Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal death and long-term neurodevelopmental impairment. Therapeutic hypothermia is an effective intervention to improve the prognosis of neonates with moderate to severe HIE, and its standardized management is crucial for optimizing outcomes. Based on domestic and international evidence and expert opinion, the Evidence-Based Medicine Group, Neonatologist Society, Chinese Medical Doctor Association developed the "Expert consensus on the clinical management of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (2026)" using the Grading of Recommendations Assessment, Development, and Evaluation approach. The consensus focuses on 14 key clinical questions related to therapeutic hypothermia that are of concern to medical staff and formulates 22 recommendations. It aims to provide standardized and practical guidance and workflow for the clinical management of therapeutic hypothermia in neonates with HIE, promote integrated collaboration between physicians and nurses, and improve patient outcomes.
In the early stages of pertussis, timely initiation of effective antibacterial treatment (including prophylactic medication before symptom onset) can halt disease progression. In China, where measures such as maternal immunization are currently lacking, this remains a crucial approach to preventing severe illness and death from infant pertussis. However, a clear and unified time-based standard defining this "early stage" is lacking, and few studies focus on diagnostic strategies targeting early treatment. Based on the natural disease course of pertussis and limited clinical evidence, a time criterion of within 7 days from illness onset is proposed in this article for early diagnosis of pertussis. Strategies to promote early diagnosis are discussed: raising public awareness to encourage early medical consultation for infant pertussis; enhancing clinical recognition to facilitate early suspicion and testing; emphasizing the cough history of close contacts; identifying early clinical features such as the triad of afebrile status, rhinorrhea, and cough; noting significant increases in white blood cell count and/or lymphocyte proportion in routine blood tests; prioritizing etiological methods for diagnosis or exclusion; and urging health authorities to establish coordinated active surveillance and screening mechanisms between hospitals and disease control institutions. This article aims to support clinical research, standardize early diagnosis, antimicrobial treatment, and chemoprophylaxis of pertussis, and ultimately minimize severe cases and deaths in infants.
Recombinant human growth hormone (rhGH) is the main therapeutic approach for height improvement. In recent years, with deepening research and clinical practice, accumulating evidence indicates that rhGH exerts additional clinical benefits on body composition, lipid metabolism, the skeletal system, and cognitive function. This article systematically reviews the multiple clinical effects of rhGH to provide a reference for optimizing treatment strategies and improving long-term health outcomes in patients.
Anaphylaxis is a rapid-onset, life-threatening systemic hypersensitivity reaction. Insufficient awareness of this condition in China and delayed or inappropriate use of epinephrine—the core treatment—are major causes of severe outcomes. Based on two clinical cases and the latest domestic and international guidelines, this article systematically describes early recognition and diagnosis of anaphylaxis in children, epinephrine-centered emergency management strategies, and the treatment protocol for refractory anaphylaxis. For classic anaphylaxis, early intramuscular injection of epinephrine into the anterolateral thigh is lifesaving. For refractory anaphylaxis, intravenous continuous infusion of epinephrine should be initiated promptly after two ineffective intramuscular injections, combined with aggressive fluid resuscitation and, if necessary, second-line vasoactive drugs. Antihistamines and corticosteroids are only adjunctive therapies and cannot replace epinephrine. Standardized post-discharge long-term management and the promotion of novel noninvasive delivery routes will further improve prognosis of pediatric anaphylaxis.
