Examination of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) in a sample of Danish children and adolescents exposed to abuse

Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire – Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD.

Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse.

Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored.

Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment.

Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population.

The International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence.

The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm.

CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD.

The link between obesity and insulin resistance among children: Effects of key metabolites

BACKGROUND

Childhood obesity became a severe public health challenge, and insulin resistance (IR) was one of the common complications. Both obesity and IR were considered as the basis of metabolic disorders. However, it is unclear which common key metabolites are associated with childhood obesity and IR.

METHODS

The children were divided into normal weight and overweight/obese groups. Fasting blood glucose and fasting insulin were measured, and homeostasis model assessment of insulin resistance was calculated. Liquid chromatography-tandem mass spectrometry was applied for metabonomic analysis. Multiple linear regression analysis and correlation analysis explored the relationships between obesity, IR, and metabolites. Random forests were used to rank the importance of differential metabolites, and relative operating characteristic curves were used for prediction.

RESULTS

A total of 88 normal-weight children and 171 obese/overweight children participated in the study. There was a significant difference between the two groups in 30 metabolites. Childhood obesity was significantly associated with 10 amino acid metabolites and 20 fatty acid metabolites. There were 12 metabolites significantly correlated with IR. The ranking of metabolites in random forest showed that glutamine, tyrosine, and alanine were important in amino acids, and pyruvic-ox-2, ethylmalonic-2, and phenyllactic-2 were important in fatty acids. The area under the curve of body mass index standard deviation  score (BMI-SDS) combined with key amino acid metabolites and fatty acid metabolites for predicting IR was 80.0% and 76.6%, respectively.

CONCLUSIONS

There are common key metabolites related to IR and obese children, and these key metabolites combined with BMI-SDS could effectively predict the risk of IR.

The efficacy of postdivorce intervention programs for children: A meta-analytical review

Preventive postdivorce interventions aim to help children cope with divorce and promote their adjustment. Nevertheless, questions remain regarding the concrete outcomes of these interventions and the intervention characteristics that influence them. This meta-analysis of 30 studies analyzes the efficacy of postdivorce interventions on children's symptomatology, personal resources, and adaptation to divorce. Likewise, it explores whether the intervention impacts the putative mediators from the family context and whether the characteristics of the studies themselves also influence the results. Using a data set of N = 4344 individuals, 258 effect sizes were calculated. Random effects analyses evidenced the impact of the interventions on specific variables instead of on children's global adjustment. There were no significant effects on children's mental health outcomes, and none of these effects were qualified by the moderators that were examined. Preventive postdivorce interventions had significant effects, specifically on children's divorce adjustment and self-esteem. The study of the moderators found that the interventions were generally homogeneous, and only one of the 20 moderators examined had a significant effect. Based on children's age, the interventions had an impact on family functioning only when they involved younger children, but this result should be interpreted with caution due to the small sample of studies. This meta-analysis provides evidence of the relevance of postdivorce interventions to critical variables as well as information about the role of the intervention characteristics in the effects and makes suggestions for future research on divorce interventions that encompass both practical and empirical developments.

The psychological impact of the Turkey-Syria earthquake on children: addressing the need for ongoing mental health support and global humanitarian response

This letter aims to explore the potential impact of the Turkey-Syria earthquake on the psychological well-being of the affected children and adolescents. It emphasises the crucial importance of prompt identification and management of emerging mental health disorders in this vulnerable population. The letter draws on existing research evidence to highlight the need for suitable mental health interventions to mitigate the anticipated suffering of many children and adolescents affected by the earthquake. A comprehensive overview of the mediating factors which may play a role in the extent of the impact of an earthquake on the mental health of children is discussed. A range of appropriate strategies and interventions are recommended and the call for continued global support is renewed. We have concluded that major earthquakes can potentially contribute to the development of mental health disorders among children and adolescents. However, by providing timely and effective support, it is possible to prevent long-term psychological consequences and facilitate early recovery. We propose the urgent implementation of effective mental health interventions in the aftermath of the Turkey-Syria earthquake to foster the recovery and resilience of the affected young population.

Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response

Background: Stepped care cognitive behavioural therapy for children after trauma (SC-CBT-CT; aged 7-12 years) can help to increase access to evidence-based trauma treatments for children. SC-CBT-CT consists of a parent-led therapist-assisted component (Step One) with an option to step up to standard therapist-led treatment (Step Two). Studies have shown that SC-CBT-CT is effective; however, less is known about what parent variables are associated with outcome of Step One.Objective: To examine parent factors and their relationship with completion and response among children receiving Step One.Method: Children (n = 82) aged 7-12 (M = 9.91) received Step One delivered by their parents (n = 82) under the guidance of SC-CBT-CT therapists. Logistic regression analyses were used to investigate whether the following factors were associated with non-completion or non-response: the parents' sociodemographic variables, anxiety and depression, stressful life experiences and post-traumatic symptoms, negative emotional reactions to their children's trauma, parenting stress, lower perceived social support, and practical barriers to treatment at baseline.Results: Lower level of educational achievement among parents was related to non-completion. Higher levels of emotional reactions to their child's trauma and greater perceived social support were related to non-response.Conclusions: The children seemed to profit from the parent-led Step One despite their parents` mental health challenges, stress, and practical barriers. The association between greater perceived social support and non-response was unexpected and warrants further investigation. To further increase treatment completion and response rates among children, parents with lower education may need more assistance on how to perform the interventions, while parents who are very upset about their child's trauma may need more emotional support and assurance from the therapist.Trial registration: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019).

Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents: development of the Traumatic Grief Inventory - Kids - Clinician-Administered

BACKGROUND

Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory - Kids - Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children.

METHODS

Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdn_age = 13.0 years, range = 8-17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items.

RESULTS

Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments.

CONCLUSION

With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument's psychometric qualities.

Implementation of an evidence-based trauma-focused treatment for traumatised children and their families during the war in Ukraine: a project description

The full-scale invasion of Ukraine by Russia in February 2022 led to an increase of traumatic events and mental health burden in the Ukrainian general population. The (ongoing) traumatisation can have a crucial impact on children and adolescents as they are especially vulnerable for developing trauma-related disorders such as Post Traumatic Stress Disorder (PTSD) or Depression. To date, these children have only very limited access to trauma-focused evidence-based treatments (EBTs) by trained mental health specialists in Ukraine. The fast and effective implementation of these treatments in Ukraine is crucial to improve the psychological wellbeing of this vulnerable population. This letter to the editor describes an ongoing project which implements a trauma-focused EBT called 'Trauma-Focused Cognitive Behavioural Therapy' (TF-CBT) in Ukraine during the war. In collaboration with Ukrainian and international agencies, the project 'TF-CBT Ukraine' was developed and implemented starting in March 2022. The project entails a large training programme for Ukrainian mental health specialists and the implementation of TF-CBT with children and their families in and from Ukraine. All components of the project are scientifically evaluated on a patient and therapist level, cross-sectionally and longitudinally, in a mixed-methods design. All together nine training cohorts with N = 133 Ukrainian therapists started the programme, all monthly case consultations (15 groups) and treatments of patients are still ongoing. Lessons learnt from this first large-scale implementation project on an EBT for children and adolescents impacted by trauma in Ukraine will help inform the field on challenges and also possibilities to expand such efforts. On a broader level, this project could be one small step in the process of helping children overcome the negative effects and experience resilience in the context of a war-torn nation.

The performance of noninvasive indexes of adults in identification of nonalcoholic fatty liver disease in children

BACKGROUND

The aim of this study is to evaluate the performance of three existing prediction scores which are applicable to adults for identifying nonalcoholic fatty liver disease (NAFLD) in Chinese children.

