CJCP
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2020 Vol.  22 No.  7
Published: 2020-07-25

RARE DISEASE RESEARCH
EXPERT FORUM
CLINICAL RESEARCH
EXPERIMENTAL RESEARCH
CASE REPORT
EXPERT FORUM
677 JIAO Fu-Yong
Kawasaki disease-a new manifestation of COVID-19 in children Hot!

Since the outbreak of coronavirus disease 2019 (COVID-19) in Europe and America, the incidence of Kawasaki disease has significantly increased, which has aroused concern among pediatricians and parents. COVID-19 can cause inflammation reactions of multiple organs, which is similar to the systemic vasculitis of Kawasaki disease, and even COVID-19 can cause skin rash on the extremities of the limbs, which is also similar to Kawasaki disease. The cause of Kawasaki disease is currently unclear, and it cannot be ruled out that COVID-19 is associated with an increased incidence of Kawasaki disease. Therefore, during the epidemic of COVID-19, if children have symptoms similar to Kawasaki disease, intravenous immunoglobulin is recommended as early as possible to reduce the incidence of coronary artery lesions.

2020 Vol. 22 (7): 677-678 [Abstract] ( 4535 ) [HTML 1KB] [PDF 970KB] ( 1243 )
679 YAO Kai-Hu, SHI Wei, YUAN Lin, GAO Wei
A comparative analysis of the Chinese and English descriptions of typical pertussis manifestations and recommendations for the diagnosis of pertussis-like or pertussis syndrome

The Chinese and English names of pertussis or whooping cough show the important clinical features of the disease in terms of its course and cough characteristics respectively. In the clinical description of typical pertussis, the meanings of the Chinese and English words are not completely consistent, such as spastic cough versus paroxysmal cough, spasmodic stage/phase versus paroxysmal stage/phase, and "back-hook" versus whoop, and some descriptions in English are not seen in Chinese. This article aims to provide more comprehensive information for the understanding of pertussis by comparing the descriptions of typical clinical manifestations of pertussis in Chinese and English literatures and to put forward suggestions for the diagnosis of pertussis syndrome based on typical clinical manifestations.

2020 Vol. 22 (7): 679-683 [Abstract] ( 2853 ) [HTML 1KB] [PDF 1055KB] ( 841 )
CLINICAL RESEARCH
684 HE Ting, LIAO Zheng-Chang, DING Ying, WANG Ming-Jie, LI Wen, GAN Ji-Min, YUE Shao-Jie
Comparison of the efficacy of domestic and imported caffeine citrate in the treatment of apnea in preterm infants: a prospective randomized double-blind controlled trial

Objective To compare the efficacy of domestic and imported caffeine citrate in the treatment of apnea in preterm infants. Methods A total of 98 preterm infants with a gestational age of 28- < 34 weeks between April 2018 and December 2019 were enrolled. They were randomly administered with domestic (n=48) or imported caffeine citrate (n=50) within 6 hours after birth. The therapeutic effects, complications, adverse effects and clinical outcomes were compared between the two groups. Results There were no significant differences in the incidence of apnea within 7 days after birth, daily frequency of apnea, the time of apnea disappearance, the failure rate of intubation-surfactant-extubation strategy, the time of non-invasive assisted ventilation, the duration of oxygen therapy, the duration of caffeine citrate therapy, the length of hospital stay, blood gas analysis results, liver and kidney function testing results between the two groups (P > 0.05). There were no significant differences in the incidence of complications and the mortality rate between the two groups (P > 0.05). There was no significant difference in the incidence of adverse effects between the two groups (P > 0.05). Conclusions The efficacy and safety of domestic caffeine citrate in the treatment of apnea are similar to those of imported caffeine citrate in preterm infants.

2020 Vol. 22 (7): 684-689 [Abstract] ( 2941 ) [HTML 1KB] [PDF 543KB] ( 998 )
690 LI Qian-Qian, DONG Xiao-Yue, QIAO Yu, YIN Yu-Jie, GAO Yan, ZHOU Jin-Jun, YANG Li, ZHU Rong-Ping, WANG Fu-Dong, WAN Jun, XU Yan, PAN Zhao-Jun, WANG Wei-Yuan, YAN Jun-Mei, HAN Shu-Ping, LU Hong-Yan, HU Yu-Hua, LI Shuang-Shuang, WANG Jin-Xiu, WU Ming-Fu, WANG Jun, DENG Xiao-Yi, YU Zhang-Bin
An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China

