Childhood malignancies, as a serious threat to children's health, not only cause tremendous suffering to children but also impose a heavy economic burden on their families and have become a major global public health challenge. The financial toxicity experienced by families of children with malignancies has distinctive features, and current assessment tools have limitations. In response to this challenge, multilevel response strategies have been developed worldwide. This review systematically examines the current situation, challenges, and response strategies, aiming to provide a basis for alleviating financial toxicity among families of children with malignancies and to promote health equity and social development.

Kawasaki disease (KD) is an acute febrile illness characterized by systemic vasculitis predominantly affecting small- and medium-sized arteries in children, and its etiology and pathogenesis remain unclear. Studies show that gut microbiota dysbiosis can aggravate vascular endothelial injury and systemic inflammation by reducing short-chain fatty acid production and activating the nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 inflammasome. Antibiotic use may further disrupt microbial homeostasis, decrease the response rate to intravenous immunoglobulin therapy in KD, and increase the risk of coronary artery lesions. This review systematically summarizes the characteristic alterations of the gut microbiota in KD and the mechanisms by which antibiotics influence disease prognosis via the gut-vascular axis, and provides a theoretical basis for microbiota-targeted interventions.

Neonatal necrotizing enterocolitis (NEC) is a life-threatening acute gastrointestinal disorder in preterm infants, characterized by high morbidity and mortality. Approximately 20%-60% of infants with NEC require emergency surgical intervention due to intestinal perforation or failure of medical management, and mortality risk increases markedly when surgery follows perforation. Traditional imaging and biomarkers have limited performance in predicting surgical timing. In recent years, multimodal imaging technologies, novel biomarkers, and machine learning algorithms have shown higher predictive value than conventional tests and clinical indicators for determining surgical timing in NEC. This review summarizes recent advances in predictive methodologies for surgical decision-making in NEC.

Kawasaki disease (KD) is an acute systemic immune‑mediated vasculitis that can lead to coronary artery lesions. Its etiology remains unclear and may involve immune responses, inflammatory reactions, and vascular endothelial injury mediated by multiple signaling pathways. In recent years, the cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) signaling pathway has attracted widespread attention for its pivotal role in infection, autoimmune diseases, and inflammatory diseases. By activating type I interferons and pro-inflammatory mediators, this pathway participates in the inflammatory cascade. This review summarizes the mechanistic roles of the cGAS-STING pathway in KD and the prospects for clinical application, providing a new perspective for basic research and clinical intervention.

With the development and launch of anti-seizure medications, some genetic epilepsies have precision treatments; however, many patients remain drug-resistant, which severely affects quality of life and overall health. Advances in gene therapy have changed traditional diagnostic and therapeutic approaches for hereditary diseases, improved diagnostic accuracy, and brought new hope to patients. Adeno-associated virus is a leading vector in gene therapy and is widely used. This review summarizes the application prospects and challenges of adeno-associated virus-mediated gene therapy for genetic epilepsy to inform clinical practice.

A 5-year-3-month-old boy presented with intellectual disability, autism spectrum disorder, short stature, long ears, large auricles, a broad nasal tip, a pointed chin, and cryptorchidism. Whole-exome sequencing revealed a de novo likely pathogenic heterozygous missense variant in KDM3B (c.5147T>C, p.Leu1716Pro), supporting a diagnosis of Diets‑Jongmans syndrome. This case further enriches the mutation spectrum of Diets‑Jongmans syndrome and suggests that early genetic testing helps clarify the etiology in children with developmental delay or intellectual disability, autism spectrum disorder, and short stature.

The patient was a 7-year-old boy admitted with facial edema. Ultrasound indicated moderate pericardial effusion and pleural effusion. Contrast-enhanced chest computed tomography showed indistinct mediastinal structures with mild-to-moderate enhancement, suggestive of a mediastinal space-occupying lesion. Further evaluation with whole-body PET-CT, pathological biopsy of the mediastinal lesion, cytological examination of pleural and pericardial effusions, and immunohistochemistry led to the final diagnosis of isolated myeloid sarcoma. Pathological examination is the gold standard for clinical diagnosis; however, limited sampling sites can result in missed or incorrect diagnoses. Multiple and multi-site sampling should be undertaken according to the clinical context, combined with flow cytometry and immunohistochemistry to assist diagnosis and reduce missed diagnoses and misdiagnoses.

