Peripherally inserted central catheter (PICC) placement is an essential routine procedure in neonatal intensive care units and an important life-support technology. In recent years, point-of-care ultrasound-guided catheter insertion and ultrasound localization of catheter tips have been widely applied in neonatal practice and demonstrate clear advantages over traditional methods. This guideline was developed on the basis of currently available evidence and the practical experience of domestic experts, and it is tailored to the Chinese context. It provides clinical practice recommendations for ultrasound-monitored vascular selection, ultrasound-guided PICC cannulation, and ultrasound localization of the PICC tip. In total, 22 recommendations addressing 10 key clinical questions are presented, covering pre-insertion vascular selection, intra-procedural ultrasound-guided localization, post-insertion dynamic monitoring, and troubleshooting of difficult scenarios. The aim is to promote standardized application of this technology in neonatal intensive care units in China, reduce complications, and improve safety.

Point-of-care critical care ultrasound plays an increasingly important role in the management of critically ill neonates. Nevertheless, it has not received sufficient attention or been widely implemented in China. To promote the adoption and development of this technology in neonatal care in China, to keep pace with the ongoing integration of ultrasound into clinical practice, and to better meet the demands of contemporary neonatal critical care, this commentary elucidates the necessity of routine use of critical care ultrasound in neonatal intensive care units.

Targeted neonatal echocardiography (TNE) refers to the purposeful use of echocardiography to assess neonatal cardiovascular physiology and hemodynamics, with the aim of improving diagnosis and treatment in the neonatal intensive care unit. Neonatal cardiac point-of-care ultrasound (cPOCUS) is a limited cardiovascular evaluation focused on catheter tip position assessment, identification of pericardial effusion, and differentiation between hypovolemia and severe reduction in myocardial contractility in hemodynamically unstable neonates. The guideline "Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the neonatal intensive care unit: an update from the American Society of Echocardiography" covers five main areas: (1) purpose and basic principles of TNE and cPOCUS; (2) an overview of the components of a standard TNE and cPOCUS evaluation; (3) disease- and/or clinical scenario-based indications for TNE; (4) training and competency-based assessment requirements for TNE and cPOCUS; and (5) components of quality assurance. This article selectively interprets the first two areas of the guideline.

Objective To evaluate the effectiveness of critical care ultrasound and noninvasive cardiac output monitoring (NICOM) in guiding fluid resuscitation in neonatal septic shock by dynamically assessing responsiveness to fluid therapy and comparing treatment outcomes and clinical applicability. Methods A total of 51 neonates were enrolled. Before initiation of fluid resuscitation, patients were randomly assigned to receive fluid resuscitation guided by critical care ultrasound or by NICOM. Differences in 14-day mortality and other clinical outcomes after the onset of septic shock were compared between the two groups. Results No significant difference was found in 14-day mortality between the critical care ultrasound group and the NICOM group (P>0.05). The cumulative duration of vasoactive drug use was shorter in the NICOM group than in the critical care ultrasound group (P<0.05). The incidences of acute kidney injury and intracranial hemorrhage within 72 hours in the NICOM group were lower than in the critical care ultrasound group (both P<0.05). However, the duration of invasive mechanical ventilation was shorter in the critical care ultrasound group than in the NICOM group (P<0.05), and the incidence of pulmonary edema within 72 hour was lower (P<0.05). No significant differences were observed between the two groups in length of hospital stay, time to achieve lactate <2 mmol/L, or the incidences of cardiac dysfunction and hepatic dysfunction (all P>0.05). Conclusions In neonates with septic shock, the risks of acute kidney injury and intracranial hemorrhage within 72 hours are lower under NICOM guidance than with critical care ultrasound, whereas fluid resuscitation guided by critical care ultrasound reduces the risk of pulmonary edema. Both critical care ultrasound and NICOM are simple, low-cost, noninvasive tools that can assist in guiding fluid resuscitation in neonatal septic shock.

