This article reviewed the Consensus Recommendations on Pediatric Acute Respiratory Distress Syndrome (ARDS) from the Pediatric Acute Lung Injury Consensus Conference in 2015 and the literature related to drug management of ARDS. The main points of drug management of pediatric ARDS were summarized.

The children with acute respiratory distress syndrome (ARDS) usually require ventilatory support treatment. At present, lung protective ventilation strategy is recommended for the treatment of ARDS. Extracorporeal membrane oxygenation (ECMO) can improve oxygenation and remove carbon dioxide by extracorporeal circuit, and can partially or completely take over cardiopulmonary function. ECMO support showed many advantages in treating severe ARDS, such as reducing ventilator-induced lung injury and correcting hypoxemia. Over the past few years, there has been an increase in the use of ECMO for ARDS in children. This paper reviews the applications of ECMO for the treatment of ARDS in children.

The application of small tidal volume and the limitation of airway pressure during mechanical ventilation in acute respiratory distress syndrome (ARDS) are well accepted. Lung recruitment and positive end-expiratory pressure (PEEP) titration can improve oxygenation and protect the lungs. However, the approaches of lung recruitment and PEEP titration remain controversial. This article reviews the lung recruitment maneuvers and PEEP titration in children with ARDS.

Acute respiratory distress syndrome (ARDS) is a common critical illness in children and has high incidence and mortality rates among critically ill pediatric patients. Noninvasive ventilation has become a common treatment method for ARDS because of its unique features. This article reviews the research status in the application of noninvasive ventilation in children with ARDS.

Pediatric acute respiratory distress syndrome (ARDS) is an important cause of deaths in critically ill children admitted to the pediatric intensive care unit. Although lung-protective ventilation improves the prognosis of pediatric ARDS, the mortality rate of children with moderate or severe ARDS is still high. Given that the epidemiology, treatment, and prognosis of pediatric ARDS are different from those of adult ARDS, pediatric ARDS was first defined in the 2015 Pediatric Acute Lung Injury Consensus Conference. Early diagnosis and appropriate clinical management of ARDS are still great challenges for pediatric critical care medicine. This paper focuses on the definition, epidemiology, and management of pediatric ARDS.

Acute respiratory distress syndrome (ARDS) is a common clinical critical disease and is one of the main causes of death and disability in neonates. The etiology and pathogenesis of neonatal ARDS are complicated. It is an acute pulmonary inflammatory disease caused by the lack of pulmonary surfactant (PS) related to various pathological factors. It is difficult to distinguish neonatal ARDS from other diseases. At present, there is no specific treatment method for this disease. Respiratory support, PS replacement, extracorporeal membrane oxygenation, nutrition support and liquid management are main treatment strategies. This paper reviews the research advance in etiology, clinical characteristics, diagnosis and treatment strategies of neonatal ARDS.

Objective To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS). Methods Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV+VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration (from onset of weaning to extubation), duration of nasal continuous positive airway pressure (NCPAP) after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and the mortality rate were compared between the two groups. Results The PSV+VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group (P < 0.05). There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups (P > 0.05). Conclusions For preterm infants with RDS, the PSV+VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.

Objective To study the value of transesophageal atrial pacing (TEAP) in neonates with tachyarrhythmia. Methods The clinical data of 26 neonates with tachyarrhythmia who underwent TEAP electrophysiological examination or cardioversion were collected. Results Of the 26 neonates, 15(58%) were diagnosed with atrioventricular reentrant tachycardia, 3(12%) were diagnosed with sinus tachycardia, 3(12%) were diagnosed with ventricular tachycardia, 2(8%) were diagnosed with fast/slow atrioventricular nodal reentrant tachycardia, 2(8%) were diagnosed with atrial tachycardia, and 1(4%) was diagnosed with sinus tachycardia with ventricular preexcitation. Overdrive suppression was performed for 22 neonates, among whom 18 achieved successful cardioversion, and 2 with atrial tachycardia and 2 with ventricular tachycardia failed to restore sinus rhythm. Conclusions TEAP is helpful to the diagnosis of tachyarrhythmia in neonates and can bring about a high rate of cardioversion success.