METHODS

We used data from routine check-up based medical records of 1845 children to validate the performance of three existing scoring systems including the hepatic steatosis index (HSI), Zhejiang University index (ZJU index), and triglyceride-glucose index (TyG index) in detection of NAFLD in children. Propensity score matching was applied to adjust for potential confounding effects in both training and validation cohorts. The area under the curve (AUC) of the receiver operating characteristic curve analysis was utilized to assess the performance of the three scoring systems.

RESULTS

Children with NAFLD had higher scores of HSI, ZJU index, and TyG index when compared with the control group (children without NAFLD). Elevated HSI, ZJU index, and TyG index scores were significantly associated with the presence of pediatric NAFLD since adjusted odds ratio and 95% CI with per interquartile range elevation of the HSI, ZJU index, and TyG index were 32.81 (20.48, 52.55), 26.31 (16.97, 40.79), and 1.83 (1.57, 2.13), respectively. In terms of discrimination of NAFLD in children, the AUC of the HSI, ZJU index, and TyG index depending on the validation cohort were 0.964, 0.960, and 0.769, respectively.

CONCLUSIONS

The HSI and ZJU index could be appropriate noninvasive biomarkers in distinguishing NAFLD in children from their controls with satisfied accuracy, which would emphasize the clinical and public health policy relevance of pediatric NAFLD. Our findings need to be confirmed by additional longitudinal studies.

儿童炎症性肠病艰难梭菌感染及其易感因素分析

OBJECTIVE

To investigate the incidence rates of Clostridium difficile colonization and Clostridium difficile infection (CDI) in children with inflammatory bowel disease (IBD) and the susceptibility factors for CDI in children with IBD.

METHODS

A total of 62 children diagnosed with IBD were enrolled as the IBD group. Forty-two children who attended the hospital due to persistent or chronic diarrhea and were excluded from IBD were enrolled as the non-IBD group. The incidence rate of CDI was compared between the two groups. According to the presence or absence of CDI, the IBD group was subdivided into two groups:IBD+CDI (n=12) and non-CDI IBD (n=50), and the clinical data were collected from the two groups to analyze the susceptibility factors for CDI.

RESULTS

The IBD group had a significantly higher incidence rate of CDI[19% (12/62) vs 2% (1/42); P < 0.05] than the non-IBD group (P < 0.05). Compared with the non-CDI IBD group, the IBD+CDI group had a significantly longer disease course (P < 0.05), and a significantly higher proportion of children with fever, diarrhea, or abdominal pain (P < 0.05). The IBD+CDI group had significantly higher activity indices of pediatric Crohn's disease, C-reactive protein levels and erythrocyte sedimentation rate than the non-CDI IBD group (P < 0.05). The univariate analysis showed that compared with the non-CDI IBD group, the IBD+CDI group had a significantly higher proportion of children with moderate-to-severe disease, use of glucocorticoids, or treatment with broad-spectrum antibiotics for more than 14 days before diagnosis (P < 0.05).

CONCLUSIONS

The children with IBD have a higher incidence of CDI than those without IBD. Severe disease conditions and use of broad-spectrum antibiotics or glucocorticoids may be associated with an increased incidence of CDI in children with IBD.

[Detection of drug-resistance genes of Mycoplasma pneumoniae in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia]

OBJECTIVE

To study the drug resistance of Mycoplasma pneumoniae (MP) in the bronchoalveolar lavage fluid (BALF) of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the distribution of drug-resistance genes, as well as the association of alleles at 2063 locus of 23SrRNA V region central ring with resistance to antimicrobial drugs.

METHODS

BALF specimens were collected from 245 children with RMPP who were admitted to the Children's Hospital Affiliated to Zhengzhou University from March 2016 to December 2020. A rapid cultured drug sensitivity assay was used to detect the resistance of MP isolates to nine commonly used antimicrobial drugs. The real-time PCR was used to measure MP DNA. The direct sequencing was used to detect gene mutations in MP 23SrRNA V region central ring.

RESULTS

Among the 245 BALF specimens, 207 tested positive for MP DNA, with a positive rate of 84.5%. The results of drug susceptibility test showed that the children with RMPP had a resistance rate of > 70% to macrolide antimicrobial drugs, with the highest resistance rate to clarithromycin, followed by roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin, and these children had a resistance rate of < 5% to quinolone antimicrobial drugs. Among the 207 MP DNA-positive specimens, 41 (19.8%) had no drug-resistance gene mutations and 166 (80.2%) had drug-resistance gene mutations, among which 154 (74.4%) had an A→G mutation at 2063 locus of 23SrRNA V region central ring, 7 (3.4%) had an A→G mutation at 2064 locus, and 5 (2.4%) had mutations in both 2063 and 2064 loci. Among the 166 specimens with point mutations of the MP 23SrRNA gene, 159 (95.8%) had point mutations at 2063 locus. The A→G point mutation at 2063 locus of 23SrRNA V region central ring had a great impact on resistance to macrolide antimicrobial drugs. There was a significant difference in the distribution of alleles at 2063 locus between the children with resistance to clarithromycin, roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin (P < 0.05).

CONCLUSIONS

MP in the BALF of children with RMPP has a relatively high resistance rate to macrolide antimicrobial drugs. Resistance to macrolide antimicrobial drugs is closely associated with the A→G point mutation in the 23SrRNA gene, and the point mutation at 2063 locus of 23SrRNA V region central ring may affect the drug-resistance mechanism of MP.

[Epstein-Barr virus-associated smooth muscle tumor in a girl]

A girl, aged 7 years, was admitted due to pain in both lower limbs for more than one year. Lumbar MRI showed soft tissue masses in the paravertebral region. Cerebral MRI showed nodular masses in the cavernous sinus at both sides. Chest CT showed high-density nodules in the outer basal segment of the right inferior lobe and the anterior segment of the left upper lobe of the lung. Biopsy of lumbar lesions showed Epstein-Barr (EB) virus-related smooth muscle tumor. Genetic testing showed a de novo mutation, c.725_730delAGAGTA (p.K242_S243del), in the ITK gene. The masses in the lumbar vertebra were removed by surgery, and then the pain in both lower limbs disappeared. This article reports a case of EB virus-related smooth muscle tumor with a deletion mutation in the ITK gene, which provides experience for the diagnosis and treatment of this disease.

[Detection of drug-resistance genes of Mycoplasma pneumoniae in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia]

OBJECTIVE

To study the drug resistance of Mycoplasma pneumoniae (MP) in the bronchoalveolar lavage fluid (BALF) of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the distribution of drug-resistance genes, as well as the association of alleles at 2063 locus of 23SrRNA V region central ring with resistance to antimicrobial drugs.

METHODS

BALF specimens were collected from 245 children with RMPP who were admitted to the Children's Hospital Affiliated to Zhengzhou University from March 2016 to December 2020. A rapid cultured drug sensitivity assay was used to detect the resistance of MP isolates to nine commonly used antimicrobial drugs. The real-time PCR was used to measure MP DNA. The direct sequencing was used to detect gene mutations in MP 23SrRNA V region central ring.