A 12-year-old boy presented with recurrent abdominal pain for more than 5 months and a perianal mass for 10 days. Gastrointestinal endoscopy revealed multiple ulcers in the terminal ileum and colon, and Crohn's disease was diagnosed based on histopathology. The patient had atopic dermatitis and had previously received upadacitinib; after the diagnosis of Crohn's disease, upadacitinib was continued. During a total follow-up of 100 weeks, the patient maintained clinical remission without serious adverse reactions. This is the first report from China on upadacitinib treatment for pediatric Crohn's disease and provides guidance for its use in this population.

Objective To examine the effect of the quality of the parent-child relationship on preschoolers' social skills and the cross-time chain mediating roles of executive function and emotion regulation. Methods Using stratified random sampling, 518 preschoolers aged 3-5 years in Nanjing were followed for one year in a two-wave longitudinal design. Questionnaires were used to assess the quality of the parent-child relationship, executive function, emotion regulation, and social skills. Results Pairwise correlations among the quality of the parent-child relationship (Time 1, T1), executive function (T1), emotion regulation (Time 2, T2), and social skills (at T1 and T2) were all significant (P<0.001). The quality of the parent-child relationship (T1) predicted preschoolers' social skills (T2) through the independent mediating effect of emotion regulation (T2), which accounted for 56.25% of the total indirect effect, and through the cross-time chain mediating effect of executive function (T1) and emotion regulation (T2), which accounted for 31.25% of the total indirect effect. Conclusions Executive function and emotion regulation play a cross-time chain mediating role in the link between the parent-child relationship and preschoolers' social skills.

Objective To evaluate the efficacy and safety of percutaneous endoscopic gastrostomy (PEG) in children with methylmalonic acidemia (MMA) or propionic acidemia (PA) complicated by feeding difficulties. Methods Clinical data of seven children with MMA/PA and feeding difficulty who underwent PEG at Shenzhen Maternity and Child Healthcare Hospital from June 2021 to April 2025 were retrospectively analyzed. Preoperative assessment, perioperative management, and postoperative follow-up were summarized. Results The median age at PEG placement was 20 months. All PEG placements were successfully completed in a single attempt. The mean operative time was (21.0 ± 2.2) minutes, intraoperative blood loss was 1-2 mL, and the mean postoperative hospital stay was (5.7 ± 1.1) days. At 6 months postoperatively, compared with preoperative values, body weight and length increased, the frequency of acidosis episodes decreased, daily feeding time was shortened, time spent on outdoor activities increased, and serum prealbumin levels rose (all P<0.05). During 6-12 months of follow-up, the most common complication was peristomal hypergranulation (five cases). One case developed gastrostomy-site perforation 7 months postoperatively. Conclusions PEG effectively improves nutritional and metabolic status in children with MMA/PA complicated by feeding difficulties and is a safe, effective method for long-term enteral nutrition support.