Objective To develop a risk prediction model for refractory pneumonia in children by combining early lung ultrasound features with clinical symptoms. Methods Data from 152 children with pneumonia hospitalized at Jiangsu Qidong Maternal and Child Health CareHospital between June 2024 and May 2025 were retrospectively collected. The children were divided according to whether the diagnostic criteria for refractory pneumonia were met into a refractory pneumonia group (n=50) and a non-refractory pneumonia group (n=102). Clinical characteristics and lung ultrasound findings were compared between groups. Independent predictors were identified using multivariable logistic regression analysis, and a nomogram-based prediction model for refractory pneumonia was developed. Model performance was evaluated using receiver operating characteristic curve, calibration curve, and decision curve analyses. Results Multivariable logistic regression analysis showed that fever (OR=4.193, 95%CI: 1.422-12.362) and lung ultrasound findings—area of pulmonary consolidation (OR=1.071, 95%CI: 1.012-1.133), pleural effusion (OR=3.794, 95%CI: 1.571-9.165), and signs of pneumothorax (OR=1.818, 95%CI: 1.014-3.261)—were independent predictors of refractory pneumonia (all P<0.05). The prediction model based on these four factors had a C-index of 0.772, and the area under the receiver operating characteristic curve was 0.772 (95%CI: 0.690-0.854), indicating good discrimination. Decision curve analysis showed favorable clinical utility when the threshold probability was between 15% and 80%. Conclusions A risk prediction model for refractory pneumonia in children mainly based on early lung ultrasound features shows good predictive performance and helps in the early assessment of refractory pneumonia risk.

Objective To explore the feasibility of lung ultrasound in the follow-up of neonatal lung disease. Methods A retrospective study was conducted of 102 infants with neonatal lung disease who were followed up in the Department of Neonatology, the First Affiliated Hospital of Zhengzhou University from March to July 2025. According to follow-up lung ultrasound results, infants were classified into a normal group and an abnormal group. Baseline and clinical characteristics were compared between groups. Multivariable logistic regression was performed to identify independent influencing factors of abnormal lung ultrasound at follow-up, and a prediction model was constructed. Its performance for predicting abnormal lung ultrasound at follow-up was evaluated using receiver operating characteristic (ROC) curve analysis. Results The median follow-up duration was 32 days, and 58 infants (56.9%) had abnormal lung ultrasound. Significant differences were found between the normal and abnormal groups in gestational age, birth weight, and follow-up duration (all P<0.05). Multivariable logistic regression showed that gestational age (OR=0.617, P<0.001) and follow-up duration (OR=0.976, P<0.001) were independent protective factors against abnormal lung ultrasound at follow-up. ROC analysis indicated that the combined model constructed with gestational age and follow-up duration, logit(P)=17.001-0.025×follow-up duration-0.483×gestational age (where P is the probability of abnormal lung ultrasound at follow-up), achieved an area under the curve of 0.833 (95%CI: 0.758-0.909, P<0.001), with a sensitivity of 62.1% and a specificity of 93.2%. The goodness of fit was good (P>0.05). Conclusions Lung ultrasound is feasible for the follow-up of neonatal lung diseases.

Objective To evaluate the clinical value of functional ultrasound for early warning of feeding intolerance (FI) in preterm infants. Methods A prospective cohort analysis was performed in 107 preterm infants (FI group, n=48; non-FI group, n=59). Functional ultrasound was used to assess gastric emptying time, intestinal peristalsis frequency, and intraluminal gas-liquid abnormalities. Results Compared with the non-FI group, the FI group had a significantly prolonged gastric emptying time [(46±8) min vs (36±7) min, P<0.001], a reduced intestinal peristalsis frequency [(8.8±2.0) times/5 min vs (12.4±3.3) times/5 min, P<0.001], and a higher rate of moderate or greater gas-liquid abnormalities (63% vs 20%, P<0.001). A multivariable logistic regression model based on three functional ultrasound parameters—gastric emptying time, intestinal peristalsis frequency, and intestinal gas-liquid interface score—achieved an area under the receiver operating characteristic curve (AUC) of 0.910 (sensitivity 79.2% and specificity 93.2%). Internal validation (AUC=0.911, 95%CI: 0.845-0.964) and external validation (AUC=0.904, 95%CI: 0.854-1.000) both showed high predictive performance. Subgroup analyses indicated that the model retained good predictive ability across gestational age and birth weight groups. Conclusions Functional ultrasound can detect intestinal dysfunction before clinical manifestations of FI. The combined parameter model can be used for FI risk assessment and individualized feeding management in preterm infants, with high clinical applicability and potential for broader implementation.