Objective To investigate the value of simultaneous amplification and testing (SAT) in the early diagnosis of Mycoplasma pneumoniae pneumonia (MPP) in children and related influencing factors. Methods A total of 526 children with community-acquired pneumonia who were hospitalized between December 2016 and December 2017 were enrolled. Particle agglutination was used to measure serum Mycoplasma pneumoniae (MP) antibody (MP-Ab). The value of SAT in the diagnosis of MPP was evaluated based on these results. Results Based on the results of serum MP-Ab measurement, 165 children were diagnosed with MPP. MP-SAT had a sensitivity of 90.9% (150/165), a specificity of 97.9% (368/376), and high accuracy (Youden index=0.89) in the diagnosis of MPP, suggesting that there was good consistency between these two methods (Kappa=0.90). The diagnostic sensitivity of MP-SAT in children with a short course of disease was significantly higher than that in children with a long course of disease (P=0.031). The diagnostic sensitivity of MP-SAT was significantly higher than that of single serum MP-Ab measurement (P=0.018), with poor consistency between these two methods (Kappa=0.039). MP-SAT had good consistency with double serum MP-Ab measurement (Kappa=0.91). The multivariate logistic regression analysis showed that course of disease (≥ 7 days) and out-of-hospital macrolide treatment were the main factors influencing the results of MP-SAT (P < 0.05). Conclusions MP-SAT has high value in the early diagnosis of MPP and can effectively cover the shortage of single serum MP-Ab test in the acute stage and thus provide help for early clinical diagnosis. MP-SAT test should be performed in the early stage of the disease (< 7 days) and before the application of macrolide treatment.

Objective To investigate the expression of the NLRP3 inflammasome signaling pathway in peripheral blood and its significance in children with Mycoplasma pneumoniae pneumonia (MPP). Methods According to the severity, 147 children with MPP were divided into mild group with 83 children and severe group with 64 children. According to the stage of disease, the children were divided into acute group with 77 children and recovery stage with 70 children. A total of 50 healthy children were enrolled as the control group. Quantitative real-time PCR was used to measure the mRNA expression of NLRP3, ASC, and caspase-1. ELISA was used to measure the serum levels of interleukin-1β (IL-1β) and interleukin-18 (IL-18). Results Compared with the control group, the children with MMP had significantly higher relative mRNA expression levels of NLRP3, ASC, and caspase-1 in peripheral blood and serum levels of IL-1β and IL-18 (P < 0.05). Compared with the control group, both mild and severe groups had significantly higher relative mRNA expression levels of NLRP3, ASC, and caspase-1 in peripheral blood and serum levels of IL-1β and IL-18 (P < 0.05). The severe group had significantly higher levels of above mentioned parameters than the mild group (P < 0.05). Both acute group and recovery group had significantly higher relative mRNA expression levels of NLRP3, ASC, and caspase-1 in peripheral blood and serum levels of IL-1β and IL-18 than the control group (P < 0.05). The acute group had significantly higher levels of above mentioned parameters than the recovery group (P < 0.05). The relative expression level of NLRP3 was positively correlated with the relative mRNA expression levels of ASC and caspase-1 and the serum levels of IL-1β and IL-18 (r=0.701, 0.717, 0.676, and 0.645 respectively; P < 0.05). Conclusions The NLRP3 inflammasome signaling pathway might be involved in the pathogenesis of MPP in children and is closely associated with the severity and course of the disease.

Objective To investigate the association between intestinal bifidobacteria and allergic diseases in infants by comparing the composition of intestinal bifidobacteria between healthy infants and infants with allergic diseases. Methods A total of 48 infants were enrolled, and fecal samples were collected on days 0, 2, 7, and 15 and at months 1, 6, and 12 after birth. Among these infants, 22 who experienced allergic diseases before the age of 1 year were enrolled as allergic group and 26 healthy infants were enrolled as healthy group. Quantitative real-time PCR was used for the qualitative and quantitative analyses of Bifidobacterium and 8 species of bifidobacteria in fecal samples. Results There was a difference in the composition of intestinal bifidobacteria between the two groups within 1 month after birth:the healthy group showed a reduction in bifidobacteria on day 2, while this feature was not observed in the allergic group. Compared with the healthy group, the allergic group had a significantly lower detection count of Bifidobacterium at month 1 (P < 0.05) and a significantly lower detection rate of B.breve on day 15 (P < 0.05), with delayed colonization of B.infantis. Conclusions Intestinal bifidobacteria and their composition within 1 month after birth may be associated with the development of allergic diseases, and this period of time may be a critical period for the prevention and treatment of allergic diseases in infants.