Objective To investigate the incidence of severe neonatal hyperbilirubinemia and the management on the treatment and follow-up of this disease in Jiangsu Province, China. Methods The neonates with severe hyperbilirubinemia who were admitted to 13 hospitals in Jiangsu Province from January to December, 2018, were enrolled as subjects. A retrospective analysis was performed on their mediacal data and follow-up data. Results In 2018, 740 neonates with severe hyperbilirubinemia were reported from the 13 hospitals in Jiangsu Province, accounting for 2.70% (740/27 386) of the total number of neonates admitted to the department of neonatology. Among these neonates, 620 (83.8%) had severe hyperbilirubinemia, 106 (14.3%) had extremely severe hyperbilirubinemia, and 14 (1.9%) had hazardous hyperbilirubinemia. Four neonates (0.5%) were diagnosed with acute bilirubin encephalopathy. A total of 484 neonates (65.4%) were readmitted due to severe hyperbilirubinemia after discharge from the delivery institution, with a median age of 7 days, among whom 214 (44.2%) were followed up for jaundice at the outpatient service before readmission, with a median age of 6 days at the first time of outpatient examination. During hospitalization, 211 neonates (28.5%) underwent cranial MRI examinations, among whom 85 (40.3%) had high T1WI signal in the bilateral basal ganglia and the globus pallidus; 238 neonates (32.2%) underwent brainstem auditory evoked potential examinations, among whom 14 (5.9%) passed only at one side and 7 (2.9%) failed at both sides. The 17 neonates with acute bilirubin encephalopathy or hazardous hyperbilirubinemia were followed up. Except one neonate was lost to follow-up, and there were no abnormal neurological symptoms in the other neonates. Conclusions Neonates with severe hyperbilirubinemia account for a relatively high proportion of the total number of neonates in the department of neonatology. Jaundice monitoring and management after discharge from delivery institutions need to be strengthened. For neonates with severe hyperbilirubinemia, relevant examinations should be carried out more comprehensively during hospitalization and these neonates should be followed up comprehensively and systematically after discharge.

2020 Vol. 22 (7): 690-695 [Abstract] ( 2877 ) [HTML 1KB] [PDF 1167KB] ( 873 )
696 WANG You-Ping, FENG Jin-Nan, LI Zhen-Yu, LYU Xiao-Ming, JIANG Qing-Lei, WU Hui
Reference ranges of platelet and related parameters within 24 hours after birth in preterm infants with different gestational ages

Objective To study the reference ranges of platelet and related parameters within 24 hours after birth in preterm infants with different gestational ages. Methods According to the inclusion and exclusion criteria, a retrospective analysis was performed for the chart review data of 1 070 preterm infants with a gestational age of 23-36+6 weeks who were admitted to the neonatal intensive care unit from January to December in 2018. The reference ranges of platelet parameters were calculated for the preterm infants within 24 hours after birth. Results There were no significant differences in platelet count (PLT) and plateletcrit (PCT) among the preterm infants with different gestational ages (P > 0.05). The late preterm infants (34-36+6 weeks; n=667) had significantly lower mean platelet volume (MPV) and platelet distribution width (PDW) than the extremely preterm infants (23-27+6 weeks; n=36) and the early preterm infants (28-33+6 weeks; n=367) (P < 0.05). There were no significant differences in these platelet parameters between the preterm infants with different sexes (P > 0.05). The reference ranges of platelet parameters in preterm infants were calculated based on gestational age. The reference ranges of PLT and PCT were (92-376)×109/L and 0.1%-0.394% respectively, for the preterm infants with a gestational age of 23-36+6 weeks. The reference ranges of MPV and PDW were 9.208-12.172 fl and 8.390%-16.407% respectively, for the preterm infants with a gestational age of 23-36+6 weeks; the reference ranges of MPV and PDW were 9.19-11.95 fl and 9.046%-15.116% respectively, for the preterm infants with a gestational age of 34-36+6 weeks. Conclusions The MPV and PDW of preterm infants with different gestational age are different within 24 hours after birth, and it is more helpful for clinical practice to formulate the reference range of MPV and PDW according to gestational age.

2020 Vol. 22 (7): 696-700 [Abstract] ( 2275 ) [HTML 1KB] [PDF 1246KB] ( 724 )
701 WANG Qun, HUANG Yan-Ping, TAO Xu-Wei, ZENG Ling-Kong
Effect of breastfeeding on insulin sensitivity in infants with intrauterine growth retardation: a follow-up study

Objective To study insulin sensitivity and the serum level of adiponectin in infants with intrauterine growth retardation (IUGR) and the effect of breastfeeding on the insulin sensitivity through a follow-up study. Methods A total of 106 full-term IUGR infants who were hospitalized from October 2014 to October 2018 were enrolled as the IUGR group, and 90 full-term appropriate for gestational age (AGA) infants who were born during the same period of time were enrolled as the AGA group. Birth weight and body length were recorded. Serum levels of fasting blood glucose (FBG), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), insulin, and adiponectin were measured on day 7 after birth. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. According to the feeding pattern, the IUGR group was further divided into a breastfeeding group with 37 infants and a formula feeding group with 42 infants. The above serum indices and growth indices were also measured at the age of 3 and 6 months. Results Compared with the AGA group, the IUGR group had significantly increased levels in serum insulin and HOMA-IR and a significantly decreased level of adiponectin (P < 0.05). There were no significant differences between the breastfeeding and formula feeding groups in growth indices and serum levels of FBG, TG, LDL, and HDL on day 7 after birth and at the ages of 3 and 6 months (P > 0.05). In the breastfeeding group, serum insulin and HOMA-IR decreased and adiponectin level increased over the time of breastfeeding (P < 0.05). Conclusions Insulin sensitivity decreases in the early stage after birth in IUGR infants, and breastfeeding can improve insulin sensitivity.

2020 Vol. 22 (7): 701-705 [Abstract] ( 2893 ) [HTML 1KB] [PDF 1271KB] ( 642 )
706 LIANG Jing-Jing, HU Yan, XING Yan-Fei, LIN Sui-Fang, SONG Yan-Yan
Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study

Objective To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. Methods A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. Results There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P < 0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P < 0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P < 0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P < 0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P < 0.05) and fine motor (OR=2.679, P < 0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P < 0.05), fine motor (OR=3.710, P < 0.05), and social ability (OR=3.515, P < 0.05). Conclusions The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.