Necrotizing enterocolitis (NEC) is a common critical gastrointestinal disease in neonates. Severe cases have a poor prognosis and may be fatal. Early and accurate diagnosis is crucial for improving outcomes. Traditional abdominal X-ray has low sensitivity. As a noninvasive, radiation-free real-time imaging technique, abdominal ultrasound can assess intestinal wall structure, peristalsis, and perfusion at an early stage and has outstanding value for early diagnosis. Typical ultrasound findings include intestinal wall thickening or thinning, abnormal blood perfusion, pneumatosis intestinalis, portal venous gas, pneumoperitoneum, and complex ascites. Ultrasound outperforms X-ray in identifying these signs, and it is particularly useful when X-ray findings are inconclusive or when dynamic monitoring is required. It can be considered one of the preferred imaging modalities for NEC.

Objective To investigate the effects of probiotics combined with breastfeeding on intestinal colonization and the risk of allergic diseases in cesarean-delivered newborns. Methods A prospective cohort of 176 cesarean-delivered mothers and newborns admitted to Xinxiang Central Hospital from January 2018 to January 2020 was enrolled, and the newborns were followed for 5 years. According to feeding practice, infants were divided into a breastfed group and a combined group (breastfeeding plus probiotics). Follow-up outcomes were compared between groups. Results Eighty-eight infants were enrolled in each group; 13 were lost to follow-up in the breastfed group and 7 in the combined group. At ages 2, 3, 4, and 5 years, fecal Lactobacillus and Bifidobacterium levels were higher in the combined group than in the breastfed group (P<0.05). Serum immunoglobulin (Ig) A, IgM, and IgG levels were higher in the combined group than in the breastfed group (P<0.05). At ages 3, 4, and 5 years, height and weight were higher in the combined group (P<0.05). The overall incidence of allergic diseases was lower in the combined group than in the breastfed group (P<0.05). At age 5 years, fine motor scores were higher in the combined group (P<0.05). In multivariable logistic regression, the combination of probiotics and breastfeeding was a protective factor for allergic diseases (OR=0.267, P<0.05), whereas family history of allergic diseases was a risk factor (OR=3.611, P<0.05). Conclusions Among cesarean-delivered newborns, the combination of probiotics and breastfeeding positively modulates the gut microbiota, promotes the growth of beneficial bacteria, enhances immunity, and reduces the risk of allergic diseases.

Objective To investigate the current status of breast milk management in neonatal intensive care units (NICUs) in Gansu Province and provide data support and a scientific basis for improvement. Methods Medical institutions at secondary level and above in prefectural and municipal areas of Gansu Province were targeted, and an online questionnaire on NICU breast milk management was administered to 107 hospitals. The questionnaire covered hospital support for breast milk management, screening of breast milk, quality control, and feeding-related health education and guidance. Results A total of 97 valid questionnaires were collected from hospitals across all prefecture-level cities in Gansu Province, with a valid response rate of 90.6%. Six hospitals had not admitted newborns in the past five years. Among the remaining 91 hospitals, 13 (14%) did not provide breastfeeding in the NICU, and 1 (1%) had a human milk bank. Among the 78 hospitals that provided breastfeeding, the utilization rate of milk preparation rooms was 89% in tertiary hospitals and 82% in secondary hospitals. The rate of establishing dedicated lactation rooms was low (19%). Tertiary hospitals used disposable feeding bottles more frequently than secondary hospitals (P<0.05), while secondary hospitals were more inclined to perform disinfection within the NICU (36%). Overall, 87% of hospitals had refrigerator temperature monitoring records, and 55% performed bacterial cultures of breast milk. Refrigerated storage was the primary method of breast milk preservation (89%). Breastfeeding education and guidance were mainly delivered through verbal education (97%). Conclusions Breast milk management in NICUs in Gansu Province remains suboptimal. Strengthening human milk bank construction to ensure supply and storage, establishing quality control systems to optimize management, enhancing staff training to standardize procedures, and reinforcing breastfeeding education to improve awareness are recommended.

