successfully used in young infants via an appropriate mask.展开更多
Importance: Chylothorax is the most common cause of pleural effusion in neonates and relatively rare in children. It can cause significant respiratory morbidity. Many clinical entities may contribute to chylothorax. O...Importance: Chylothorax is the most common cause of pleural effusion in neonates and relatively rare in children. It can cause significant respiratory morbidity. Many clinical entities may contribute to chylothorax. Objective: To investigate the causes and manifestations of chylothorax in infants and children in China. Methods: Case records of 107 cases with chylothorax seen in Beijing Children's Hospital from 2007 to 2017 were retrieved and analyzed; follow-up was carried out by telephone. Results: Of 107 cases, 58.9％ (63/107) were primary chylothorax (PC) and 41.1％(44/107) were secondary chylothorax (SC). Also, 36.4％ (39/107) were neonatal chylothorax (NC) and 35.5％ (38/107) were postoperative chylothorax. In PC with a verified lymphatic anomaly, there was one case of diffuse pulmonary lymphangiomatosis (DPL) and six cases of generalized lymphatic anomaly (GLA), which accounted for 6.5％ (7/107) of cases. In most patients, chylothorax was alleviated by conservative treatment based on total parenteral nutrition (TPN);13.1％ (14/107) of cases needed further surgery. In NC, the median duration of TPN was 9 days, but 10 of 20 cases who improved had recurrence upon re-introduction of a fat-free diet, which was alleviated by further TPN. The duration of hospitalization was (23 ± 14) days for congenital chylothorax. Upon long-term follow-up, except for GLA and DPL, most patients were doing well without recurrence. Interpretation: NC and postoperative chylothorax are the common subtypes. TPN is effective for most patients. Despite a prolonged and fluctuating clinical course, most patients had a good long-term prognosis.展开更多
Importance:The Coronavirus disease 2019(COVID-19)global pandemic poses a considerable challenge for pediatricians.Objective:This study aimed to identify the epidemiological characteristics and clinical features of ped...Importance:The Coronavirus disease 2019(COVID-19)global pandemic poses a considerable challenge for pediatricians.Objective:This study aimed to identify the epidemiological characteristics and clinical features of pediatric patients with COVID-19 in China.Methods:This multicenter retrospective study included pediatric patients from 46 hospitals in China,covering 12 provinces and two municipalities.Epidemiological,demographic,clinical,laboratory,treatment,and outcome data were analyzed.Results:In total,211 pediatric patients with COVID-19 were included in this study.The median age was 7.0 years(range:22 days to 18 years).Approximately 16.3%of the patients exhibited asymptomatic infections,23.0%had upper respiratory tract infections,and 60.7%had pneumonia,including two with severe pneumonia and one with critical illness.Approximately 78.7%of the pediatric patients occurred in familial clusters.The most three common symptoms or signs at onset in children with COVID-19 were fever(54.5%),cough(49.3%),and pharyngeal congestion(20.8%).Only 17.6%of the patients presented with decreased lymphocyte count,whereas 13.6%had increased lymphocyte count.Among the patients with pneumonia who exhibited abnormal chest computed tomography findings,18.2%(23/127)of the patients had no other symptoms.Generally,the chest radiographs showed abnormalities that affected both lungs(49.6%);ground-glass opacity(47.2%)was the most common manifestation.The cure and improvement rates were 86.7%(183/211)and 13.3%(28/211),respectively.Only one patient with an underlying condition received invasive mechanical ventilation;none of the patients died.Interpretation:Similar to adults,children of all age groups are susceptible to COVID-19.Fortunately,most pediatric patients have mild symptoms or remain asymptomatic,despite the high incidence of pneumonia.Decreased proportions of white blood cells and lymphocytes are less frequent in children than in adults.展开更多
Congenital chylothorax(CCT)is the most prevalent form of pleural effusion in the first few days of life.1 It is a rare condition that results from thoracic duct damage with chyle leakage from the lymphatic system into...Congenital chylothorax(CCT)is the most prevalent form of pleural effusion in the first few days of life.1 It is a rare condition that results from thoracic duct damage with chyle leakage from the lymphatic system into the pleural space,with complications including malnutrition,immunosuppression,and respiratory distress,2 resulting in complicated clinical course and high mortality.The medium-chain triglycerides formulas or total parenteral nutrition,octreotide,and surgical interventions are main clinical choices for treatment.展开更多