RESULTS

Among the 245 BALF specimens, 207 tested positive for MP DNA, with a positive rate of 84.5%. The results of drug susceptibility test showed that the children with RMPP had a resistance rate of > 70% to macrolide antimicrobial drugs, with the highest resistance rate to clarithromycin, followed by roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin, and these children had a resistance rate of < 5% to quinolone antimicrobial drugs. Among the 207 MP DNA-positive specimens, 41 (19.8%) had no drug-resistance gene mutations and 166 (80.2%) had drug-resistance gene mutations, among which 154 (74.4%) had an A→G mutation at 2063 locus of 23SrRNA V region central ring, 7 (3.4%) had an A→G mutation at 2064 locus, and 5 (2.4%) had mutations in both 2063 and 2064 loci. Among the 166 specimens with point mutations of the MP 23SrRNA gene, 159 (95.8%) had point mutations at 2063 locus. The A→G point mutation at 2063 locus of 23SrRNA V region central ring had a great impact on resistance to macrolide antimicrobial drugs. There was a significant difference in the distribution of alleles at 2063 locus between the children with resistance to clarithromycin, roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin (P < 0.05).

CONCLUSIONS

MP in the BALF of children with RMPP has a relatively high resistance rate to macrolide antimicrobial drugs. Resistance to macrolide antimicrobial drugs is closely associated with the A→G point mutation in the 23SrRNA gene, and the point mutation at 2063 locus of 23SrRNA V region central ring may affect the drug-resistance mechanism of MP.

[Value of airway pH monitoring in determining the association between chronic cough and laryngopharyngeal reflux in children]

OBJECTIVE

To study the value of airway pH monitoring in determining the association between chronic cough and laryngopharyngeal reflux (LPR) in children.

METHODS

A total of 274 children with chronic cough who were treated from January 2016 to December 2019 were enrolled. The DX-pH detection system was used to conduct 24-hour airway pH monitoring. The association between chronic cough and LPR was analyzed.

RESULTS

Among the 274 children, there were 168 boys and 106 girls, with a median age of 62.8 months and a median airway pH value of 7.3. Of all the 274 children, 99 (36.1%) had LPR, and the incidence rate of LPR was 36.9% (62/168) in boys and 34.9% (37/106) in girls (P=0.737). The comparison of the incidence rate of LPR among children aged < 1 year, 1-6 years, and > 6 years showed that the younger children had a significantly higher incidence rate of LPR than the older ones (P=0.003). There was no significant difference in the incidence of LPR between the two groups with chronic cough of unknown etiology and definite etiology. The incidence of chronic cough was positively correlated with that of LPR (r_s=0.861, P < 0.01). Among the 99 children with positive RYAN index, 65 (66%) suffered from simple LPR.

CONCLUSIONS

LPR is highly associated with the development of chronic cough, and airway pH monitoring may be a safe and effective method for the diagnosis of LPR.

[Recurrence factors for myelin oligodendrocyte glycoprotein antibody disease in children and the effect of recurrence prevention regimens]

OBJECTIVE

To study the clinical features and recurrence factors of myelin oligodendrocyte glycoprotein (MOG) antibody disease in children and the effect of recurrence prevention regimens.

METHODS

A retrospective analysis was performed on the medical data of 41 children with MOG antibody disease who were hospitalized in the Department of Pediatric Neurology, Xiangya Hospital of Central South University, from December 2014 to September 2020. According to the presence or absence of recurrence, they were divided into a monophasic course group (n=19) and a recurrence group (n=22). According to whether preventive treatment for recurrence was given, the children with recurrence were further divided into a preventive treatment group and a non-preventive treatment group. The clinical features were analyzed for all groups, and the annualized relapse rate (ARR) was compared before and after treatment with prevention regimens.

RESULTS

For these 41 children, acute disseminated encephalomyelitis was the most common initial manifestation and was observed in 23 children (56%). Of the 41 children, 22 (54%) experienced recurrence, with 57 recurrence events in total, among which optic neuritis was the most common event (17/57, 30%). The proportion of children in the recurrence group who were treated with corticosteroids for less than 3 months in the acute phase was higher than that in the monophasic course group (64% vs 32%; P < 0.05). There was no significant difference in the ARR between the preventive treatment and non-preventive treatment groups (P > 0.05). The assessment of preventive treatment regimens for 32 cases showed that the children treated with rituximab or azathioprine had a significant reduction in the ARR during treatment (P < 0.05).

CONCLUSIONS

More than half of the children with MOG antibody disease may experience recurrence. Most children with recurrence are treated with corticosteroids for less than 3 months in the acute phase. Rituximab and azathioprine may reduce the risk of recurrence.

[Recurrence factors for myelin oligodendrocyte glycoprotein antibody disease in children and the effect of recurrence prevention regimens]

OBJECTIVE

To study the clinical features and recurrence factors of myelin oligodendrocyte glycoprotein (MOG) antibody disease in children and the effect of recurrence prevention regimens.

METHODS

A retrospective analysis was performed on the medical data of 41 children with MOG antibody disease who were hospitalized in the Department of Pediatric Neurology, Xiangya Hospital of Central South University, from December 2014 to September 2020. According to the presence or absence of recurrence, they were divided into a monophasic course group (n=19) and a recurrence group (n=22). According to whether preventive treatment for recurrence was given, the children with recurrence were further divided into a preventive treatment group and a non-preventive treatment group. The clinical features were analyzed for all groups, and the annualized relapse rate (ARR) was compared before and after treatment with prevention regimens.

RESULTS

For these 41 children, acute disseminated encephalomyelitis was the most common initial manifestation and was observed in 23 children (56%). Of the 41 children, 22 (54%) experienced recurrence, with 57 recurrence events in total, among which optic neuritis was the most common event (17/57, 30%). The proportion of children in the recurrence group who were treated with corticosteroids for less than 3 months in the acute phase was higher than that in the monophasic course group (64% vs 32%; P < 0.05). There was no significant difference in the ARR between the preventive treatment and non-preventive treatment groups (P > 0.05). The assessment of preventive treatment regimens for 32 cases showed that the children treated with rituximab or azathioprine had a significant reduction in the ARR during treatment (P < 0.05).

CONCLUSIONS

More than half of the children with MOG antibody disease may experience recurrence. Most children with recurrence are treated with corticosteroids for less than 3 months in the acute phase. Rituximab and azathioprine may reduce the risk of recurrence.

[Early identification and diagnosis of epilepsy related to fever sensitivity]

Febrile seizures are the most common nervous system disease in childhood, and most children have a good prognosis. However, some epilepsy cases are easily induced by fever and are characterized by "fever sensitivity", and it is difficult to differentiate such cases from febrile seizures. Epilepsy related to fever sensitivity includes hereditary epilepsy with febrile seizures plus, Dravet syndrome, and PCDH19 gene-related epilepsy. This article mainly describes the clinical manifestations of these three types of epilepsy and summarizes their clinical features in the early stage of disease onset, so as to achieve early identification, early diagnosis, and early intervention to improve prognosis.

呼气峰值流量在儿童哮喘诊断及管理中的应用进展

Peak expiratory flow (PEF) is a portable, reliable, and inexpensive method for lung function assessment. PEF can reflect expiratory airflow limitation and its variability can document reversibility, which provides an objective basis for the diagnosis of asthma in children. Short-term PEF monitoring can be an important aid in the management of acute asthma exacerbations, identification of possible triggers, and assessment of response to treatment. Long-term PEF monitoring can assist in the assessment of asthma control and warning of acute exacerbations, and this is useful for children with severe asthma. This article reviews the measurements, influencing factors, interpretation, and application of PEF, and its role in the diagnosis and management of asthma in children, to provide references for the clinical application of PEF in children.

基于ICF-CY核心分类组合的康复治疗方案对脑性瘫痪患儿日常生活能力影响的前瞻性随机对照研究

OBJECTIVE

To study the effect of rehabilitation treatment based on the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) Core Sets on activities of daily living in children with cerebral palsy.