Objective To analyze changes in neutrophil infiltration and chemokines in intestinal tissue from neonates with necrotizing enterocolitis (NEC), and to assess the expression of related receptors in peripheral blood, in order to explore their significance in NEC. Methods Clinical data, peripheral blood, and intestinal tissue from neonates with NEC and intestinal atresia who underwent surgery at the Third Affiliated Hospital of Zhengzhou University from June 2022 to September 2023 were prospectively collected and classified into an NEC group and an intestinal atresia group. Pathology results, chemokine levels in intestinal tissue, and neutrophil chemokine receptors in peripheral blood were compared between the two groups. Results In the NEC group, marked accumulation of neutrophils was observed in intestinal tissue. Compared with the intestinal atresia group, intestinal tissue concentrations of CCL2, CCL3, CCL4, CCL5, CXCL1, CXCL8, and interleukin-1 receptor antagonist were higher (all P<0.05). In peripheral blood leukocyte subsets, the percentages of cells co-expressing CXCR2/CCR1 and CD66/CXCR2 were higher in the NEC group (both P<0.05). Conclusions In NEC, chemokine concentrations in intestinal tissue are broadly elevated, and peripheral blood leukocytes express neutrophil chemokine receptors, which together may promote the migration and infiltration of neutrophils from peripheral blood into intestinal tissue.

Objective To examine how different ibuprofen treatment regimens affect the occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants with patent ductus arteriosus (PDA). Methods A retrospective case-control study was conducted at the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to December 2019. A total of 230 extremely preterm infants with PDA who met the inclusion criteria were included. The inverse probability of treatment weighting method was applied to evaluate the associations of ibuprofen treatment, the age at treatment initiation, and the total ibuprofen dose in the first course with the risk of BPD. Results Among extremely preterm infants with PDA, the risk of BPD after ibuprofen treatment was 0.326 times that of infants without treatment (OR=0.326, 95%CI: 0.134-0.698). Initiating treatment at an age of ≤2 weeks was associated with a 0.393-fold risk of BPD compared with initiation at >2 weeks (OR=0.393, 95%CI: 0.187-0.800). The use of a high dose (30-50 mg/kg) in the first course of ibuprofen showed no statistically significant association with BPD risk (OR=1.846, 95%CI: 0.903-3.887). Conclusions In extremely preterm infants with PDA, ibuprofen treatment and initiating treatment at an age of ≤2 weeks are protective factors for BPD, while use of a high dose in the first course appears to be unrelated to the risk of BPD.