2020 Vol. 22 (7): 706-710 [Abstract] ( 2884 ) [HTML 1KB] [PDF 1308KB] ( 771 )
711 XU Jun, YANG Du-Jiao, HUANG Fu-Rong, ZHANG Ai-Min
Application of magnetic resonance diffusion tensor imaging in bilirubin-induced neurological dysfunction in neonates

Objective To study the value of fractional anisotropy (FA) of regions of interest (ROI) on magnetic resonance diffusion tensor imaging (DTI) in bilirubin-induced neurological dysfunction in neonates. Methods A total of 91 neonates with hyperbilirubinemia who were hospitalized from January 2017 to January 2018 were enrolled. According to the peak level of total serum bilirubin, they were divided into three groups:mild/moderate increase (n=45), severe increase (n=35), and extremely severe increase (n=11). According to the presence or absence of abnormal neurological manifestations, they were divided into two groups:neurological dysfunction (n=20) and non-neurological dysfunction (n=71). Ten healthy full-term infants were enrolled as the control group. Head DTI was performed for all neonates to measure the FA values of the bilateral globus pallidus, the anterior limb of the internal capsule, the posterior limb of the internal capsule, and the cerebellar dentate nucleus. Results The extremely severe increase group had significantly lower FA values of the globus pallidus than the control, mild/moderate increase, and severe increase groups (P < 0.05). The severe increase group had significantly lower FA values of the globus pallidus than the control group (P < 0.05). The extremely severe increase group had significantly lower FA values of the posterior limb of the internal capsule than the control, mild/moderate increase, and severe increase groups (P < 0.05). The neurological dysfunction group had significantly lower FA values of the globus pallidus and the posterior limb of the internal capsule than the non-neurological dysfunction group (P < 0.05). Conclusions Serum bilirubin level combined with the changes in the DTI FA values of the globus pallidus and the posterior limb of the internal capsule can be used to predict the injury of cerebral nuclei and white matter fibers.

2020 Vol. 22 (7): 711-715 [Abstract] ( 2410 ) [HTML 1KB] [PDF 1394KB] ( 609 )
716 CHEN Jun-Long, ZHANG Chun-Li
Changes of serum interleukin-33 in preterm infants with bronchopulmonary dysplasia

Objective To study the role of interleukin-33 (IL-33) in the development and progression of bronchopulmonary dysplasia (BPD) in preterm infants. Methods A prospective cohort study was performed on 128 preterm infants with a gestational age of ≤ 32 weeks and/or a birth weight of ≤ 1 500 g. They were classified to a non-BPD group with 50 infants, a mild BPD group with 32 infants, a moderate BPD group with 30 infants, and a severe BPD group with 16 infants. Related data were collected, including antepartum factors of mothers (antepartum hormone and chorioamnionitis), intrapartum factors of preterm infants (sex, gestational age, birth weight, mode of birth, and birth asphyxia), treatment after birth (pulmonary surfactant, duration of invasive ventilation, duration of noninvasive ventilation, duration of parenteral nutrition, and length of hospital stay). The high-risk factors for BPD were analyzed. ELISA was used to measure the serum level of IL-33 in preterm infants on days 1, 14, and 28 after birth. The serum level of IL-33 was compared between groups at different time points after birth. The preterm infants with moderate or severe BPD were treated with conventional corticosteroid therapy (DART regimen), and the serum level of IL-33 was measured before and after treatment. Results There were significant differences between the preterm infants with BPD and those without BPD in the incidence of maternal chorioamnionitis, gestational age, birth weight, the incidence of birth asphyxia, duration of invasive ventilation, duration of noninvasive ventilation, duration of parenteral nutrition, and total length of hospital stay (P < 0.05). There were significant differences in the above indices among the preterm infants with different severities of BPD (P < 0.05). On days 1, 14, and 28 after birth, the infants with BPD had a significantly higher serum level of IL-33 than those without BPD, and the serum level of IL-33 tended to increase with the severity of BPD and over the time after birth (P < 0.05). The preterm infants with moderate or severe BPD had a significant reduction in the serum level of IL-33 after the treatment with DART regimen (P < 0.05). Conclusions Serum IL-33 is closely associated with the development and severity of BPD. Anti-inflammatory therapy with DART regimen can decrease the serum level of IL-33.

2020 Vol. 22 (7): 716-720 [Abstract] ( 2483 ) [HTML 1KB] [PDF 464KB] ( 755 )
721 HUO Meng-Yue, MEI Hua, ZHANG Yu-Heng, LIU Chun-Zhi, HU Ya-Nan, SONG Dan
Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a Meta analysis