METHODS

The children with cerebral palsy were divided into an observation group (n=63) and a control group (n=59) using a random number table. The children in the observation group were evaluated using the brief ICF-CY Core Sets for children under 6 years to identify intervention targets and develop rehabilitation plans and goals, and then specific methods were selected for rehabilitation treatment. The children in the control group were evaluated and treated with the traditional rehabilitation mode. The scores of the Functional Independence Measure for Children (WeeFIM) and the Infants-Junior Middle School Students' Social-Life Abilities Scale were assessed for both groups before treatment and after three courses of treatment. The intervention of environmental factors was compared between the two groups.

RESULTS

There was no significant difference in the scores of the WeeFIM and Social-Life Abilities scales between the two groups before treatment (P > 0.05). After treatment, both groups had significant increases in the scores of the WeeFIM and Social-Life Abilities scales (P < 0.001). The observation group had significantly higher scores of WeeFIM and Social-Life Abilities scales than the control group after treatment (P < 0.05). There was no significant difference in the use rate of orthosis between the two groups (P > 0.05), but the use rate of assistive devices for self-help, transfer and communication, the rate of facility renovation, and the rate of family rehabilitation guidance in the observation group were significantly higher than those in the control group (P < 0.05).

CONCLUSIONS

The rehabilitation treatment regimen for cerebral palsy based on the CF-CY Core Sets pays more attention to the influence of environmental factors in the process of rehabilitation and can effectively improve the activities of daily living of children with cerebral palsy.

儿童急性巨核细胞白血病临床特点及预后分析

OBJECTIVE

To study the clinical features and prognosis of children with acute megakaryocytic leukemia (AMKL) and the clinical effect of acute myeloid leukemia 03 (AML03) regimen for the treatment of pediatric AMKL.

METHODS

The clinical data were collected from 47 children with AMKL who were diagnosed from May 2011 to December 2019. The treatment outcomes and prognostic factors were analyzed. The Kaplan-Meier method and the log-rank test were used for survival analysis.

RESULTS

Among the 47 children with AMKL, 22 with non-Down syndrome-AMKL were treated by the AML03 regimen, with a median follow-up time of 11.4 months. For the 22 non-Down syndrome-AMKL patients, the remission rate of bone marrow cytology was 85% and the negative rate of minimal residual disease (MRD) was 79% after induction Ⅱ, with a 2-year overall survival (OS) rate of (50±13)% and a 2-year event-free survival (EFS) rate of (40±12)%. The group with positive immunophenotypic marker CD56 had significantly lower 2-year EFS and OS rates than the group with negative CD56 (P < 0.05). The group without remission of bone marrow cytology after induction Ⅱ had significantly lower 2-year EFS and OS rates than the group with remission (P < 0.05). The group with positive MRD after induction Ⅱ had a significantly lower 2-year EFS rate than the group with negative MRD (P < 0.05). There was no significant difference in 2-year OS and EFS rates between the patients with transplantation and those without transplantation (P > 0.05).

CONCLUSIONS

Children with AMKL tend to have a low remission rate and a poor prognosis. Positive immunophenotypic marker CD56, bone marrow cytology during early treatment response, and MRD results are important factors influencing the prognosis. Allogeneic hematopoietic stem cell transplantation has no significant effect on the prognosis of AMKL.

"Please, Help Me!": Children's Perceptions of Parental Dispute as Shared in Forensic Interviews Following Alleged Maltreatment

Over the last few decades, the phenomenon of child maltreatment (CM) has been recognized as a major social problem by professionals, policymakers, and researchers. Relatedly, high-intensity parental dispute (HIPD) has been increasingly recognized, particularly in terms of its detrimental effect on the family unit and on child welfare in particular. Few studies, however, have considered these two phenomena jointly. The present study examines experiences and perceptions of children situated at their intersection. The sample comprised forensic interviews with 42 children referred to the Israeli Service of Child Forensic Interviews following alleged maltreatment. The results of a thematic analysis pointed to the centrality of children's exposure to HIPD in the context of the CM allegations for which they were referred to and about which they were asked during the interview. In addition, the analysis identified various displays of potential deficiencies in parent-child relationship in the context of HIPD and two main profiles for the disclosure of the CM allegations. The discussion stresses the exposure of the children to HIPD as a possible risk context that should receive further attention by scholars and practitioners. Moreover, it highlights the multifaceted nature of the children's experiences, which generate enormous challenges for practitioners in both clinical and forensic contexts, as well as the importance of an integrated approach that considers the HIPD context while not ignoring the CM allegations.

[Short-term effect of intensity-modulated radiotherapy for children with high-risk neuroblastoma: an analysis of 24 cases]

OBJECTIVE

To study the efficacy and safety of intensity-modulated radiotherapy (IMRT) in children with high-risk neuroblastoma (NB).

METHODS

A retrospective analysis was performed on the medical data of 24 children with high-risk NB who were diagnosed and treated with IMRT in the Department of Hematology and Oncology, Hunan Provincial People's Hospital, from April 2018 to December 2020. The medical data included age, radiotherapy dose, times of radiotherapy, laboratory examination results, adverse reactions, and survival.

RESULTS

All 24 children (14 boys and 10 girls) received IMRT, with a mean age of (65±23) months and a median age of 59 months. The primary tumor was located in the abdomen in 23 children and 1 child had primary tumor in the mediastinum. The median age was 41.5 months at the time of radiotherapy. The radiation dose of radiotherapy ranged from 14.4 to 36.0 Gy, with a mean dose of (22±3) Gy and a daily dose of 1.8-2.0 Gy. The radiotherapy was performed for a total number of 8-20 times, with a mean number of 11.9 times. Among these children, 6 received radiotherapy for the residual or metastatic lesion. Of all the 23 children, 3 experienced cough, 2 experienced diarrhea, and 1 experienced vomiting during radiotherapy. At 2 weeks after radiotherapy, serum creatinine ranged from 2.3 to 70.1 μmol/L and alanine aminotransferase ranged from 9.1 to 65.3 μ/L. Ten children experienced grade Ⅲ bone marrow suppression and 2 experienced grade Ⅳ bone marrow suppression 1 to 2 weeks after radiotherapy. Four children experienced grade Ⅲ bone marrow suppression and 1 experienced grade Ⅳ bone marrow suppression 3 to 4 weeks after radiotherapy. During a median follow-up time of 13.5 months, 23 children (96%) achieved stable disease and 1 died. Up to the follow-up date, second malignant tumor or abnormal organ function was not observed.

CONCLUSIONS

IMRT can improve the local control rate of NB. IMRT appears to be safe in the treatment of children with NB.

[Effect of rehabilitation treatment based on the ICF-CY Core Sets on activities of daily living in children with cerebral palsy: a prospective randomized controlled study]

OBJECTIVE

To study the effect of rehabilitation treatment based on the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) Core Sets on activities of daily living in children with cerebral palsy.

METHODS

The children with cerebral palsy were divided into an observation group (n=63) and a control group (n=59) using a random number table. The children in the observation group were evaluated using the brief ICF-CY Core Sets for children under 6 years to identify intervention targets and develop rehabilitation plans and goals, and then specific methods were selected for rehabilitation treatment. The children in the control group were evaluated and treated with the traditional rehabilitation mode. The scores of the Functional Independence Measure for Children (WeeFIM) and the Infants-Junior Middle School Students' Social-Life Abilities Scale were assessed for both groups before treatment and after three courses of treatment. The intervention of environmental factors was compared between the two groups.