Objective To investigate the clinical characteristics and prognosis of childhood acute lymphoblastic leukemia (ALL) with PDGFRB rearrangement. Methods A retrospective analysis was conducted of 7 childhood ALL patients with PDGFRB rearrangement who were diagnosed and initiated on therapy at the Children's Hospital, The First Affiliated Hospital of Zhengzhou University from January 2020 to December 2024, assessing clinical features, laboratory findings, treatment, and survival. Results Seven children with PDGFRB-rearranged ALL were identified, accounting for 1.0% (7/673) of ALL cases during the same period. There were 3 males and 4 females, with a median age at diagnosis of 8 years (range: 1-12 years). One case was T-acute lymphoblastic leukemia (T-ALL) and 6 cases were B-acute lymphoblastic leukemia (B-ALL). Fusion partners included EBF1-PDGFRB in 4 cases, ROCK1-PDGFRB in 1 case, CCDC88C-PDGFRB in 1 case, and SSBP2-PDGFRB in 1 case. Six patients had concurrent gene mutations, including IKZF1, EBF1, PAX5, CDKN2A, and CDKN2B. One patient was positive for the ETV6-RUNX1 fusion gene, and one for the STIL-TAL1 fusion gene. All 7 patients had normal karyotypes. All patients received chemotherapy, achieving a 100% complete remission rate after one course. Minimal residual disease (MRD) negativity rate was 57% (4/7), and PDGFRB fusion transcript became negative in 3/7 (43%). Three patients underwent allogeneic hematopoietic stem cell transplantation in remission and remain disease-free, while 2 of the 4 non-transplanted patients died. Conclusions PDGFRB-rearranged ALL in children is uncommon, is most often detected in B-ALL, and presents at a relatively older age. Fusion partners are diverse and frequently co-occur with additional gene mutations. Despite high initial remission, MRD negativity and molecular clearance rates remain suboptimal, and allogeneic hematopoietic stem cell transplantation may improve prognosis.

Objective To assess the predictive value of the Pediatric Sequential Organ Failure Assessment (pSOFA), Pediatric Index of Mortality 3 (PIM-3), Pediatric Risk of Mortality IV (PRISM IV), Phoenix Sepsis Score (PSS), Phoenix Sepsis Score-8 (Phoenix-8), the ratio of neutrophil count to lymphocyte and platelet count (N/LPR), and a nomogram constructed from these factors for 28-day mortality in children with sepsis. Methods A retrospective analysis was conducted on 267 children with sepsis admitted to the Pediatric Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University from January 2017 to January 2025. Patients were categorized into a survival group (n=208) and a death group (n=59). Differences in clinical indicators between the two groups were compared. Univariate and multivariable logistic regression were used to identify independent risk factors for 28-day mortality and to construct a nomogram. Predictive performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis. Results pSOFA, PIM-3, PRISM IV, PSS, Phoenix-8 scores, N/LPR, and lactate levels were significantly higher in the death group than in the survival group (P<0.05). Multivariable logistic regression identified pSOFA, PRISM IV, PSS, and N/LPR as independent risk factors for 28-day mortality. The nomogram based on these factors achieved the area under the receiver operating characteristic curves of 0.940 in the training group and 0.911 in the validation group, with good calibration according to the Hosmer-Lemeshow test (P>0.05), and decision curve analysis indicated good clinical applicability. Conclusions A nomogram incorporating pSOFA, PRISM IV, PSS, and N/LPR shows good predictive value for 28-day mortality risk in children with sepsis.

Objective To study the clinical characteristics of children with severe drowning admitted to the pediatric intensive care unit and to identify risk factors for mortality. Methods Clinical data of 49 children with severe drowning admitted between January 2015 and December 2024 were retrospectively analyzed. Multivariable logistic regression was used to determine risk factors for mortality and to construct a prediction model. Model performance for mortality risk was evaluated using the receiver operating characteristic (ROC) curve. Results Among the 49 patients, the mortality rate was 24% (12/49), and the incidence of neurological sequelae among survivors was 22% (8/37). Multivariable logistic regression analysis showed that admission Glasgow Coma Scale (GCS) score (OR=0.43, P<0.05), drowning duration (OR=1.22, P<0.05), and total prehospital time (per 10 minutes increase, OR=1.85, P<0.05) were associated with mortality. A mortality prediction model was constructed based on these three factors: logit(P)=6.26-0.85×GCS score at admission + 0.20×drowning duration (minutes) + 0.62×[total prehospital time (minutes)/10]. The area under the ROC curve was 0.912 (P<0.001), with a sensitivity of 83.3% and a specificity of 91.9%. Conclusions Severe drowning in children has a high mortality and a high rate of adverse outcomes. Admission GCS score, drowning duration, and total prehospital time are core risk factors for predicting mortality, and their combination serves as an effective indicator for early risk stratification.