Objective To investigate the influencing factors for the progression of glomerular injury in children with Henoch-Schönlein purpura nephritis (HSPN) and to develop a predictive model. Methods A total of 259 children with HSPN admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2022 to December 2024 were retrospectively enrolled. Based on renal biopsy pathology reports, the children were classified into a low-grade group (grade Ⅰ-Ⅱ glomerular injury; n=61), and a high-grade group (grade Ⅲ-Ⅵ glomerular injury; n=198). Clinical indicators and pathological characteristics were compared between the two groups. A multivariable logistic regression model was constructed to predict progression to high-grade injury. The model's discrimination and calibration were evaluated using receiver operating characteristic curve analysis and the Hosmer-Lemeshow goodness-of-fit test. Results Compared with the low-grade group, the high-grade group showed significantly higher urinary red blood cell count, urinary cast count, urinary small round epithelial cell count, urine protein-to-creatinine ratio, urinary IgG-to-creatinine ratio, urinary N-acetyl-β-D-glucosaminidase, fibrinogen, white blood cell count, and neutrophil-to-lymphocyte ratio, while albumin, albumin-to-globulin ratio, and prothrombin time were significantly decreased (all P<0.05). The proportions of patients with dyslipidemia, diffuse mesangial hyperplasia, glomerular segmental sclerosis or adhesion, tubular atrophy/interstitial fibrosis, and crescent formation were also significantly higher (all P<0.05). Multivariable logistic regression identified urinary small round epithelial cell count, urine protein-to-creatinine ratio, fibrinogen level, albumin level, neutrophil-to-lymphocyte ratio, and dyslipidemia as factors associated with progression from low to high-grade injury (all P<0.05). A prediction model was constructed based on these variables. The Hosmer-Lemeshow test indicated excellent calibration (P=0.977). Receiver operating characteristic analysis showed an area under the curve of 0.818 (95%CI: 0.766-0.863), with a sensitivity of 71.2% and a specificity of 80.3% (P<0.05). Conclusions Children with higher-grade glomerular injury from HSPN exhibit more severe clinical and pathological manifestations. The prediction model incorporating urinary small round epithelial cell count, urine protein-to-creatinine ratio, fibrinogen level, albumin level, neutrophil-to-lymphocyte ratio, and dyslipidemia demonstrates good predictive performance for identifying progression to high-grade (Ⅲ-Ⅵ) glomerular injury and has potential for clinical application.

Objective To evaluate the associations of serum methotrexate (MTX) concentrations and MTHFR gene polymorphisms with delayed metabolism of high-dose MTX and adverse reactions in children with acute lymphoblastic leukemia (ALL). Methods Children with ALL treated at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between August 2021 and December 2023 were included (n=214). Serum MTX concentrations after the first HD-MTX administration and MTHFR C677T and A1298C polymorphisms were determined. Clinical data were retrospectively analyzed. Results Among 214 children with ALL, the C677T TT genotype had a higher rate of delayed metabolism than the CT genotype, and the CC genotype had a higher rate than the CT genotype. For A1298C, the AC genotype was associated with a higher incidence of grade I or higher neutropenia than the AA genotype. Higher MTX concentrations were closely associated with grade Ⅱ or higher renal injury, gastrointestinal reactions, and hyperbilirubinemia. Intermediate/high-risk disease category, age >14 years, and body mass index ≥17 kg/m² were risk factors for delayed metabolism. Compared with the C677T CC genotype, the CT genotype had a reduced risk of delayed metabolism, whereas no significant difference was observed between TT and CC. Conclusions Serum MTX concentration serves as an objective marker of MTX-related toxicity. Under adequate rescue therapy and concentration monitoring, a single MTHFR polymorphism appears insufficient to guide dose adjustment. A combined strategy is recommended, with concentration monitoring as the primary approach and genetic factors as an adjunct.

Objective To investigate B1 cell and follicular helper T (Tfh) levels in children with systemic lupus erythematosus (SLE) and to assess whether mesenchymal stem cells (MSCs) regulate peripheral blood B1 cells and Tfh cells in pediatric SLE. Methods Peripheral blood mononuclear cells (PBMCs) were isolated from children with SLE and from controls. B1 and Tfh cells were measured, differences between groups were analyzed, and correlations with clinical indices were evaluated. Human umbilical cord mesenchymal stem cells (hUCMSCs) were co-cultured with PBMCs for 48 hours at hUCMSC:PBMC ratios of 1:10 and 1:20, with PBS-treated PBMCs as control; post-culture proportions of B1 and Tfh cells were re-assessed. Results hUCMSCs adhered to plastic with spindle-shaped morphology, showed robust growth, and exhibited osteogenic and adipogenic differentiation. B1 and Tfh cell levels were higher in children with SLE than in controls (P<0.05) and were not significantly correlated with serum complement, immunoglobulins, antibody levels, or SLE Disease Activity Index scores (P>0.05). Tfh cells showed a trend toward association with serum C4 and IgM. After co-culture, no statistically significant differences in B1 or Tfh cell proportions were detected among the PBS control and hUCMSC co-culture groups (P>0.05). Conclusions B1 cells and Tfh cells differ between children with SLE and controls and may be involved in SLE pathogenesis. hUCMSCs do not appear to exert therapeutic effects in SLE by regulating peripheral blood B1 and Tfh cell numbers.