Objective To study the clinical characteristics, treatment, and outcomes of neonatal dengue fever in Foshan. Methods A retrospective study was conducted on 49 neonatal dengue fever cases collected from eight hospitals in Foshan between June and November 2024. Clinical characteristics and outcomes were evaluated. Cases were divided into an early-onset group (diagnosed ≤7 days of age; n=32) and a late-onset group (diagnosed 7 days of age; n=17) for comparison of clinical characteristics. Results Among the 49 neonates, fever was the predominant symptom (45 cases, 92%), followed by bleeding tendency (12 cases, 24%), tachypnea (11 cases, 22%), and jaundice (5 cases, 10%). The mothers of 30 neonates (61%) had perinatal dengue infection. Rates of maternal peripartum fever, confirmed maternal dengue fever during pregnancy, and perinatal dengue infection were significantly higher in the early-onset group than in the late-onset group (P0.05). The early-onset group had a longer hospital stay than the late-onset group (P0.05). Alanine aminotransferase levels were significantly higher in the late-onset group than in the early-onset group (P0.05). Symptomatic treatments, including short-term hemostatic therapy, nasal cannula oxygen supplementation, and noninvasive positive pressure ventilation when indicated, resulted in favorable outcomes without severe cases or deaths. Conclusions Neonatal dengue fever in Foshan is associated with maternal perinatal dengue infection. Fever is the predominant clinical manifestation. Clinical characteristics differ by age at diagnosis, but overall prognosis is good. During dengue epidemic seasons, prevention and screening of perinatal dengue fever in pregnant women should be strengthened, and early laboratory tests such as pathogen detection and blood biochemistry should be performed on high-risk neonates.
Objective To study the clustering of Streptococcus pneumoniae carriage among school children aged 6-10 years in Haidong City of Qinghai Province, and its influencing factors, providing scientific evidence for preventing and controlling the transmission of Streptococcus pneumoniae in this population. Methods Multistage stratified cluster sampling and simple random sampling were used to select 834 healthy children aged 6-10 years from seven kindergartens and five primary schools in Haidong City of Qinghai Province. Oral and nasal swabs were collected for isolation and identification of Streptococcus pneumoniae. Parents completed questionnaire surveys. Data analysis was performed using chi-square tests and random-effects logistic regression models. Results The carriage rate of Streptococcus pneumoniae was 21.6% (180/834). Cluster analysis showed statistically significant random effects at the school level (Z=2.965, P=0.003; ICC=14.189%). Children aged 8-10 years had a lower carriage rate than those aged 6-7 years (OR=0.467, 95%CI: 0.232-0.938, P=0.032). Children living in households with more than three cohabiting individuals had a higher risk of carriage compared to those with three or fewer (OR=1.541, 95%CI: 1.016-2.339, P=0.042). Conclusions Streptococcus pneumoniae carriage among school children aged 6-10 years in Haidong City of Qinghai Province exhibits school-level clustering. Age and number of cohabiting individuals are significant influencing factors for carriage.
Objective To evaluate the performance of metagenomic next-generation sequencing (mNGS) in detecting pathogens in suspected neonatal sepsis and central nervous system infections. Methods This retrospective study included 648 neonates with suspected sepsis or central nervous system infections, with 734 cerebrospinal fluid and 733 blood samples collected. The pathogen spectra detected by mNGS and traditional culture were compared. Using clinical diagnosis as the gold standard, the diagnostic efficacy of the two methods was analyzed. Results The positive rates of pathogen detection by mNGS in cerebrospinal fluid and blood samples were 15.3% and 40.0%, respectively, significantly higher than those of traditional culture (1.4% and 10.7%, respectively). mNGS identified 25 and 40 distinct pathogenic species from cerebrospinal fluid and blood, respectively, exceeding the 4 and 24 species detected by culture. Ureaplasma, Mycoplasma, and other fastidious pathogens difficult to culture were detected exclusively by mNGS. Using clinical diagnosis as the reference, mNGS showed sensitivities of 50.4% (cerebrospinal fluid) and 46.7% (blood), compared to 5.8% and 18.0% for culture. Conclusions mNGS significantly improves pathogen detection rates in neonatal infections compared with traditional culture, provides more comprehensive pathogen information, and holds important clinical value for the precise diagnosis and treatment of neonatal infections.