Objective To evaluate the efficacy and safety of less invasive surfactant administration (LISA) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods PubMed, Cochrane Library, Embase, China Biology Medicine disc, China Scientific Journal Database, CNKI Database, and Wanfang Database were searched for randomized controlled trials (RCTs) on the use of LISA strategy in the treatment of NRDS. Literature screening and quality assessment were performed according to inclusion and exclusion criteria. Review Manager 5.3 software was used to perform the Meta analysis. Results A total of 9 RCTs were included, with a total of 1 212 children with NRDS. There were 611 children in the experimental group (treated with LISA strategy) and 601 children in the control group[treated with intubation-surfactant-extubation (INSURE) strategy]. The Meta analysis showed that the use of LISA strategy reduced the rate of mechanical ventilation within 72 hours after birth (OR=0.39, 95% CI:0.29-0.51, P < 0.001) and the incidence rates of bronchopulmonary dysplasia (OR=0.53, 95% CI:0.38-0.72, P < 0.001) and pneumothorax (OR=0.56, 95% CI:0.33-0.93, P=0.02). There were no significant differences in the mortality rate and incidence rates of other neonatal diseases between the two groups (P > 0.05). There was no significant difference in the rate of repeated use of pulmonary surfactant (PS) between the two groups (P > 0.05), but there was a higher incidence rate of PS reflux observed by LISA strategy (OR=2.60, 95% CI:1.64-4.12, P < 0.001). Conclusions Compared with INSURE strategy, LISA strategy has advantages in reducing the need for mechanical ventilation and the incidence rates of bronchopulmonary dysplasia and pneumothorax in children with NRDS.

2020 Vol. 22 (7): 721-727 [Abstract] ( 3943 ) [HTML 1KB] [PDF 1543KB] ( 1330 )
728 ZHANG Lu-Yang, CHEN Xiao-Juan, WANG Shu-Chun, GUO Ye, YANG Wen-Yu, CHEN Yu-Mei, ZHANG Li, ZOU Yao, ZHU Xiao-Fan
CD20 is not a poor prognostic factor for childhood B-lineage acute lymphoblastic leukemia with high white blood cell count

Objective To study the significance of CD20 combined with white blood cell (WBC) count at diagnosis in the prognosis assessment in children with B-lineage acute lymphoblastic leukemia (ALL). Methods A retrospective analysis was performed on the medical data of 821 B-ALL children who were treated with CCLG-ALL2008 regimen from April 2008 to April 2015. Their survival status was followed up. Results Among the 821 children, 547 (66.6%) were negative, while 274 (33.4%) were positive for CD20 expression. Among 694 children with WBC < 50×109/L (lower WBC count), the 5-year EFS rates were 65.9%±3.2% and 77.3%±2.0% for CD20 positive and negative patients respectively (P=0.001); the 5-year OS rates were 78.3%±2.9% and 87.5%±1.6% for CD20 positive and negative patients respectively (P=0.005); CD20 positive expression was an independent risk factor for EFS (HR=1.634, P=0.001) and OS (HR=1.761, P=0.005). Among 127 children with WBC > 50×109/L (higher WBC count), the 5-year EFS rates was 64.3%±7.7% and 53.7%±5.5% for CD20 positive and negative patients respectively (P=0.135); the 5-year OS rate was 81.4%±6.4% and 58.6%±5.6% for CD20 positive and negative patients respectively (P=0.022); CD20 positive expression was an independent protective factor for OS (HR=0.367, P=0.016). Conclusions In children with B-ALL who are treated with CCLG-ALL2008 regimen, those with CD20 positive expression in lower WBC count at diagnosis have a poor prognosis; however, those with CD20 positive expression in higher WBC count at diagnosis have a better long-time survival.

2020 Vol. 22 (7): 728-733 [Abstract] ( 2504 ) [HTML 1KB] [PDF 1570KB] ( 643 )
734 RAO Chun-Bao, LUO Dong, LIN Zi-Tian, XIE Ming-Yu, HU Yuan, PENG Qi, JIANG Hua, ZHANG Zhen-Hong, LU Xiao-Mei
Expression of long non-coding RNA linc00467 in childhood acute myeloid leukemia and its role in drug resistance

Objective To study the expression and function of long non-coding RNA linc00467 in childhood acute myeloid leukemia (AML). Methods Bone marrow samples were collected from 5 children with AML who were diagnosed from May 2016 to June 2018. Normal bone marrow samples based on bone marrow examination were collected from 3 children as controls. Quantitative real-time PCR was used to measure the expression of linc00467 in the two groups. A lentivirus system was used to achieve overexpression of linc00467 in AML cells (HL-60) (linc00467 overexpression group), and empty vector expressing green fluorescent protein (GFP) was transfected into AML cells to establish a GFP control group. A lentivirus system was used to insert an interfering sequence into AML cells (sh-linc00467 interfering group), and a random sequence was inserted to establish an sh-NC control group. Cell proliferation and resistance to doxorubicin were observed for all groups. Results Compared with the normal control group, the children with AML had a significant increase in linc00467 (P=0.018). Overexpression and interference with linc00467 expression had no significant effect on cell proliferation. Compared with the GFP control group, the linc00467 overexpression group had a significant increase in the viability of HL-60 cells at the adriamycin concentrations of 0.1, 0.2, 0.3, 0.4, and 0.5 μg/mL (P < 0.05). Compared with the sh-NC control group, the sh-linc00467 interfering group had a significant reduction in the viability of HL-60 cells at the adriamycin concentrations of 0.1, 0.2, 0.3, 0.4, and 0.5 μg/mL (P < 0.05). Compared with the untreated group, the adriamycin treatment group had a significant increase in the expression of linc00467 in HL-60 cells (P < 0.05). Conclusions This study reveals the biological function of linc00467 to promote the resistance to adriamycin in AML, which provides a basis for developing new therapeutic drugs for AML.