RESULTS

There was no significant difference in the scores of the WeeFIM and Social-Life Abilities scales between the two groups before treatment (P > 0.05). After treatment, both groups had significant increases in the scores of the WeeFIM and Social-Life Abilities scales (P < 0.001). The observation group had significantly higher scores of WeeFIM and Social-Life Abilities scales than the control group after treatment (P < 0.05). There was no significant difference in the use rate of orthosis between the two groups (P > 0.05), but the use rate of assistive devices for self-help, transfer and communication, the rate of facility renovation, and the rate of family rehabilitation guidance in the observation group were significantly higher than those in the control group (P < 0.05).

CONCLUSIONS

The rehabilitation treatment regimen for cerebral palsy based on the CF-CY Core Sets pays more attention to the influence of environmental factors in the process of rehabilitation and can effectively improve the activities of daily living of children with cerebral palsy.

[Epidemiological features of severe acute respiratory syndrome coronavirus 2 infection in children in Shijiazhuang, China: an analysis of 133 cases]

OBJECTIVE

To study the epidemiological features of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Shijiazhuang, China.

METHODS

Based on the information officially announced on the official website of the Health Commission of Hebei Province, epidemiological data were collected from 133 children, aged 0-18 years, who were diagnosed with SARS-CoV-2 infection in Shijiazhuang from January 2 to January 30, 2021. A statistical analysis was performed for general status, regional distribution, presence or absence of clusters, and results of SARS-CoV-2 nucleic acid tests.

RESULTS

Among the 133 children with SARS-CoV-2 infection, there were 65 boys and 68 girls, with a male/female ratio of 0.96:1. The youngest age of onset was 3 months and 7 days, and the mean age of onset was (9±5) years. Of all the 133 children, 90(67.7%) were the first confirmed case of SARS-CoV-2 infection among their family members. Of all the children, 108(81.2%) came from the Gaocheng District in Shijiazhuang, among whom 38(28.6%) were from Xiaoguozhuang Village where the first patient with a confirmed diagnosis lived. SARS-CoV-2 nucleic acid test at week 2 after the outbreak showed positive results in 88 children (66.2%), and only 5 children had clinical symptoms before positive SARS-CoV-2 results were obtained. Of all the 133 children, 19(14.3%) were found positive in the first SARS-CoV-2 nucleic acid test after the outbreak, and 70(52.6%) had positive results for ≥4 times. There were 98 school students with infection, among whom 74(75.5%) were the first confirmed case in their family, and among 35 non-school students, 16(45.7%) were the first confirmed case in their family (P < 0.05).

CONCLUSIONS

Among the children confirmed with SARS-CoV-2 infection in Shijiazhuang, there is a high proportion of children who are the first confirmed case in their family, and the children are mainly distributed in the rural areas of Gaocheng. Most of these children are students, so the prevention and control of cluster infection in schools should be taken seriously. There are often no symptoms before SARS-CoV-2 nucleic acid test, with a low positive rate of the first nucleic acid test, which increases the difficulty of early discovery of the epidemic.

[Recurrent thrombocytopenia with hemolytic anemia in a boy aged 3 years]

A boy, aged 3 years and 8 months, had recurrent thrombocytopenia with hemolytic anemia for more than 3 years. The physical examination showed no enlargement of the liver, spleen, and lymph nodes or finger deformities. Laboratory results showed a negative result of the direct antiglobulin test, normal coagulation function, and increases in bilirubin, lactate dehydrogenase and reticulocytes. The results of von Willebrand factor-cleaving protease ADAMTS13 activity assay showed extreme deficiency, and antibody assay showed negative ADAMTS13 inhibitory autoantibodies. Next-generation sequence showed compound heterozygous mutation in the ADAMTS13 gene. The boy was diagnosed with congenital thrombotic thrombocytopenic purpura. This disease may be easily misdiagnosed as Evans syndrome and is difficult to diagnose in clinical practice. The child had developed the disease since birth, but it took 3 years to make a confirmed diagnosis. Therefore, congenital thrombotic thrombocytopenic purpura should be considered for children with jaundice at birth, recurrent thrombocytopenia with hemolytic anemia, and negative results of the direct antiglobulin test. The detection of ADAMTS13 activity and ADAMTS13 inhibitory autoantibodies should be performed as soon as possible for a definite diagnosis, and gene detection should be performed to make a confirmed diagnosis when necessary.

[Fever for 2 months and disturbance of consciousness for 1 week in a preschool-aged girl]

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome (ROHHADS) is a rare multi-system disease, and delayed diagnosis and treatment may lead to catastrophic cardiopulmonary complications. As far as we know, no patient with ROHHADS has been reported in China, and this article reports a child with ROHHADS to improve the awareness of this disease among clinicians. A girl, aged 3 years, had the clinical manifestations of rapid weight gain, fever, disturbance of consciousness, and convulsion. The physical examination showed a body weight of 20 kg, somnolence, irregular breathing, and stiff neck. She had increased blood levels of prolactin and follicle-stimulating hormone and hyponatremia. The lumbar puncture showed an increased intracranial pressure. The brain MRI and magnetic resonance venography showed symmetrical lesions in the periventricular region and venous thrombosis in the right transverse sinus and the superior sagittal sinus. The sleep monitoring showed hypopnea. The girl was finally diagnosed with ROHHADS and intracranial venous thrombosis. She recovered after symptomatic treatment including decreasing intracranial pressure, anticoagulation, and respiratory support. The possibility of ROHHADS should be considered for patients with unexplained obesity, fever, and hypoventilation, with or without central nervous system symptoms. Early diagnosis and standardized follow-up can improve the prognosis of children with ROHHADS.

[Clinical features and antibiotic sensitivity of invasive pneumococcal disease versus noninvasive pneumococcal disease in children]

OBJECTIVE

To analyze the clinical data of children with invasive pneumococcal disease (IPD) or noninvasive pneumococcal disease (NIPD), and to provide a reference for clinical diagnosis and treatment.

METHODS

A retrospective analysis was performed on the medical data and the drug susceptibility test results of isolated strains of 518 children who were hospitalized due to Streptococcus pneumoniae (SP) infection from January 2013 to December 2017. According to the location of the isolated strains, the children were divided into an IPD group with 35 children and an NIPD group with 483 children.

RESULTS

The children with IPD had a median age of 2.2 years, and the children aged ≤5 years accounted for 80.0%. For the children with IPD, the main type of infection was meningitis which was observed in 19 children (54.3%), and the most common underlying disease was hematological malignancy in 8 children (22.9%); 14 children (40.0%) were admitted to the pediatric intensive care unit (PICU), 18 children (51.4%) experienced complications, and 8 children (22.9%) died. For the children with NIPD, the median age was 1.2 years; the main type of infection was pneumonia in 429 children (88.8%), and the most common underlying disease was congenital heart disease in 60 children (12.4%); 60 children (12.4%) were admitted to the PICU, 102 children (21.1%) experienced complications, and 11 children (2.3%) died. The IPD group had significantly higher incidence rate of complications, PICU admission rate, and mortality rate than the NIPD group (P < 0.01). The invasive SP strains had a significantly lower susceptibility rate to penicillin than noninvasive SP strains (68.6% vs 94.2%, P < 0.01).

CONCLUSIONS

SP infection is common in children under 5 years of age, and the children with underlying diseases including hematological malignancy are at high risk for IPD. Although the complication rate, PICU admission rate, and mortality rate of NIPD children are lower than those of IPD children, they still cannot be ignored. Penicillin may be used as an empirical treatment for children with NIPD, but not for those with IPD.

[A clinical study of influenza A virus infection with neurological symptoms in children]

OBJECTIVE

To study the clinical features of children with influenza A virus infection and neurological symptoms.