Objective To study the clinical features and prognostic impact of CRLF2 overexpression in children with B-cell acute lymphoblastic leukemia (B-ALL). Methods A retrospective study included pediatric B-ALL patients admitted to Sichuan Provincial Maternity and Child Health Care Hospital and Kunming Children's Hospital from October 2018 to October 2022. Patients were divided into a CRLF2 overexpression group and a control group without CRLF2 overexpression according to CRLF2 gene testing at initial diagnosis. Clinical features and prognosis between groups were compared. Results A total of 93 children with B-ALL were enrolled, including 29 with CRLF2 overexpression. The age of onset ranged from 2 to 12 years. At diagnosis, the proportions of hepatosplenomegaly and thrombocytopenia in the CRLF2 overexpression group were significantly lower than those in the control group (P0.05), while the proportion of masses was significantly higher (P0.05). Significantly higher CRLF2 protein expression in the CRLF2 overexpression group than in the control group (P0.05). The mean 3-year event-free survival (EFS) and overall survival (OS) rates in the CRLF2 overexpression group were 75.9% and 85.9%, respectively, lower than the control group (90.1% and 91.0%, respectively), but the differences lacked statistical significance by log-rank test. Conclusions These findings suggest a potential role of CRLF2 overexpression in disease progression. Further studies with larger sample sizes are warranted to confirm its prognostic significance.
Objective To investigate treatment strategies and prognostic factors in children with relapsed acute lymphoblastic leukemia (ALL). Methods A retrospective cohort study enrolled 86 children diagnosed with and relapsed from ALL between 2015 and 2019. Kaplan-Meier method and Cox regression model were applied for analysis. Results The median follow-up after relapse was 36 months. The 4-year overall survival (OS) rate was 59%. Multivariate analysis (based on the subgroup receiving induction chemotherapy) identified high-risk relapse and minimal residual disease (MRD) ≥0.01% after induction therapy as independent risk factors for 4-year OS (P0.05). The introduction of chimeric antigen receptor T-cell (CAR-T) therapy in 2017 significantly improved the 4-year OS rate in children with relapsed ALL (61% vs 26%, P=0.030). According to relapse risk stratification, all low-risk patients survived whether receiving chemotherapy alone or CAR-T therapy. Among intermediate-risk patients, those achieving MRD negativity after re-induction had a high survival rate with chemotherapy (12/13), whereas MRD-positive patients had a high survival rate with CAR-T combined with transplantation (7/8). In high-risk patients, the survival rate for those receiving transplantation (after chemotherapy or CAR-T) was 60% to 62.5%, significantly higher than that of the chemotherapy-alone group (0% survival). The 4-year OS rate for the CAR-T followed by hematopoietic stem cell transplantation group was higher than that of the CAR-T alone group (75% vs 24%, P=0.067). Conclusions An individualized treatment strategy based on risk stratification combined with MRD status is recommended for children with relapsed ALL.
Objective To investigate associations among auditory processing (AP), working memory, and language function in preschool children with developmental language disorder (DLD), and to analyze the mediating role of working memory. Methods A prospective cross-sectional design was adopted. Forty-two children with DLD (DLD group) and 45 typically developing children (normal control group) were enrolled. The Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), Preschool Auditory Processing Assessment Scale (PAPAS), Wechsler Intelligence Scales (Fourth Edition), and Conners Parent Symptom Questionnaire (PSQ) were used for evaluation. Correlations among scales were analyzed. The relationships among auditory decoding, working memory, and overall language function, as well as the mediating effect of working memory, were examined. Results Scores on all PAPAS dimensions and the proportion of children at risk for AP abnormalities were significantly higher in the DLD group than in the control group (P0.001). In all children, DREAM-C dimension scores were negatively correlated with PAPAS dimension scores (P0.05). In the DLD group, working memory was negatively correlated with total PAPAS score and scores for auditory decoding, auditory attention, and communication (P0.05). PSQ scores for conduct problems, learning problems, and hyperactivity index were positively correlated with total PAPAS score and scores for auditory decoding, auditory attention, communication, and hyperactivity-impulsivity (P0.05). The impulsivity-hyperactivity score was positively correlated with total PAPAS score and scores for auditory attention and hyperactivity-impulsivity (P0.05). The anxiety score was positively correlated only with the communication score (P0.05). After controlling for confounders, the auditory decoding score (b'=-0.431, P=0.009) and the working memory score (b'=0.437, P0.001) were independently associated with the DREAM-C overall language score. Working memory partially mediated the association between auditory decoding and overall language ability, accounting for 40% of the total effect. Conclusions Auditory processing in preschool children with DLD is closely associated with language, cognitive, and behavioral problems. Auditory decoding directly affects language function and indirectly influences it through working memory. PAPAS may serve as a convenient screening tool for clinical use.