2020 Vol. 22 (7): 734-738 [Abstract] ( 2586 ) [HTML 1KB] [PDF 1345KB] ( 749 )
739 LIU Chao, CHEN Xiao-Yan, YI Mei-Hui, WU Wen-Qi, RUAN Min, ZHU Xiao-Fan
Clinical features and prognosis of core binding factor acute myeloid leukemia in children

Objective To study the clinical features and prognosis of core binding factor acute myeloid leukemia (CBF-AML) in children. Methods A retrospective analysis was performed from the chart review data of children who were newly diagnosed with CBF-AML in the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from August 2009 to November 2015. According to the type of fusion gene, the children were divided into CBFB-MYH11 and AML1-ETO groups. Clinical features and prognosis were analyzed and compared between the two groups. Results A total of 91 children with CBF-AML were enrolled in this study, among whom there were 74 (81%) in the AML1-ETO group and 17 (19%) in the CBFB-MYH11 group. Additional chromosomal abnormalities were observed in 38 children (42%), and deletion of sex chromosome was the most common abnormality and was observed in 28 children (31%). After the first course of induction treatment, the complete remission rate was 97% (88/91), the recurrence rate was 29% (26/91), the 5-year event-free survival (EFS) rate was 65%±6%, and the 5-year overall survival (OS) rate was 75%±5%. There were no significant differences between the AML1-ETO and CBFB-MYH11 groups in 5-year EFS rate (62%±7% vs 77%±11%, P > 0.05) or 5-year OS rate (72%±6% vs 88%±9%, P > 0.05). Conclusions AML1-ETO is the main type of fusion gene in children with CBF-AML, and deletion of sex chromosome is the most common type of additional chromosomal abnormalities. Children with CBF-AML often have a good prognosis, and the children with AML1-ETO have a similar prognosis to those with CBFB-MYH11.

2020 Vol. 22 (7): 739-743 [Abstract] ( 2872 ) [HTML 1KB] [PDF 1496KB] ( 838 )
744 ZHANG Hua-Yong, LI Chang-Jian, LONG Yuan, SUN Dong-Ming, WANG Rui-Geng, ZHANG Yong
Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases

Objective To study the clinical features of children with severe adenovirus pneumonia (SAP) and hemophagocytic syndrome (HPS). Methods A retrospective analysis was performed from the chart review data of 30 children with SAP and HPS who were admitted from January 2014 to June 2019. According to the prognosis, the children were divided into a good prognosis group (n=18) and a poor prognosis group (n=12). Results Among the 30 children with SAP and HPS, the ratio of male to female was 2:1. The median age of onset was 1 year and 3 months (range 3 months to 5 years), and the mean course of fever was 19±7 d. Of the 30 children, 28 (93%) experienced disease onset in January to June. High-throughput gene detection of serum pathogens showed that 16 (53%) children were positive for human adenovirus type 7 (HAdV-7), and the other 14 (47%) children were positive for HAdV antigen based on immunofluorescence assay for throat swab, with unknown type. Of all 30 children, 29 (97%) had respiratory complications, 24 (80%) had cardiovascular complications, 16 (53%) had gastrointestinal complications, and 9 (30%) had toxic encephalopathy. Eighteen children (60%) improved or recovered and 12 (40%) did not recover (3 died). Compared with the good prognosis group, the poor prognosis group had a significantly longer course from onset to diagnosis of HPS (P < 0.05), significantly higher levels of fibrinogen and tumor necrosis factor-α (P < 0.05), and a significantly lower level of interferon-γ (P < 0.05). The mean follow-up time was 6±2 months; 11 (41%) children recovered, 1 (4%) experienced recurrence of HPS, and 15 (56%) had the sequela of post-infectious bronchiolitis obliterans (PIBO). Conclusions HPS may be observed in children with SAP, and PIBO is the most common sequela of SAP.

2020 Vol. 22 (7): 744-748 [Abstract] ( 3103 ) [HTML 1KB] [PDF 1441KB] ( 678 )
749 CHEN Jie, CHEN Xi, TAN Xin-Rui, LIU Dong-Hai, LI Xing-Fang, ZHANG Xing-Xing
Adenovirus pneumonia with hemophagocytic lymphohistiocytosis in children: a clinical analysis of 7 children

Objective To study the clinical features of children with adenovirus pneumonia and hemophagocytic lymphohistiocytosis (HLH). Methods A retrospective analysis was performed on the mediacal data of 7 children with adenovirus pneumonia and HLH from March to September, 2019. Results The age of these children ranged from 11 months to 5 years, and among these children, 5 were aged < 2 years and 5 were boys. None of these children had underlying diseases. All children were hospitalized due to persistent high fever and cough, and the peak temperature of fever was 39℃ to 41℃. With disease progression, 7 children developed hepatomegaly and 6 developed splenomegaly. Routine blood test results showed reductions in two or three lineages of blood cells, with increases in serum ferritin (SF), C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH). Phagocytosis of blood cells was observed in 6 children. Radiological examination of lungs showed pneumonia changes. All 7 children were diagnosed with human adenovirus type 7 infection based on pathogenic metagenome detection. No abnormality was found by HLH gene detection and the children were diagnosed with secondary HLH. All children received intravenous immunoglobulin. Among these children, 4 received dexamethasone and etoposide chemotherapy, 3 received dexamethasone alone, and 4 received plasma exchange. Of the 7 children, 2 died and 5 were recovered. Compared with those who survived, the children who died had significantly greater reductions in the three lineages of blood cells and significantly greater increases in serum levels of CRP, PCT, SF, and LDH. Conclusions The children with adenovirus pneumonia and HLH have main clinical features of persistent high fever, progressive reductions in two or three lineages of peripheral blood cells, and involvement of other organ systems, including hepatosplenomegaly. Significant increases in serum levels of CRP, PCT, SF, and LDH may suggest a poor prognosis.