METHODS

A retrospective analysis was performed for the clinical data of children with laboratory-confirmed influenza A and neurological symptoms who were treated in Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University from January to December, 2019.

RESULTS

A total of 895 children were diagnosed with influenza A, among whom 291 had neurological symptoms. Boys had a significantly higher incidence rate of influenza A than girls (P < 0.05), and the children aged 1-3 years had a significantly higher incidence rate than the other age groups (P < 0.05). Common neurological symptoms included seizures (97.3%), vomiting (24.1%), and headache (7.2%). Febrile seizures were the most common type of seizures, accounting for 88%. There was no significant difference in the time from disease onset to seizures and frequency seizures between the children with a history of febrile seizures and those without such history (P > 0.05). Of all the children, 3 were diagnosed with acute necrotizing encephalopathy (ANE), all of whom were girls and suffered seizures; the time from the first seizures to the occurrence of disturbance of consciousness was 0-7 hours, and 2 girls died within 2 days after disease onset. All children, except 2 who died of ANE and 1 with neurological sequelae, were cured.

CONCLUSIONS

There is a high incidence rate of neurological symptoms in children with influenza A, and seizures are the most common symptom. Most of the patients with neurological symptoms tend to have a good prognosis, but those with ANE may have a poor prognosis.

[Value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid for predicting refractory Mycoplasma pneumoniae pneumonia in children]

OBJECTIVE

To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children.

METHODS

A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP.

RESULTS

Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP.

CONCLUSIONS

There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.

[Epidemiological and clinical features of children with mild coronavirus disease 2019]

OBJECTIVE

To study the epidemiological and clinical features of children with mild coronavirus disease 2019 (COVID-19).

METHODS

The children who were diagnosed with mild COVID-19 in the Wuchang Shelter Hospital in Wuhan from February 5 to March 10, 2020 were enrolled as subjects. The clinical, laboratory, and lung imaging data were collected during hospitalization and isolation. This was a retrospective single-center case series analysis.

RESULTS

A total of 1 124 patients with mild COVID-19 were admitted from February 5 to March 10, 2020, including 13 children (1.16%). All the 13 children (7 boys and 6 girls) were residents of Wuhan in China, with a median age of 16 years (range: 10-18 years). Of all the 13 children, 9(69%) were from family clusters of COVID-19 and 4(31%) had unknown sources of infection. The mean time from exposure to onset was 6.8 days (range: 2-13 days) in 9 children with a definite history of exposure. There were 6 symptomatic children with the main manifestations of fever, cough, weakness, and myalgia, and the mean time from onset to hospitalization was 9.2 days. Of all the 13 children, 7(54%) were asymptomatic with positive nucleic acid test of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). There were 4 children (31%) with abnormal lung CT findings, mainly patchy shadows or ground-glass opacities in the lung field, and 6 children (46%) had no symptoms with normal lung CT findings. All children had normal routine blood test results and C-reactive protein levels. Eight children underwent SARS-CoV-2 IgM and IgG tests at least once, among whom 6 had negative SARS-CoV-2 IgM but positive IgG, and 2 underwent SARS-CoV-2 IgM and IgG tests twice and had negative results. Of all the 13 children, 11(85%) had negative results of two SARS-CoV-2 nucleic acid tests during hospitalization and were discharged, and 2(15%) had positive results of four SARS-CoV-2 nucleic acid tests and were transferred to another hospital and lost to follow-up. Among the 11 children who were followed up, 1 had positive results of two SARS-CoV-2 nucleic acid tests at the isolation point, and 10 had negative results. The mean hospital stay was 10.9 days for the 13 children. Eleven children recovered during follow-up, with good living and learning conditions.

CONCLUSIONS

Children with mild COVID-19 often have an uncertain history of exposure and may not have any clinical symptoms. Etiological diagnosis is more important than clinical diagnosis. The disappearance of clinical manifestations may not parallel with the result of SARS-CoV-2 nucleic acid test. SARS-CoV-2 has a long detoxification time, and there may be recurrent cases of SARS-CoV-2 positivity. Further studies are needed to investigate the production patterns of SARS-CoV-2 IgM and IgG and their effect on the body.

[Influence of coronavirus disease 2019 on the nervous system of children]

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and can occur at any age, including children. Children with COVID-19 can develop the clinical symptoms of multiple systems, among which symptoms of the nervous system have been reported increasingly, and thus it is particularly important to understand COVID-19-associated neurological damage in children. This article reviews the mechanisms and types of COVID-19-associated neurological damage in children.

[Change of serum levels of pentraxin-3 and syndecan-4 in children with chronic heart failure]

OBJECTIVE

To study the change and significance of serum pentraxin-3 (PTX-3) and syndecan-4 in children with chronic heart failure (CHF).

METHODS

A total of 40 children with CHF who were admitted to the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University were enrolled as the heart failure group, and 30 children who underwent physical examination in the outpatient service during the same period of time were enrolled as the control group. The serum levels of PTX-3, syndecan-4, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups.

RESULTS

The children with CHF had significant reductions in the serum levels of PTX-3, syndecan-4, and NT-proBNP after treatment. The levels of these markers in children with CHF were significantly higher than the control group before and after treatment (P < 0.05). The CHF children with grade II/III/IV cardiac function had significantly higher serum levels of PTX-3 and syndecan-4 than the control group (P < 0.05). The levels of PTX-3 and syndecan-4 were related to the severity of cardiac function. Compared with the grade II cardiac function group, the grade IV cardiac function group had significant increases in the serum levels of PTX-3 and syndecan-4 (P < 0.05). The serum level of PTX-3 was positively correlated with that of syndecan-4 in children with CHF (r_s=0.999, P < 0.05); the serum level of PTX-3 was positively correlated with NT-proBNP, left ventricular mass index (LVMI), and cardiac function grade (r_s=0.726, 0.736, and 0.934 respectively, P < 0.05) and was negatively correlated with left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) (r_s=-0.852 and -0.767 respectively, P < 0.05); the serum level of syndecan-4 was positively correlated with NT-proBNP, LVMI, and cardiac function grade (r_s=0.733, 0.743, and 0.934 respectively, P < 0.05) and was negatively correlated with LVEF and LVFS (r_s=-0.856 and -0.771 respectively, P < 0.05).

CONCLUSIONS

Serum PTX-3 and syndecan-4 may be involved in the development and progression of ventricular remodeling in children with CHF and may be used as markers for the diagnosis, cardiac function grading, and treatment outcome evaluation of children with heart failure.

[Clinical features and antibiotic sensitivity of invasive pneumococcal disease versus noninvasive pneumococcal disease in children]

OBJECTIVE

To analyze the clinical data of children with invasive pneumococcal disease (IPD) or noninvasive pneumococcal disease (NIPD), and to provide a reference for clinical diagnosis and treatment.

METHODS

A retrospective analysis was performed on the medical data and the drug susceptibility test results of isolated strains of 518 children who were hospitalized due to Streptococcus pneumoniae (SP) infection from January 2013 to December 2017. According to the location of the isolated strains, the children were divided into an IPD group with 35 children and an NIPD group with 483 children.

RESULTS

The children with IPD had a median age of 2.2 years, and the children aged ≤5 years accounted for 80.0%. For the children with IPD, the main type of infection was meningitis which was observed in 19 children (54.3%), and the most common underlying disease was hematological malignancy in 8 children (22.9%); 14 children (40.0%) were admitted to the pediatric intensive care unit (PICU), 18 children (51.4%) experienced complications, and 8 children (22.9%) died. For the children with NIPD, the median age was 1.2 years; the main type of infection was pneumonia in 429 children (88.8%), and the most common underlying disease was congenital heart disease in 60 children (12.4%); 60 children (12.4%) were admitted to the PICU, 102 children (21.1%) experienced complications, and 11 children (2.3%) died. The IPD group had significantly higher incidence rate of complications, PICU admission rate, and mortality rate than the NIPD group (P < 0.01). The invasive SP strains had a significantly lower susceptibility rate to penicillin than noninvasive SP strains (68.6% vs 94.2%, P < 0.01).