As the coronavirus disease 2019(COVID-19)pandemic struck the entire world,our health systems,global economy,and humanity have been put to a test that was never seen before.By September 1,2020 when this article was sub...As the coronavirus disease 2019(COVID-19)pandemic struck the entire world,our health systems,global economy,and humanity have been put to a test that was never seen before.By September 1,2020 when this article was submitted,COVID-19 has infected over 25 million people worldwide,and resulted in a total mortality of more than 856555(https://covid19.who.int).The actions taken by global medical professionals,health agencies and organizations,governments,etc.,can directly impact the health,safety,and wellbeing of our lives,including lives of our most vulnerable population,children.展开更多
To the editor:I would like to thank Bellini and colleagues1 for their thoughtful insight into our previous work.2 The role of the lymphatic system is crucial on the physiological and pathophysiological dynamics of ple...To the editor:I would like to thank Bellini and colleagues1 for their thoughtful insight into our previous work.2 The role of the lymphatic system is crucial on the physiological and pathophysiological dynamics of pleural effusion of chylothorax in the newborn.Usually,the precise disorder of lymphatic system was not revealed in the neonatal chylothorax,as almost all the cases had an excellent prognosis without recurrence by conservative treatment,as also shown in our data.However,the seven cases affected by congenital lymphatic malformations diagnosed as generalized lymphatic anomaly(GLA)or diffuse pulmonary lymphangiomatosis(DPL),seem not to be the same entity with chylothorax in the newborn.展开更多
基金This study was supported by National Science and Technology Supported Projects(grant number:2013BAI09B11)the National Major Science&Technology Project for Control and Prevention of Major Infectious Diseases in China(grant number:2018ZX10201002-008-008,2017ZX10103004-004)。
文摘Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland.During November2014 to June 2016,the prospective study was conducted in 13 hospitals.The hospitalized children under 18 years old who met the criteria for CAP were enrolled.The throat swabs or nasopharyngeal aspirates(NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay.Viral pathogens were present in 56.6%(1539/2721) of the enrolled cases,with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases.The most frequently detected virus was respiratory syncytial virus(RSV)(15.2%,414/2721).The highest detection rate of virus was in <6-month-age group(70.7%,292/413).RSV,human metapneumovirus(HMPV),human parainfluenza viruses(HPIVs) and influenza B virus(Flu B) showed the similar prevalence patterns both in north and south China,but HPIVs,Flu A,human bocavirus(HBoV),human adenovirus(HAdV) and human coronaviruses(HCoVs) showed the distinct circulating patterns in north and south China.Human enterovirus/human rhinovirus(HEV/HRV)(27.6%,27/98),HBoV(18.4%,18/98),RSV(16.3%,16/98) and HMPV(14.3%,14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection.In conclusion,viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP.RSV was the most important virus in hospitalized children with CAP in Chinese mainland.
文摘Mycoplasma pneumoniae pneumonia (MPP) becomes one of the most important health problems in China recently. Date for MPP inChinais scarce. Although macrolides and/or cortical steroids had been reported to be effective treatment for MPP, the long-term outcome remained uncertain. A study on status of MPP in China was conducted via a systematic review of published studies which have the Chinese data and collected from published PubMed and core journals of China Knowledge Resource Integrated Database (CNKI). The analysis was based on epidemiology, clinical characteristics, treatment, drug resistance and prognosis. Twenty five articles concerned about MPP in Chinese children and adolescent were enrolled, including 11 studies on epidemiology/etiology, 11 studies on clinical characteristics, 7 studies on drug resistance, 5 studies on treatment from China's Mainland respectively. The overall incidence of MPP ranged from 7.1% to 54.4%. Fever and cough were most frequently identified in manifestations. Drug resistance to macrolides ranged from 18.9% to 90%. The outcome of treatment in patients who received combined treatment of macrolides, cephalosporin antibiotics and/or cortical steroid seems to be better than those who received macrolides only. Macrolide combined with cephalosporin or cortical steroid both may decrease the severity of MPP in the past decade. There was not enough evidence to suggest that cortical steroid can decrease the mortality of MPP in children. And a multi-center, randomized double blind research on the effect of cortical steroid was encouraged.