Objective To compare the efficacy and safety of expectant management versus acetaminophen for early treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in very preterm infants. Methods A prospective randomized controlled trial was conducted from April 2024 to November 2025, enrolling 99 very preterm infants aged 4 to 7 days diagnosed with hsPDA. Participants were randomly assigned to either the expectant management group (n=54), which received no drug intervention, or the acetaminophen group (n=45), which received oral acetaminophen at 15 mg/kg every 6 hours for 3 days. Rates of hsPDA persistence at 3-4 days post-enrollment (7-11 days of age), 14-17 days of age, and at discharge or 36 weeks of corrected gestational age were compared between the two groups. Additionally, total duration of respiratory support, serum levels of alanine aminotransferase and cystatin C, and incidences of oliguria, upper gastrointestinal bleeding, intraventricular hemorrhage, moderate to severe bronchopulmonary dysplasia (BPD) were compared. Results The acetaminophen group showed lower rates of hsPDA persistence at 3-4 days post-enrollment and at 14-17 days of age compared to the expectant management group (both P0.05). No significant differences were found between groups at discharge or 36 weeks of corrected gestational age in hsPDA persistence, total respiratory support duration, or incidences of oliguria, upper gastrointestinal bleeding, intraventricular hemorrhage, and moderate to severe BPD (all P0.05). The acetaminophen group exhibited higher serum alanine aminotransferase and cystatin C levels at 3-4 days post-enrollment, and lower hourly urine output within 4 days post-enrollment compared with the expectant management group (all P0.05). Smaller gestational age and assisted reproductive technology were independent risk factors for persistent hsPDA at 14-17 days of age (OR=8.569 and 7.092, respectively; P0.05), while acetaminophen use was an independent protective factor (OR=0.126, P0.05). Conclusions Early oral acetaminophen treatment in very preterm infants with hsPDA aged 4-7 days reduces the rate of persistent hsPDA at 14-17 days and demonstrates a favorable safety profile compared with expectant management, but does not affect hsPDA persistence at discharge or 36 weeks of corrected gestational age or the rate of moderate to severe BPD.
Objective To study the clinical characteristics and influencing factors of routine pulmonary ventilation function in children with allergic rhinitis induced by house dust mites. Methods A retrospective cross-sectional study was conducted on 361 children with allergic rhinitis scheduled for house dust mite-specific immunotherapy at Shenzhen Children's Hospital from November 2019 to December 2025. Routine pulmonary ventilation function test results and influencing factors were analyzed. Results Among the 361 children, 159(44.0%) showed abnormal pulmonary ventilation function, of which 107(67.3%) involved small airway dysfunction. Multiple linear regression analysis showed that age was negatively correlated with forced vital capacity (FVC) (β=-1.83, P0.05) and forced expiratory volume in the first second (FEV1) (β=-1.97, P0.05). Body mass index was positively correlated with FVC (β=1.08, P0.05) and FEV1 (β=0.75, P0.05), and negatively correlated with FEV1/FVC ratio (β=-0.31, P0.05). Conclusions Children with allergic rhinitis induced by house dust mites may present with early abnormalities in pulmonary ventilation function. Age and body mass index are influencing factors on routine pulmonary ventilation function parameters. Early and regular monitoring of lung function is recommended, especially for children at different ages and those with obesity.
