中国当代儿科杂志最新文献

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 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.

Objectives: 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.

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.

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.

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.

Objectives: 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.

Objectives: 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.

Objectives: 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.

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.