基金Clinical and Translational Medicine Research Project of Chinese Academy of Medical Sciences,Grant/Award Number:2023-I2M-C&T-A-015High-Level Public Health Technical Personnel Training Plan of Beijing Municipal Health Commission,Grant/Award Number:2022-2-023+1 种基金Beijing Research Ward Construction Demonstration Unit Project,Grant/Award Number:BCRW202101Beijing Research Center for Respiratory Infectious Diseases Project,Grant/Award Number:BJRID2024-013
文摘Mycoplasma pneumoniae pneumonia(MPP)is the most common atypical pneumonia among children,with non-specific clinical manifestations.Despite various laboratory diagnostic methods,the diagnostic criteria remain inconsistent,potentially leading to missed or overdiagnosis.The incidence of severe and refractory cases of MPP is increasing,and there are issues with non-standard treatment in clinical practice.To standardize the diagnosis and treatment of MPP in Chinese children,the Subspecialty Group of Respiratory,the Society of Pediatrics,Chinese Medical Association,China National Clinical Research Center of Respiratory Diseases and the Editorial Board of Chinese Journal of Pediatrics jointly established a guideline expert group to formulate the"Evidence-Based Guideline for the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children(2023)"based on both domestic and international research findings.
文摘INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 million hospitalizations,and>100000 deaths in children under 5 years globally,with a mortality rate of up to 9%in low-resource countries,which have 99%of the global RSV mortality.1 RSV infection is associated with an increased risk of respiratory failure,admission to the ICU,mechanical ventilation,use of oxygen therapy,and death.2,3 Severe RSV-LRTI in early childhood increases the risk of long-term respiratory disorders such as repeated wheezing or asthma.
文摘Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Wuhan City,China,by January 30,2020,a total of 9692 confirmed cases and 15,238 suspected cases have been reported around 31 provinces or cities in China.Among the confirmed cases,1527 were severe cases,171 had recovered and been discharged at home,and 213 died.And among these cases,a total of 28 children aged from 1 month to 17 years have been reported in China.For standardizing prevention and management of 2019-nCoV infections in children,we called up an experts' committee to formulate this experts' consensus statement.This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections.The present consensus statement summarizes current strategies on diagnosis,treatment,and prevention of 2019-nCoV infection in children.
文摘Importance:Recurrent respiratory tract infection(RRTI)is common in children.Inappropriate RRTI treatment will lead to asthma and other diseases,thereby seriously affecting the growth and physical health of children.Immune function modulation can prevent and alleviate childhood RRTI.Yupingfeng(YPF),a patented traditional Chinese medicine(TCM),has immunomodulatory effects and is widely used in China to treat children with RRTI.Objective:To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI.Methods:This multicenter,randomized,double-blind,double-simulation,noninferiority clinical trial was conducted from January 2015 to August 2017,with an 8-week treatment period and 52-week follow-up after the drug withdrawal.Children aged 2–6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups(2:2:1 ratio)to receive YPF,pidotimod,or placebo.The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up.The secondary outcomes were reduction in the number of RRTI recurrences,effect on clinical symptoms(in accord with TCM practice),effect per symptom,and safety.The trial was registered at the Chinese Clinical Trials Registry(www.chictr.org.cn)under the unique identifier ChiCTR-IPR-15006847.Results:Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups;124,125,and 61 children in the YPF,pidotimod,and placebo groups,respectively,had completed the trial.During the follow-up,the proportion of RRTI returning to normal standard level was 73.13%,67.15%,and 38.81%with YPF,pidotimod,and placebo,respectively(P<0.0001).The proportion of cases who returned to normal standard level in the YPF group was 34.32%higher than that in the placebo group.The safety profile did not significantly differ among the groups.Interpretation:YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children,and were superior to placebo,with a high safety profile.
基金Special Fund of the Pediatric Medical Coordinated Development Center of Beijing Municipal Administration,No.XTZD20180105.
文摘Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.