Objective To summarize the clinical characteristics of neurofibromatosis type 1 (NF1) associated with infantile epileptic spasms syndrome (IESS). Methods A retrospective analysis was conducted on the medical records of six children with NF1 and IESS who were treated at Xiangya Hospital, Central South University, between January 2018 and April 2025. Clinical manifestations, ancillary examinations, treatment, and prognosis were summarized. Results Among the six children, two were male and four were female. All presented with café-au-lait spots, and each had one or more additional NF1-related manifestations. Three children had a first-degree family history of NF1. Seizure type was epileptic spasms in all cases, with hypsarrhythmia observed on electroencephalogram. Brain magnetic resonance imaging showed NF1-related T2 hyperintense lesions in the basal ganglia region in five cases. Electroclinical remission was achieved in all patients after treatment with adrenocorticotropic hormone and/or vigabatrin; however, varying degrees of neurodevelopmental delay remained. Conclusions Children with NF1 and IESS commonly present with the typical triad of IESS. Some patients show NF1-related T2 hyperintense lesions in the basal ganglia on brain magnetic resonance imaging. Standard first-line treatments often control spasms effectively, but neurodevelopmental outcomes require long-term monitoring.
Objective To investigate the protective effects and molecular mechanisms of thymosin β4 (Tβ4) on pyroptosis in BV2 microglial cells. Methods BV2 cells were divided into three groups: control group (no treatment), pyroptosis group [stimulated with 1 μg/mL lipopolysaccharide (LPS) for 12 hours, followed by 10 μmol/L nigericin (Nig) treatment for 1 hour], and Tβ4 treatment group (co-incubated with LPS and Nig, then treated with 1 μg/mL Tβ4 for 1 hour). An in vitro sepsis-associated encephalopathy model was established by LPS and Nig co-treatment. Viability of BV2 cells was assessed by CCK-8 assay. RT-qPCR was performed to detect mRNA expression of interleukin (IL)-1β, interferon-induced protein with tetratricopeptide repeats 1 (IFIT1), and interferon-β (IFN-β). IL-1β levels in cell supernatants were measured by ELISA. Protein expression of NLRP3, GSDMD-N, cleaved caspase-1, phosphorylated stimulator of interferon genes (p-STING), and phosphorylated interferon regulatory factor 3 (p-IRF3) was analyzed by Western blot. Cell death rate and mitochondrial reactive oxygen species (ROS) levels were detected by flow cytometry using propidium iodide staining and MitoSOX indicator, respectively. Results Compared with the pyroptosis group, Tβ4 treatment alleviated morphological damage caused by pyroptosis in BV2 cells. Intracellular mRNA expression of IL-1β, IFIT1, and IFN-β; IL-1β concentration in supernatant; protein expression of NLRP3, GSDMD-N, cleaved caspase-1, p-STING, and p-IRF3; cell death rate; and mitochondrial ROS levels were significantly decreased (P0.05). Conclusions Tβ4 protects BV2 microglial cells against LPS and Nig-induced pyroptosis by inhibiting oxidative stress and inflammatory responses, potentially through regulation of the cGAS-STING signaling pathway.
Objective To investigate the role and mechanism of miR-146b-5p in pulmonary vascular remodeling in neonatal rats with bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) induced by hyperoxia. Methods Thirty-two Sprague-Dawley neonatal rats were randomly assigned to normoxia group, BPD-PH group, overexpression group, and inhibitor group (n=8 per group). The normoxia group was raised in 21% oxygen, while the other groups were exposed to 85.0%±0.5% hyperoxia to induce BPD-PH. The overexpression group received tail vein injection of ADV1-miR-146b-5p adenovirus; the inhibitor group received miR-146b-5p inhibitor injections. After 14 days, adenovirus transfection efficiency in lung tissue was confirmed by confocal microscopy. Right ventricular systolic pressure (RVSP) was measured by direct manometry. Right ventricular hypertrophy index (RVHI) was calculated by weighing isolated ventricular tissues. Hematoxylin-eosin staining was used to assess pulmonary vascular morphology, and medial thickness percentage (MT%) and medial area percentage (MA%) of pulmonary vessels were calculated. Mitochondrial ultrastructure of pulmonary vascular endothelial cells was observed by transmission electron microscopy (TEM). Iron deposition in lung tissue was detected by DAB Prussian blue staining and ferrous ion colorimetric assay. Quantitative real-time PCR was used to measure mRNA expression levels of nuclear factor erythroid 2-related factor 2 (Nrf2), glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), and acyl-CoA synthetase long-chain family member 4 (ACSL4). Protein expression levels of these molecules were detected by Western blotting. Results Compared with the normoxia group, the BPD-PH group showed significantly increased RVSP, RVHI, MT%, and MA% (P0.05), swollen mitochondria, increased iron deposition, downregulated mRNA and protein expression of Nrf2, GPX4, and SLC7A11, and upregulated expression of ACSL4 (P0.05). Compared with the BPD-PH group, the overexpression group exhibited further increases in RVSP, RVHI, MT%, and MA%, severe mitochondrial swelling, significantly elevated iron deposition, decreased Nrf2, GPX4, and SLC7A11 mRNA and protein levels, and increased ACSL4 expression (P0.05). In contrast, the inhibitor group demonstrated decreased RVSP, RVHI, MT%, and MA%, alleviated mitochondrial swelling, reduced iron deposition, upregulated mRNA and protein levels of Nrf2, GPX4, and SLC7A11, and downregulated mRNA and protein levels of ACSL4 (P0.05). Conclusions Overexpression of miR-146b-5p promotes pulmonary vascular remodeling in neonatal rats exposed to hyperoxia, likely through inhibition of the Nrf2/GPX4 signaling pathway and regulation of ferroptosis.
The clinical diagnosis and treatment processes of four children with Castleman disease admitted to Guangzhou Women and Children's Medical Center, Guangzhou Medical University, from March 2021 to December 2024 were retrospectively analyzed. Among them, three cases were unicentric Castleman disease, presenting as abdominal pain with ileocecal ulceration, concomitant classical Hodgkin lymphoma, and choledochal cyst, respectively. One case was severe idiopathic multicentric Castleman disease involving lymph nodes in the neck and axillary regions, presenting with fever, abdominal distension, generalized edema, fatigue, anemia, hepatic dysfunction, polyserous effusion, and other systemic manifestations. The three unicentric cases underwent complete surgical resection of enlarged lymph nodes. The case with abdominal pain received subsequent enteral nutrition and oral thalidomide therapy. The case complicated with Hodgkin lymphoma received chemotherapy according to the Hodgkin lymphoma protocol. The severe multicentric case was treated with rituximab combined with vincristine, pirarubicin, cyclophosphamide, and prednisone. All four cases achieved complete remission during 6 to 30 months of follow-up. Clinical manifestations of Castleman disease in children lack specificity. Surgical resection remains the main treatment for unicentric cases, while treatment regimens for multicentric cases are more varied. The overall prognosis is favorable. Further studies are needed to determine the optimal treatment for Castleman disease complicated by gastrointestinal ulcers and severe idiopathic multicentric Castleman disease.
Pediatric polycythemia vera is an exceedingly rare myeloproliferative neoplasm characterized by clonal overgrowth of the erythroid lineage. Although research on adult polycythemia vera is relatively well established, standardized diagnostic and therapeutic protocols for pediatric patients are lacking. Due to substantial differences in physiological characteristics and disease progression between children and adults, directly applying adult treatment regimens is not appropriate. Pediatric-specific management strategies tailored to the unique features of children are urgently needed. This article systematically reviews the etiology, clinical manifestations, diagnostic methods, and therapeutic advances of pediatric polycythemia vera, aiming to provide evidence to support clinical decision-making and basic research.
Non-suicidal self-injury (NSSI) is a common psychological and behavioral problem among children and adolescents and an important predictor of suicidal behavior. Studies indicate that emotion regulation difficulties, impaired impulse control, psychiatric comorbidities, family adversity, and adverse social environments increase the risk of NSSI, while family, school, and peer support exert protective effects. The biological mechanisms underlying NSSI include genetic and epigenetic susceptibility, stress response and endocrine dysregulation, abnormalities in the opioid system and pain modulation, immune-inflammatory imbalance, and dysfunction of neural circuits related to emotion regulation, executive function, and reward processing. This review systematically summarizes the influencing factors and biological mechanisms of NSSI in children and adolescents to provide a reference for early identification, prevention, and intervention of NSSI.
