中国当代儿科杂志最新文献

Objectives: 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.

Objectives: 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.

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.

Objectives: 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.

Objectives: 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.

Objectives: 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.

Objectives: 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.

Objectives: 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.

A 26-day-old male infant presented with recurrent convulsions from 18 days of life. Laboratory investigations revealed severe hypomagnesemia (0.07 mmol/L) and hypocalcemia (1.65 mmol/L). Whole-exome sequencing was performed and identified compound heterozygous pathogenic variants in the TRPM6 gene, comprising c.5616G>A (p.Trp1872Ter) and a deletion of exons 20-23. The c.5616G>A variant was inherited from the father, and the exon 20-23 deletion was inherited from the mother; neither variant has been previously reported. Based on these findings, the diagnosis of primary hypomagnesemia with secondary hypocalcemia was confirmed. Oral magnesium sulfate supplementation was initiated, and no further convulsions occurred. At the 8-year follow-up, the patient exhibited persistent hypomagnesemia without other abnormalities. This case highlights that genetic testing helps confirm the diagnosis, and early magnesium supplementation effectively controls symptoms and prevents irreversible neurological impairment.