2020 Vol. 22 (7): 749-754 [Abstract] ( 3012 ) [HTML 1KB] [PDF 1462KB] ( 810 )
755 LIAO Xin, LI Ying-Jie, TAN Jin-Lan, ZHANG Miao, ZHONG Fa-Zhan, WANG Chang-Xi, QIU Jiang, FU Qian, LIU Long-Shan, GAO Yan
Clinical features of catch-up growth after kidney transplantation in children

Objective To study the clinical features of catch-up growth of body height after kidney transplantation in children and related influencing factors. Methods A retrospective analysis was performed from the chart review data of 15 children who underwent kidney transplantation in Guangzhou Women and Children's Medical Center from July 2017 to November 2019. According to whether the increase in height standard deviation score (ΔHtSDS) in the first year after kidney transplantation reached ≥ 0.5, the children were divided into a catch-up group with 8 children and a non-catch-up group with 7 children. According to whether final HtSDS was ≥ -2, the children were divided into a standard group with 6 children and a non-standard group with 9 children. The features of catch-up growth of body height and related influencing factors were compared between groups. Results The data showed that median ΔHtSDS was 0.8 in the first year after transplantation, which suggested catch-up growth of body height. There was a significant difference in HtSDS between the non-catch-up and catch-up groups (P < 0.05). Baseline HtSDS before transplantation was positively correlated with HtSDS at the end of follow-up (r=0.622, P < 0.05) and was negatively correlated with △HtSDS in the first year after transplantation (r=-0.705, P < 0.05). Age of transplantation and mean dose of glucocorticoid (GC) per kg body weight were risk factors for catch-up growth after kidney transplantation (OR=1.23 and 1.74 respectively; P < 0.05), while baseline HtSDS and use of antihypertensive drugs were independent protective factors for catch-up growth (OR=0.08 and 0.18 respectively; P < 0.05); baseline HtSDS and ΔHtSDS in the first year after kidney transplantation were influencing factors for final HtSDS (β=0.984 and 1.271 respectively; P < 0.05). Conclusions Kidney transplantation should be performed for children as early as possible, growth retardation before transplantation should be improved as far as possible, and multiple treatment methods (including the use of GC and antihypertensive drugs) should be optimized after surgery, in order to help these children achieve an ideal body height.

2020 Vol. 22 (7): 755-761 [Abstract] ( 2600 ) [HTML 1KB] [PDF 1724KB] ( 678 )
762 WANG Ling-Xiao, CHENG Ruo-Qian, ZHANG Miao-Ying, LI Xiao-Jing, XI Li, ZHENG Zhang-Qian, LUO Fei-Hong
Association of body fat ratio with precocious puberty in girls

Objective To study the association of body fat ratio with precocious puberty in girls. Previous studies have shown that body mass index (BMI) is associated with the girls' age of puberty but have not revealed the association of body fat ratio with age of puberty. Methods Based on the consensus on the diagnosis and treatment of central precocious puberty (CPP), 128 children with precocious puberty who were admitted to the hospital from July to August, 2017, were divided into a CPP group with 87 children and a peripheral precocious puberty (PPP) group with 41 children. A total of 51 girls without any puberty development signs were enrolled as the control group. Dual-energy X-ray absorptiometry was used to measure the body fat ratios of upper limbs, legs, trunk, android area, gynoid area, and the whole body. The association between body fat ratios and precocious puberty was analyzed with reference to age, BMI, BMI-Z score, bone age, ovarian volume, and hormone levels. Results Compared with the control group, the CPP and PPP groups had significantly higher body fat ratios of upper limbs, legs, trunk, android area, gynoid area, and the whole body, legs/whole body fat ratio, and (upper limbs+legs)/trunk fat ratio (P < 0.05), while there were no significant differences in the above body fat ratios and fat distribution indicators between the CPP and PPP groups (P > 0.05). For the girls with precocious puberty, the high body fat ratio group had significantly higher luteinizing hormone (LH) base value, luteinizing hormone releasing hormone (LHRH)-stimulated LH peak value, and LH/follicle-stimulating hormone peak value than the low body fat ratio group (P < 0.05). Compared with the control group, both the high body fat ratio and low body fat ratio groups had a significantly higher LH base value (P < 0.05). Conclusions The increase in body fat may be a factor inducing precocious puberty in girls, but further studies are needed to determine the mechanism.