This report describes the potential diagnostic value of decreased plasma citrulline (pCit) levels for the early recognition of MT-ATP6-related mitochondrial disease. Two cases were reported, and relevant literature was reviewed. Case 1: Onset occurred at 3 months of age with an acute presentation that rapidly progressed to metabolic crisis, multiorgan failure, and central respiratory failure, resulting in death in early infancy. Case 2: Onset occurred at 6 months of age with progressive developmental delay. Brain magnetic resonance imaging revealed bilateral symmetric basal ganglia lesions, and Leigh syndrome was diagnosed. Following citrulline supplementation and comprehensive intervention, improvements were observed in intellectual development and metabolic indices. Both patients carried the MT-ATP6 variant m.8993T>G (p.L156R), confirming MT-ATP6-associated mitochondrial disease. This case series indicates that decreased pCit on newborn screening is an early biochemical marker of MT-ATP6-associated mitochondrial disease. Early diagnosis and metabolic intervention are beneficial for prognosis.

A boy aged 5 years and 2 months with a history of acute myeloid leukemia of more than 10 months was admitted. Twenty days after admission, he underwent an HLA 8/10-matched unrelated umbilical cord blood stem cell transplantation. On day 6 post-transplant, high fever and a generalized erythematous papular rash occurred, with elevations of liver enzymes and interleukin-6; pre-engraftment syndrome was diagnosed and symptoms improved after symptomatic treatment. On day 22 post-transplant, refractory hyponatremia occurred. After drug effects, infection, central nervous system lesions, other organ dysfunction, and renal salt wasting were excluded, syndrome of inappropriate antidiuretic hormone secretion (SIADH) was diagnosed. Fluid restriction, 3% sodium chloride infusion, and oral salt capsules were administered, and SIADH resolved completely as the pre-engraftment syndrome resolved. One pediatric case of SIADH after hematopoietic stem cell transplantation is reported, and published cases are summarized to inform early diagnosis and treatment.

This article reports the case of a 15-year-old girl with primary amenorrhea and olfactory dysfunction. Evaluation demonstrated hypogonadotropic hypogonadism, and an initial clinical diagnosis of Kallmann syndrome was made. Whole-exome sequencing identified a novel heterozygous CHD7 variant, c.5238_5239del(p.Tyr1746*), which was classified as likely pathogenic according to the variant interpretation guidelines of the American College of Medical Genetics and Genomics. In light of the typical clinical phenotype and genetic findings, the patient was diagnosed with CHD7-related Kallmann syndrome. This case broadens the CHD7 mutational spectrum in Kallmann syndrome and provides valuable insights to inform clinicians' understanding of this disease.

This article reports a rare pediatric case of allergic bronchopulmonary aspergillosis (ABPA) complicated by concurrent pinworm infection, highlighting immune interaction and individualized, stepwise management. A 10-year-7-month-old girl presented with recurrent cough and wheezing; laboratory testing showed marked eosinophilia (1.23×10⁹/L) and elevated total immunoglobulin E (1 196 IU/mL). Aspergillus fumigatus IgG was 88.61 AU/mL, and Aspergillus fumigatus allergen m3-specific IgE was 0.37 IU/mL. Stool parasite examination confirmed pinworm infection. Chest computed tomography demonstrated atypical segmental pulmonary consolidation. Through multidisciplinary collaboration, stepwise anti-infective therapy (cefoperazone-sulbactam followed by imipenem and then voriconazole), pulsed anthelminthic therapy (albendazole), and immunomodulatory treatment were implemented, resulting in complete symptom resolution and sustained remission over 30 months of follow-up. This case illustrates a dynamic balance of Th2 immune polarization under parasitic-fungal co-infection and, for the first time, proposes a "parasite-fungus-immune memory triangle" conceptual model, offering insights for individualized management in complex pediatric infections.