文摘Effective prophylactic and therapeutic interventions are urgentlyneeded to address the coronavirus disease 2019(COVID-19)pandemic.Various antiviral drugs have recently been tested.Type I interferon(IFN)is a regulatory protein involved in the innate immune response,with broad-spectrum antiviral activities and the ability to directly block viral replication and support the immune response to eliminate virus infection.Insufficient virus-induced type I IFN production is characteristic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection,because SARS-CoV-2 suppresses the IFN response by interacting with essential IFN signaling pathways.Exogenous type I IFN is recommended for treating COVID-19.Unexpectedly however,angiotensin converting enzyme-2(ACE2)receptor,which acts as a SARS-CoV-2 receptor,was shown to be stimulated by IFN,raising doubts about the suitability of IFN use.However,further studies have excluded concerns regarding IFN administration.Type I IFNs,including IFN-α1b,have been used clinically as antiviral drugs for many years and have shown strong antiviral activity against SARS-CoV-2in vitro.Preliminary clinical studies of type I IFNs,especially when delivered via aerosol inhalation,have demonstrated efficacy for the treatment and prevention of COVID-19.Randomized controlled trials of IFN for COVID-19 treatment are ongoing.
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)-induced multisystem inflammatory syndrome in children(MIS-C)is a life-threatening illness that has been reported in the United States and Europe.It affects multiple organ systems and often requires patient admission to an intensive care unit.Although some features of MIS-C overlap with Kawasaki disease,MIS-C is more common among older children and adolescents,more often affects cardiovascular and gastrointestinal systems,and more frequently presents with elevated inflammatory markers.Rapid and complete clinical recovery is possible in nearly all patients following immunomodulation therapy.Thus far,MIS-C pathophysiology and long-term prognosis are not sufficiently clear;further studies are needed.
文摘With the increasing awareness of genetics in respiratory medicine and improvements in molecular diagnostic techniques,many complicated and rare diseases in respiratory medicine can be diagnosed.Most respiratory diseases have no specific phenotype.However,the clinical spectrum of monogenic diseases in respiratory medicine varies,from pulmonary disease to other inherited disorders that involve the lung.The genes that mediate some of these diseases have been identified.Certain monogenic diseases remain poorly characterized clinically.Because of the specificity of the phenotype of respiratory disease,a future challenge will be to correlate the phenotype and genotype and understand its phenotypic variability.With the development of precision medicine,research on monogenic disorders has been intensive and vigorous.In this article,we provide a brief clinical introduction to monogenic diseases in pediatrics.
文摘Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).
基金The Special Fund of the Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority,No.XTYB201807Sanming Project of Medicine in Shenzhen,No.SZSM201512030.
文摘Introduction:Congenital central hypoventilation syndrome(CCHS)is a rare disorder characterized by alveolar hypoventilation and autonomic system dysregulation secondary to mutations of the PHOX2B gene.Treatment consists of assisted ventilation using positive-pressure ventilators via tracheostomy,bi-level positive airway pressure(BPAP)via a noninvasive interface,negative-pressure ventilators,or diaphragm pacing.The long-term use of BPAP in younger children at home has been less frequently reported.Case presentation:We present a case of a 2-month-old infant with CCHS who was successfully managed by BPAP without the need for tracheostomy and followed up for 7 years.Conclusion:CCHS is a rare disease that manifests as nocturnal desaturation and carbon dioxide retention in early life.Noninvasive ventilation can be successfully used in young infants via an appropriate mask.
文摘Importance: Chylothorax is the most common cause of pleural effusion in neonates and relatively rare in children. It can cause significant respiratory morbidity. Many clinical entities may contribute to chylothorax. Objective: To investigate the causes and manifestations of chylothorax in infants and children in China. Methods: Case records of 107 cases with chylothorax seen in Beijing Children's Hospital from 2007 to 2017 were retrieved and analyzed; follow-up was carried out by telephone. Results: Of 107 cases, 58.9％ (63/107) were primary chylothorax (PC) and 41.1％(44/107) were secondary chylothorax (SC). Also, 36.4％ (39/107) were neonatal chylothorax (NC) and 35.5％ (38/107) were postoperative chylothorax. In PC with a verified lymphatic anomaly, there was one case of diffuse pulmonary lymphangiomatosis (DPL) and six cases of generalized lymphatic anomaly (GLA), which accounted for 6.5％ (7/107) of cases. In most patients, chylothorax was alleviated by conservative treatment based on total parenteral nutrition (TPN);13.1％ (14/107) of cases needed further surgery. In NC, the median duration of TPN was 9 days, but 10 of 20 cases who improved had recurrence upon re-introduction of a fat-free diet, which was alleviated by further TPN. The duration of hospitalization was (23 ± 14) days for congenital chylothorax. Upon long-term follow-up, except for GLA and DPL, most patients were doing well without recurrence. Interpretation: NC and postoperative chylothorax are the common subtypes. TPN is effective for most patients. Despite a prolonged and fluctuating clinical course, most patients had a good long-term prognosis.