CONCLUSIONS

SP infection is common in children under 5 years of age, and the children with underlying diseases including hematological malignancy are at high risk for IPD. Although the complication rate, PICU admission rate, and mortality rate of NIPD children are lower than those of IPD children, they still cannot be ignored. Penicillin may be used as an empirical treatment for children with NIPD, but not for those with IPD.

[Association between serum trace elements and core symptoms in children with autism spectrum disorder: a national multicenter survey]

OBJECTIVE

To study the association of serum levels of trace elements with core symptoms in children with autism spectrum disorder (ASD).

METHODS

From September 2018 to September 2019, an investigation was performed for 1 020 children with ASD and 1 038 healthy children matched for age and sex in the outpatient service of grade A tertiary hospitals and special education institutions in 13 cities of China. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Childhood Autism Rating Scale (CARS) were used to assess the core symptoms of the children with ASD. The inductively coupled plasma mass spectrometry was used to measure serum levels of trace elements magnesium, iron, copper, and zinc.

RESULTS

The children with ASD had significantly lower serum levels of magnesium, copper, and zinc than the healthy children (P < 0.05). The children with severe ASD had significantly lower serum levels of magnesium and zinc than those with mild-to-moderate ASD (P < 0.05). The results of partial correlation analysis showed that serum magnesium level was negatively correlated with the total score of ABC and the score of communication (r=-0.318 and -0.282 respectively; P 0.001), and serum zinc level was negatively correlated with the total score of ABC and the scores of communication and somatic movement (r=-0.221, -0.270, and -0.207 respectively; P < 0.001).

CONCLUSIONS

The serum levels of magnesium and zinc may be associated with core symptoms in children with ASD, which requires further studies. The nutritional status of trace elements should be monitored for children with ASD in clinical practice.

孤独症筛查量表在早期识别孤独症谱系障碍中的临床价值

OBJECTIVE

To evaluate the value of autism screening checklists in the early identification of autism spectrum disorder (ASD).

METHODS

A total of 2 571 children who attended the Children's Hospital of Chongqing Medical University and completed autism screening and diagnostic test were enrolled as subjects, among whom 2 074 were diagnosed with ASD, 261 were diagnosed with global developmental delay (GDD), 206 were diagnosed with developmental language disorder (DLD), and 30 had normal development. The sensitivity, specificity, and optimal threshold value of the Modified Checklist for Autism in Toddlers (M-CHAT) and the Autism Behavior Checklist (ABC) for the early identification of ASD were evaluated by the receiver operating characteristic (ROC) curve.

RESULTS

The M-CHAT had a high sensitivity of 88.3% but a low specificity of 36.0% for the identification of ASD. Its sensitivity decreased with age, and was maintained above 80% for children aged 16 to < 48 months. The ABC had a high specificity of 87.3% but a low sensitivity of 27.2%, with an optimal cut-off value of 47.5 based on the ROC curve analysis. The multivariate linear regression model based on a combination of the M-CHAT and ABC for screening of ASD showed a specificity of 85.8% and a sensitivity of 56.6%.

CONCLUSIONS

The M-CHAT has a high sensitivity and a low specificity in the identification of ASD, with a better effect in children aged 16 to < 48 months. The ABC has a high specificity and a low sensitivity. The multiple linear regression model method based on the combined M-CHAT and ABC to screen ASD appears to be effective.

左乙拉西坦与苯妥英作为二线用药治疗儿童惊厥性癫痫持续状态的有效性及安全性的Meta分析

OBJECTIVE

To systematically evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) as second-line drugs for the treatment of convulsive status epilepticus (CSE) in children.

METHODS

English and Chinese electronic databases were searched for the randomized controlled trials comparing the efficacy and safety of LEV and PHT as second-line drugs for the treatment of childhood CSE. RevMan 5.3 software was used for data analysis.

RESULTS

Seven studies with 1 434 children were included. The Meta analysis showed that compared with the PHT group, the LEV group achieved a significantly higher control rate of CSE (RR=1.12, 95%CI:1.00-1.24, P=0.05), but there was no significant difference between the two groups in the recurrence rate of epilepsy within 24 hours (RR=0.82, 95%CI:0.22-3.11, P=0.77) and the rate of further antiepileptic drug therapy (RR=0.97, 95%CI:0.64-1.45, P=0.87). There was no significant difference in the incidence rate of adverse events between the two groups (RR=0.77, 95%CI:0.55-1.09, P=0.15).

CONCLUSIONS

LEV has a better clinical effect than PHT in the treatment of children with CSE and does not increase the incidence rate of adverse events.

儿童喂养问题的评估工具及其研究进展

As one of the most important non-nutritional factors associated with children's growth and development, feeding problems in children are getting more and more attention from medical professionals and guardians. The evaluation of feeding problems has developed from the single-factor and descriptive research in the past to the multi-factor and analytical research at present, and thus a good quantitative analysis system is increasingly important for researchers. However, the development of localized quantitative analysis tools remains a weak link in this field. Therefore, it is a research hotspot to develop child feeding assessment scales and questionnaires with high reliability, validity, and operability in combination with China's cultural background and eating habits and provide effective assessment tools for feeding problems in Chinese children. Through classification based on research mode and screening, this article reviews the research findings in the field of child feeding, so as to provide a basis for future research.

儿童新型冠状病毒肺炎流行病学特点及机制分析

Compared with adults, children tend to have lower incidence rate, hospitalization rate, and mortality rate of coronavirus disease 2019 (COVID-19), while the cause of such age-based differences in disease severity remains unclear. An investigation of pathogenesis in children may help to analyze the therapies for the high-risk population. Human angiotensin-converting enzyme Ⅱ is the main receptor of severe acute respiratory syndrome coronavirus 2 and can limit pulmonary capillary leakage and inflammation mediated by angiotensin 2 and exert a protective effect against acute lung injury. Its expression decreases with age. Regular vaccination and frequent upper respiratory virus infection in children can lead to regular immune activation, and its combination with strong innate immunity can help to achieve virus clearance in the early stage of infection in children with COVID-19. Meanwhile, there are strong regeneration and repair abilities of alveolar epithelial cells in children, which may help with the early recovery of infection. In addition, risk factors, such as underlying cardiopulmonary diseases, obesity, and smoking, are relatively uncommon in children. Social factors, including home quarantine and timely closure of schools, may help to reduce the infection rate in children. However, children with immunodeficiency are a high-risk population and should be closely monitored. Further studies are needed to investigate the immune and protection mechanisms against COVID-19 in children.