Objective To study the effect of vitamin D (VitD) deficiency on cardiac autonomic nerve function in obese pre-school children. Methods A total of 242 pre-school children with simple obesity were enrolled, and according to the serum 25-(OH) VitD level, they were divided into VitD deficiency group (76 children), VitD insufficiency group (83 children), and VitD sufficiency group (83 children). The three groups were compared in terms of deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heart rate variability (HRV). The correlations of VitD level with DC, AC, and HRV were analyzed for the VitD insufficiency and VitD deficiency groups. Results The VitD deficiency group had the lowest DC, root mean square of successive differences between adjacent RR intervals (RMSSD), and low-frequency power (LF) and the highest AC (P < 0.05). The VitD insufficiency group had significantly lower DC, RMSSD, and LF and significantly higher AC compared with the VitD sufficiency group (P < 0.05). The VitD deficiency group had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and high-frequency power (HF) than the VitD sufficiency group (P < 0.05). In the VitD deficiency group, VitD level was positively correlated with DC, SDNN, standard deviation of average normal-to-normal RR intervals, RMSSD, LF, and HF and was negatively correlated with AC (P < 0.05). In the VitD insufficiency group, VitD level was negatively correlated with AC (P < 0.05). Conclusions Obese pre-school children with VitD insufficiency or deficiency have cardiac autonomic dysfunction, and cardiac vagal tone decreases with the reduction in VitD level.

Progressive familial intrahepatic cholestasis type Ⅱ (PFIC-2) is an autosomal recessive disorder caused by biallelic variants of ABCB11 gene. This paper reports the clinical and laboratory features of a pediatric patient with PFIC-2. The patient was a 2.4-month-old male infant with jaundice and hepatomegaly as the main clinical manifestations. The serum levels of total bilirubin, direct bilirubin and total bile acids were increased, while the serum γ-glutamyl transpeptidase (GGT) level was normal. Next generation sequencing revealed two missense variants, c.1493T > C(p.Ile498Thr) and c.1502T > G(p.Val501Gly), in the ABCB11 gene of the patient, which were inherited from his father and mother, respectively. The latter was a novel variant which was predicted to be pathogenic by using a variety of bioinformatic tools, and the affected p.Val501 residue was highly conserved in 112 homologous peptides.

Congenital muscular dystrophy type 1C (MDC1C) is caused by the homozygous or compound heterozygous mutations of the FKRP gene. This article reported the clinical and mutation features of a child with MDC1C. The boy aged 8 months visited the hospital due to delayed development. As for clinical manifestations, the boy could not turn over or sit stably by himself, and there was a significant reduction in muscle tension; biceps reflex in both upper extremities and patellar tendon reflex and Achilles tendon reflex in both lower extremities could not be induced. The boy also had a stereotyped facial expression and strabismus. Gene detection revealed c.350C > G and c.1303C > T compound heterozygous mutations in the FKRP gene. The c.350C > G mutation came from the mother and had been reported as a pathogenic missense mutation. The c.1303C > T mutation came from the father and was a new missense mutation, and a bioinformatics analysis showed that it might be a pathogenic mutation. The boy was diagnosed with MDC1C with reference to the clinical features of hypotonia and motor developmental delay and FKRP gene mutation sequencing.

Both of genetic and environmental factors play important roles in the pathogenesis of attention deficit hyperactivity disorder (ADHD), and genetic factors can increase the susceptibility of individuals to environmental risk factors. There are extensive and various structural and functional abnormalities of the brain in patients with ADHD. Given the close functional relationship between brain areas, exploration has also been expanded to the dysfunction of brain network in recent years. As for the biochemical mechanism underlying ADHD, monoamine neurotransmitters are still most valued, and abnormalities of brain-derived neurotrophic factors and glutamic acid/γ-aminobutyric acid imbalance may also be present. Due to the abnormal neuroendocrine function and connectivity between brain areas caused by the synergistic effect of genetic and environmental factors, the prefrontal cortex loses control of the lower brain areas, so that the basal ganglia and amygdala affect normal behavioral and emotional reactions. Dysfunction of the endocrine axes may further aggravate neuroendocrine disorder. The above process may eventually lead to changes in brain structure and function, which may be associated with the development of ADHD. However, considering the heterogeneity of ADHD, its pathological process may not be the same, and the exact mechanism needs to be further clarified.