Objective To investigate the impact of maternal prepregnancy body mass index (BMI) on maternal and infant outcomes in twin pregnancies. Methods A retrospective analysis included 4 824 twin pairs and their mothers with complete records, delivered at 21 tertiary grade-A hospitals nationwide from January 2018 to December 2020. Participants were grouped by prepregnancy BMI: underweight (<18.5 kg/m²; n=566), normal weight (18.5 to <24.0 kg/m²; n=3 120), overweight (24.0 to <28.0 kg/m²; n=892), and obese (≥28.0 kg/m²; n=246). Differences and associations in adverse maternal and infant outcomes were compared among groups. Results The gestational age in the overweight group was lower than in the normal and underweight groups, with a higher rate of very preterm birth (P<0.008). Compared with the normal and overweight groups, the proportion of small-for-gestational-age (SGA) neonates was higher in the underweight group (P<0.008). After adjustment for confounders, the obese group had higher risks of gestational diabetes mellitus and hypertensive disorders of pregnancy than the normal and underweight groups (all P<0.001). Compared with the normal group, the underweight group had a higher risk of SGA among twins (P<0.05). Conclusions Maternal prepregnancy BMI is closely associated with maternal and infant outcomes in twin pregnancies, providing evidence-based support for individualized weight management.

Objective To systematically evaluate the incidence and risk factors of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) in preterm infants. Methods Cohort and case-control studies on the incidence and risk factors of PH complicating BPD (hereinafter referred to as BPD-PH) in preterm infants, published from database inception to July 2024, were retrieved from China National Knowledge Infrastructure, Wanfang Data, VIP Database, Chinese Biomedical Literature Database, PubMed, Web of Science, Embase, MEDLINE, and Cochrane Library. Meta analysis was performed using Stata 15.0 software. Results A total of 15 studies involving 4 561 preterm infants were included. Meta analysis results showed that the overall incidence of BPD-PH in preterm infants was 20.1% (95%CI: 16.1%-24.0%). Hemodynamically significant patent ductus arteriosus (OR=3.43), mechanical ventilation duration (OR=1.05), small for gestational age (SGA) (OR=7.30), severe BPD (OR=13.25), patent ductus arteriosus requiring surgical ligation (OR=6.03), oligohydramnios (OR=7.24), ventilator-associated pneumonia (OR=3.97), and respiratory distress syndrome (OR=2.70) were identified as risk factors for BPD-PH in preterm infants (P<0.05). Conclusions The overall incidence of BPD-PH in preterm infants is relatively high. Hemodynamically significant patent ductus arteriosus, mechanical ventilation duration, SGA, severe BPD, patent ductus arteriosus requiring surgical ligation, oligohydramnios, ventilator-associated pneumonia, and respiratory distress syndrome can increase the risk of PH in preterm infants with BPD, and clinical monitoring should prioritize BPD infants with these high-risk factors.

Objective To investigate the dynamic development of gut microbiota in preterm infants during their first year after birth and to compare the microbiota profiles between preterm infants of different gestational ages. Methods In this prospective study, 81 preterm infants (including 37 early preterm and 44 moderate-to-late preterm infants) and 26 full-term infants were enrolled from Shenzhen Bao'an Women and Children's Hospital between January 2021 and September 2022. Fecal samples were collected at 1, 6, and 12 months of age. 16S rRNA sequencing was conducted, followed by comprehensive bioinformatics analysis. Results The alpha diversity indices of the gut microbiota in preterm infants increased significantly from 1 to 12 months of age (P<0.001). With increasing age, the relative abundances of Clostridium, Streptococcus, Klebsiella, and Staphylococcus decreased, whereas those of Bifidobacterium, Lactobacillus, and Bacteroides increased. At 1 month of age, significant disparities were observed in alpha diversity, beta diversity, and taxonomic abundances among different gestational age groups. Specifically, Clostridium and Aeromonas were enriched in early preterm infants. By 12 months of age, no significant differences in these microbial metrics were detected across the gestational age groups (P>0.05). Conclusions The gut microbiota of preterm infants becomes progressively more diverse during the first year of life. Preterm infants with lower gestational age harbor a higher relative abundance of potentially pathogenic genera in their early gut microbiota. However, the influence of gestational age on microbial composition diminishes over time.