基金This study was supported by CAMS Innovation Fund for Medical Sciences(CIFMS,2019-12M-5-0262020-I2M-C&T-B-098).
文摘Importance:The Coronavirus disease 2019(COVID-19)global pandemic poses a considerable challenge for pediatricians.Objective:This study aimed to identify the epidemiological characteristics and clinical features of pediatric patients with COVID-19 in China.Methods:This multicenter retrospective study included pediatric patients from 46 hospitals in China,covering 12 provinces and two municipalities.Epidemiological,demographic,clinical,laboratory,treatment,and outcome data were analyzed.Results:In total,211 pediatric patients with COVID-19 were included in this study.The median age was 7.0 years(range:22 days to 18 years).Approximately 16.3%of the patients exhibited asymptomatic infections,23.0%had upper respiratory tract infections,and 60.7%had pneumonia,including two with severe pneumonia and one with critical illness.Approximately 78.7%of the pediatric patients occurred in familial clusters.The most three common symptoms or signs at onset in children with COVID-19 were fever(54.5%),cough(49.3%),and pharyngeal congestion(20.8%).Only 17.6%of the patients presented with decreased lymphocyte count,whereas 13.6%had increased lymphocyte count.Among the patients with pneumonia who exhibited abnormal chest computed tomography findings,18.2%(23/127)of the patients had no other symptoms.Generally,the chest radiographs showed abnormalities that affected both lungs(49.6%);ground-glass opacity(47.2%)was the most common manifestation.The cure and improvement rates were 86.7%(183/211)and 13.3%(28/211),respectively.Only one patient with an underlying condition received invasive mechanical ventilation;none of the patients died.Interpretation:Similar to adults,children of all age groups are susceptible to COVID-19.Fortunately,most pediatric patients have mild symptoms or remain asymptomatic,despite the high incidence of pneumonia.Decreased proportions of white blood cells and lymphocytes are less frequent in children than in adults.
文摘Congenital chylothorax(CCT)is the most prevalent form of pleural effusion in the first few days of life.1 It is a rare condition that results from thoracic duct damage with chyle leakage from the lymphatic system into the pleural space,with complications including malnutrition,immunosuppression,and respiratory distress,2 resulting in complicated clinical course and high mortality.The medium-chain triglycerides formulas or total parenteral nutrition,octreotide,and surgical interventions are main clinical choices for treatment.
文摘As the coronavirus disease 2019(COVID-19)pandemic struck the entire world,our health systems,global economy,and humanity have been put to a test that was never seen before.By September 1,2020 when this article was submitted,COVID-19 has infected over 25 million people worldwide,and resulted in a total mortality of more than 856555(https://covid19.who.int).The actions taken by global medical professionals,health agencies and organizations,governments,etc.,can directly impact the health,safety,and wellbeing of our lives,including lives of our most vulnerable population,children.
文摘To the editor:I would like to thank Bellini and colleagues1 for their thoughtful insight into our previous work.2 The role of the lymphatic system is crucial on the physiological and pathophysiological dynamics of pleural effusion of chylothorax in the newborn.Usually,the precise disorder of lymphatic system was not revealed in the neonatal chylothorax,as almost all the cases had an excellent prognosis without recurrence by conservative treatment,as also shown in our data.However,the seven cases affected by congenital lymphatic malformations diagnosed as generalized lymphatic anomaly(GLA)or diffuse pulmonary lymphangiomatosis(DPL),seem not to be the same entity with chylothorax in the newborn.