2020 Vol. 22 (7): 762-767 [Abstract] ( 2906 ) [HTML 1KB] [PDF 1590KB] ( 1197 )
768 LIU Jian-Bo, XUE Zhen-Peng, LIN Ling, XU Jian-Chang, SUN Yu-Meng, LU Jian-Ping
Moderated mediation analysis for symptoms of attention deficit/hyperactivity disorder with the symptoms of anxiety in children

Objective To study the moderated mediation for attention deficit/hyperactivity disorder (ADHD) with the symptoms of anxiety in children. Methods A total of 12 271 students were included with an average age of 8.9±1.9 years, including 6 743 male students and 5 508 female students, and 20 students with missing data on gender. Child psychological trauma questionnaires (parents version) and Conners questionnaires (parent version) were completed by the parents of primary school students. The data was studied by univariate analysis, multivariate analysis and moderated mediation analysis. Results The results of the univariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index and childhood trauma were positively correlated with the score of anxiety (P < 0.01), and ADHD and childhood trauma positively predicted anxiety disorder (P < 0.001). The results of the multivariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index (ADHD symptoms) and childhood trauma positively predicted the score of anxiety (P < 0.001), and both ADHD and childhood trauma positively predicted anxiety disorder (P < 0.001). The results of the moderated mediation analysis showed that childhood trauma was a mediating factor for the relationship between hyperactivity index and anxiety index in boys and girls (P < 0.05), and sex moderated the relationship between hyperactivity index and anxiety index (P < 0.001). Conclusions ADHD symptoms/ADHD are closely associated with anxiety symptoms/anxiety disorder. Childhood trauma exerts a mediating effect on the relationship between ADHD symptoms and anxiety symptoms, and sex moderates the relationship between ADHD symptoms and anxiety symptoms.

2020 Vol. 22 (7): 768-773 [Abstract] ( 2876 ) [HTML 1KB] [PDF 1591KB] ( 680 )
774 WANG Yue-Sheng, ZHANG Jing, LI Xiao-Qin, YU Zhi-Dan, ZHOU Fang
Complications of upper gastrointestinal foreign body in children and related risk factors

Objective To study the complications of upper gastrointestinal foreign body in children and related risk factors. Methods Clinical data were collected from 772 children with upper gastrointestinal foreign bodies who were treated at the outpatient service or were hospitalized from January 2014 to December 2018. A multivariate logistic regression analysis was used to investigate the risk factors for the development of complications in children with upper gastrointestinal foreign bodies. Results The upper gastrointestinal foreign bodies were taken out by electronic endoscopy for the 772 children. There were 414 boys and 358 girls, with a median age of 2.8 years. Children under 3 years old accounted for 59.5%. The foreign bodies were mainly observed in the esophagus (57.5%) and the stomach (28.9%), with a retention time of ≤ 24 hours in 465 children (60.2%) and > 24 hours in 307 children (39.8%). The types of upper gastrointestinal foreign bodies mainly included round metal foreign bodies (37.2%), long foreign bodies (24.7%), sharp foreign bodies (16.2%), batteries (14.4%), corrosive substances (4.8%), and magnets (2.7%). As for the severity of complications, 47.7% (368 children) had mild complications, 12.7% (98 children) had serious complications, and 39.6% (306 children) had no complications. The logistic regression analysis showed that an age of < 3 years, underlying diseases, location of foreign body, type of foreign body, and a retention time of > 24 hours were risk factors for the development of complications in these children (OR=2.141, 7.373, 6.658, 8.892, and 6.376 respectively, P < 0.05). Conclusions An understanding of the above high-risk factors for the complications of upper gastrointestinal foreign bodies is helpful to choose appropriate intervention methods and thus reduce the incidence of serious complications.

2020 Vol. 22 (7): 774-779 [Abstract] ( 2799 ) [HTML 1KB] [PDF 2084KB] ( 614 )
780 WANG Shuo, ZOU Run-Mei, CAI Hong, DING Yi-Yi, XIAO Hai-Hui, WANG Xin, LI Fang, WANG Yu-Wen, WANG Cheng
Efficiency of heart rate and heart rate difference at different time points during head-up tilt test in the diagnosis of postural tachycardia syndrome in children and adolescents

Objective To study the efficiency of heart rate (HR) and heart rate difference (HRD) at different time points during head-up tilt test (HUTT) in the diagnosis of postural tachycardia syndrome (POTS) in children and adolescents. Methods A total of 217 children and adolescents, aged 6-16 years, who were diagnosed with POTS were enrolled as the POTS group, and 73 healthy children and adolescents, matched for sex and age, were enrolled as the control group. The POTS group was further divided into ≤ 12 years old group with 127 children/adolescents and > 12 years old group with 90 children/adolescents. The two groups were compared in terms of HR at baseline and at 5 and 10 minutes of HUTT (HR0, HR5, and HR10 respectively), difference between HR5/HR10 and HR0 (HRD5 and HRD10 respectively). The efficiency of HR5, HR10, HRD5 and HRD10 in the diagnosis of POTS was assessed. Results Compared with the control group, the POTS group had significant increases in HR5, HR10, HRD5, and HRD10 (P < 0.05). The coincidence rate of HR or HRD for the diagnosis of POTS in males was higher than that in females at 5 minutes of HUTT (P < 0.05), while the coincidence rate of HR or HRD for the diagnosis of POTS in males was lower than that in females at 10 minutes of HUTT (P < 0.05). The coincidence rate of HR for the diagnosis of POTS was higher in the > 12 years old subgroup (P < 0.05), while the coincidence rate of HRD for the diagnosis of POTS was higher in the ≤ 12 years old subgroup (P < 0.05). The combination of HR5, HR10, HRD5, and HRD10 for the diagnosis of POTS had a greater area under the curve (0.974; 95% CI:0.949-0.989) than HR5, HR10, HRD5, or HRD10 alone, with a sensitivity of 87.80% and a specificity of 95.83%. The diagnostic efficacy of HRD for POTS was higher than that of HR (P < 0.05). Conclusions HR and HRD at different time points during HUTT have a good value in the diagnosis of POTS in children and adolescents, and the accuracy of diagnosis varies with age and gender.