Objective To investigate the clinical diagnostic value of the endothelial glycocalyx injury biomarker syndecan-1 (SDC-1) for necrotizing enterocolitis (NEC) in preterm infants. Methods A multicenter, prospective study was conducted from February to July 2025 at the First Affiliated Hospital of Army Medical University, Sichuan Maternal and Child Health Hospital, and Liaocheng People's Hospital. Preterm infants with Bell stage Ⅱ-Ⅲ NEC were enrolled as the NEC group (n=38), and contemporaneous non-NEC preterm infants were selected in a 1∶1 ratio as the non-NEC group (n=38). Perinatal data and measurements of complete blood counts, SDC-1, and high-sensitivity C-reactive protein (hs-CRP) were collected. Multivariable logistic regression was used to evaluate risk factors for NEC. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance of SDC-1. Results Neutrophil count, SDC-1, and hs-CRP levels were significantly higher in the NEC group than in the non-NEC group (P<0.05), while platelet count was significantly lower (P<0.05). Elevated SDC-1 (OR=1.081, 95%CI: 1.028-1.137; P<0.05) and hs-CRP (OR=1.267, 95%CI: 1.051-1.527; P<0.05) were independent risk factors for NEC. ROC analysis showed that SDC-1 (cutoff 125 ng/mL) and hs-CRP (cutoff 6.56 mg/L) yielded areas under the curve (AUCs) of 0.882 and 0.863, respectively. Their combination achieved an AUC of 0.938 with a sensitivity of 76.3% and a specificity of 97.4%. Conclusions SDC-1 is a potential biochemical biomarker for diagnosing NEC in preterm infants, but its clinical utility requires further validation in larger-sample studies.

Objective To characterize the molecular profiles of Klebsiella pneumoniae isolates causing neonatal sepsis and assess their clinical implications. Methods Clinical data and bloodstream isolates from neonates with Klebsiella pneumoniae sepsis admitted to four hospitals in Hebei Province from 2020 to 2024 were collected. Whole-genome sequencing was performed to analyze molecular characteristics of the pathogenic strains. Clinical features were compared between virulence gene-carrying and non-carrying groups. A phylogenetic tree based on sequencing data was constructed to explore potential transmission routes. Results A total of 37 infants and their clinical bloodstream isolates were included. Thirty-three (89%) had late-onset infection, and 32 (86%) were hospital-acquired. Preterm infants accounted for 95%. Twenty-eight (76%) underwent invasive procedures, and 13 (35%) had prior exposure to broad-spectrum antimicrobials. All infants were cured after treatment. Resistance rates to third-generation cephalosporins and carbapenems were 89% and 27%, respectively. ST45 was the most common sequence type. The carriage rates of extended-spectrum β-lactamase and carbapenemase genes were 84% and 24%, respectively. Concordance between resistance genes and phenotypic resistance was 86%. Clinical antimicrobial use was not fully consistent with resistance phenotypes or gene carriage. Among virulence genes, ybt had the highest carriage rate (54%). The proportion of concurrent infections at other sites did not differ significantly between the virulence gene-carrying and non-carrying groups (50% vs 29%, P=0.315). Phylogenetic analysis revealed intra-hospital and inter-hospital transmission of Klebsiella pneumoniae strains causing neonatal sepsis. Conclusions Detection of antimicrobial resistance and virulence genes facilitates deeper understanding of bacterial pathogenesis and provides a basis for optimizing regional infection control and antimicrobial treatment strategies.

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.

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.

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 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.

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.

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 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 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 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 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 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.

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.