2020 Vol. 22 (7): 780-784 [Abstract] ( 2584 ) [HTML 1KB] [PDF 1614KB] ( 559 )
785 CHEN Yong-Qi, ZHONG Li-Li, DING Xiao-Fang
Clinical effect of propranolol in the treatment of respiratory hemangioma in infants and young children

Objective To study the clinical effect of oral propranolol in the treatment of respiratory hemangioma in infants and young children. Methods A retrospective analysis was performed from the chart review data of children with respiratory hemangioma treated by oral propranolol and diagnosed by bronchoscopy and laryngeal plain enhanced CT/MRI from November 2012 to December 2019. Results A total of 20 children were enrolled. All children had improvement in the symptoms of laryngeal stridor and dyspnea after oral administration of propranolol for 1-2 days. The median treatment time was 10 months (range 6-12 months). The median follow-up time was 10 months (range 3-15 months). Of the 20 children, 19 (95%) achieved regression of tumor, and 1 (5%) experienced an increase in tumor size during reexamination at 6 months after drug withdrawal and had no recurrence after the treatment with an increased dose of propranolol for 6 months. Only 1 child (5%) had adverse reactions, and 1 child (5%) was still under treatment. Conclusions Oral propranolol can quickly relieve the symptoms such as dyspnea and achieve tumor regression, with few adverse events, and it is therefore an effective method for the treatment of respiratory hemangioma in infants and young children.

2020 Vol. 22 (7): 785-789 [Abstract] ( 2347 ) [HTML 1KB] [PDF 2206KB] ( 918 )
RARE DISEASE RESEARCH
790 CHU Guo-Ming, LI Ping-Ping, CHANG Wen-Jing, HE Rong, ZHAO Yan-Yan
Variant analysis on steroid 5-reductase type 2 deficiency caused by a novel SRD5A2 mutation

This article reported the clinical characteristics and SRD5A2 gene mutation pattern of a child with steroid 5-α reductase type 2 deficiency. The 2-month-old boy showed hypospadias and short penis shortly after birth. DNA was extracted from the peripheral blood of the child and his parents. The endocrine disease-related genes were captured and sequenced by high-throughput sequencing technology, and the family DNA samples were verified by Sanger sequencing. The results showed that c.680G > A(p.R227Q) and c.608G > A(p.G203D) compound heterozygous mutations existed in the SRD5A2 gene of the child. The c.680G > A mutation inherited from his father, which was a known pathogenic mutation. The c.608G > A mutation originated from his mother, which was a novel mutation discovered in this study. These results provide molecular evidence for the etiological diagnosis of the child and genetic counseling for the family, as well as extend the mutation spectrum of SRD5A2 gene.

2020 Vol. 22 (7): 790-795 [Abstract] ( 2919 ) [HTML 1KB] [PDF 2479KB] ( 685 )
EXPERIMENTAL RESEARCH
796 GUO Xin, LIU Cong, WANG Guo-Bing, XU Ming-Guo
Quantitative proteomics and bioinformatics analyses of human coronary artery endothelial cell injury induced by Kawasaki disease

Objective To study the biomarkers for human coronary artery endothelial cell (HCAEC) injury induced by Kawasaki disease (KD) using isobaric tags for relative and absolute quantitation (iTRAQ) proteomics. Methods HCAECs cultured with the serum of children with KD were used as the KD group, and those cultured with the serum of healthy children was used as the healthy control group. The iTRAQ technique was used to measure the expression of proteins in two groups. The data on proteins were analyzed by bioinformatics. Western blot was used for the validation of protein markers. Results A total of 518 significantly differentially expressed proteins were identified (with an absolute value of difference fold of > 1.2, P < 0.05). The gene ontology analysis showed that the differentially expressed proteins were significantly enriched in biological processes (including cellular processes, metabolic processes, and biological regulation), cellular components (including cell parts, cells, and organelles), and molecular functions (including binding, catalytic activity, and molecular function regulators). The KEGG analysis showed that the proteins were significantly enriched in the signaling pathways of ribosomes, PI3K-Akt signaling pathway, and transcriptional dysregulation in cancer. The PPI network showed that the top 9 protein markers in relation density were PWP2, MCM4, MCM7, MCM5, MCM3, MCM2, SLD5, HDAC2, and MCM6, which were selected as the protein markers for coronary endothelial injury in KD. Western blot showed that the KD group had significantly lower expression levels of the protein markers HDAC2, PWP2, and MCM2 than the healthy control group (P < 0.05). Conclusions The serum of children with KD significantly changes the protein expression pattern of HCAECs and affects the signaling pathways associated with the cardiovascular system, which provides a new basis for the pathophysiological mechanism and therapeutic targets of KD.

2020 Vol. 22 (7): 796-803 [Abstract] ( 2680 ) [HTML 1KB] [PDF 2757KB] ( 882 )
CASE REPORT
804 XIA Yao-Fang, MA Li, QIU Xiang-Li, LI Gui-Xia, GUO Ying-Hui, LIU Shu-Hua, PU Wei-Cong, WANG Le
Early-onset septic shock in a preterm infant caused by Kingella Kingae

No abstract available

2020 Vol. 22 (7): 804-805 [Abstract] ( 1694 ) [HTML 1KB] [PDF 1134KB] ( 500 )
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