《国际专家建议：需立即转诊进行脑性瘫痪诊断评估的临床特征》解读

Under the guidance and support of national policies in recent years, the community medical system has been developed rapidly, among which primary child healthcare is carried out routinely in community hospitals, greatly alleviating the pressure of specialized pediatric hospitals and departments of pediatrics in secondary and tertiary general hospitals. However, due to the lack of professional training for primary child healthcare personnel in community medical institutions, early symptoms of children with cerebral palsy cannot be identified and so children with cerebral palsy are often unable to receive early diagnosis and intervention, which may affect their prognosis. An article about international expert consensus and recommendations on early identification and referral of cerebral palsy in community medical institutions was published in Development Medicine and Child Neurology in 2020. It proposed six clinical features that should prompt referral and two warning signs that warrant enhanced monitoring, as well as five recommendations for referral to medical experts and other healthcare professionals for the diagnosis of cerebral palsy. The recommendations may help primary child healthcare personnel in community medical institutions to early identify the children at high risk of cerebral palsy, thus reducing the delay of referral and intervention. This article gives an interpretation of the recommendations based on the actual situation in China, in order to improve the ability of primary child healthcare personnel in community medical institutions to early identify high-risk signals of cerebral palsy and conduct reasonable referral. This will help to achieve the early identification, early diagnosis, and early intervention to improve the prognosis of children with cerebral palsy.

静脉注射用免疫球蛋白在儿童血液/肿瘤性疾病中应用的儿科专家共识

Intravenous immunoglobulin (IVIG) has been widely used in chemotherapy for hematological malignancies, targeted therapy, and hematopoietic stem cell transplantation; however, there are still no available guidelines or consensus statements on the application of IVIG in pediatric hematological/neoplastic diseases at present in China and overseas. This consensus is developed based on the research advances in the application of IVIG in pediatric hematological/neoplastic diseases across the world and provides detailed recommendations for the clinical application of IVIG in pediatric hematological/neoplastic diseases and the prevention and treatment of related adverse reactions.

幼儿园儿童肺炎链球菌携带的聚集性及影响因素分析

OBJECTIVE

To study the clustering and influencing factors of Streptococcus pneumoniae carriage among kindergarten children, and to provide a scientific basis for the prevention of pneumococcal diseases.

METHODS

The multi-stage stratified cluster sampling method was used to collect nasal swabs via the nasal vestibule at both sides from 1 702 kindergarten children in Liuzhou, China. A questionnaire survey was performed on their parents. The chi-square test and the random effects logistic regression analysis were used to analyze data.

RESULTS

The carriage rate of Streptococcus pneumoniae was 13.16% (224/1 702) among kindergarten children. The clustering analysis showed that the class-level random effect of Streptococcus pneumoniae carriage was statistically significant (Z=2.07, P=0.038), with an intraclass correlation coefficient of 5.9%. The random effects logistic regression analysis showed that the children aged 5-7 years had a lower risk of Streptococcus pneumoniae carriage than those aged 2-< 5 years (OR=0.55, 95%CI:0.40-0.76, P=0.001), and the children with ≥ 5 family members living together had a higher risk of Streptococcus pneumoniae carriage than those with < 5 family members (OR=1.34, 95%CI:1.01-1.79, P=0.043).

CONCLUSIONS

Streptococcus pneumoniae carriage shows a class-level clustering effect, and age and the number of cohabitants are important influencing factors for Streptococcus pneumoniae carriage in children.

疑难病研究：STAT3基因突变致免疫失调综合征

A boy, aged 4 years and 6 months, had disease onset of fever, cough, pale complexion, and weakness, with hepatosplenomegaly, lymphadenectasis, and pancytopenia. He had been having repeated respiratory and digestive tract infections. Gene detection showed a pathogenic heterozygous mutation, c.C2147 > T(p.T716M), in the STAT3 gene. The boy was thus diagnosed with immune dysregulation syndrome. Anti-infective therapy and irregular corticosteroid therapy had an unsatisfactory effect in the early stage, but the symptoms improved after regular corticosteroid therapy. This article reported the case of immune dysregulation syndrome caused by STAT3 gene mutation and summarized the epidemiology, clinical features, diagnosis, and treatment of this disease, which can provide a reference for early diagnosis, treatment, and future studies of this disease.

霉酚酸酯和环磷酰胺治疗儿童大量蛋白尿型过敏性紫癜性肾炎的前瞻性随机对照研究

OBJECTIVE

To study the efficacy and safety of mycophenolate mofetil (MMF) versus cyclophosphamide (CTX) in the treatment of children with Henoch-Schönlein purpura nephritis (HSPN) and nephrotic-range proteinuria.

METHODS

A prospective clinical trial was conducted in 68 pediatric patients who were admitted to the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics and who were diagnosed with HSPN and nephrotic-range proteinuria from August 2016 to November 2019. The patients were randomly divided into two groups:MMF treatment (n=33) and CTX treatment (n=35). The two groups were compared in terms of complete remission rate, response rate (complete remission + partial remission), urinary protein clearance time, and adverse events.

RESULTS

At months 3, 6, and 12 of treatment, there was no significant difference in the complete remission rate and the response rate between the MMF treament and CTX treatment groups (P > 0.05). There was also no significant difference between the two groups in the urinary protein clearance time and the incidence rate of adverse events (P > 0.05).

CONCLUSIONS

MMF and CTX have similar efficacy and safety in the treatment of HSPN children with nephrotic-range proteinuria.

[Dynamic change of hippocampal volume in children with recurrent febrile seizures]

OBJECTIVE

To study the change and significance of hippocampal volume (HCV) in children with recurrent febrile seizures.

METHODS

A retrospective analysis was performed on the medical data and examination results of 34 children with recurrent febrile seizures who underwent two magnetic resonance plain scans of the head and the hippocampus from January 1, 2013 to September 30, 2019. According to the follow-up time, they were divided into the first follow-up group and the second follow-up group. According to prognosis, they were divided into a febrile seizure group, a non-febrile group and an epilepsy group. The change in HCV was analyzed and compared.

RESULTS

Total HCV was positively correlated with age (rs=0.683, P < 0.05). The second follow-up group had a significantly larger total HCV than the first follow-up group (P < 0.05). For both groups, preschool children (≥ 3 years old) had significantly larger total HCV, left HCV, and right HCV than those at an age of < 3 years (P < 0.05). For both groups, the children with persistent seizures had significantly lower average annual increment (ΔV) of total HCV, left HCV, and right HCV than those without persistent seizures (P < 0.05). There was no significant difference in ΔV of total HCV, left HCV, and right HCV among the febrile seizure, non-febrile seizure and epilepsy groups (P > 0.05).

CONCLUSIONS

HCV gradually increases with age in children with recurrent febrile seizures. Persistent seizures may damage the development of the hippocampus.

[Dynamic change of hippocampal volume in children with recurrent febrile seizures]

OBJECTIVE

To study the change and significance of hippocampal volume (HCV) in children with recurrent febrile seizures.

METHODS

A retrospective analysis was performed on the medical data and examination results of 34 children with recurrent febrile seizures who underwent two magnetic resonance plain scans of the head and the hippocampus from January 1, 2013 to September 30, 2019. According to the follow-up time, they were divided into the first follow-up group and the second follow-up group. According to prognosis, they were divided into a febrile seizure group, a non-febrile group and an epilepsy group. The change in HCV was analyzed and compared.

RESULTS

Total HCV was positively correlated with age (r_s=0.683, P < 0.05). The second follow-up group had a significantly larger total HCV than the first follow-up group (P < 0.05). For both groups, preschool children (≥ 3 years old) had significantly larger total HCV, left HCV, and right HCV than those at an age of < 3 years (P < 0.05). For both groups, the children with persistent seizures had significantly lower average annual increment (ΔV) of total HCV, left HCV, and right HCV than those without persistent seizures (P < 0.05). There was no significant difference in ΔV of total HCV, left HCV, and right HCV among the febrile seizure, non-febrile seizure and epilepsy groups (P > 0.05).

CONCLUSIONS

HCV gradually increases with age in children with recurrent febrile seizures. Persistent seizures may damage the development of the hippocampus.

[Epidemiological features and mechanism of coronavirus disease 2019 in children]

Compared with adults, children tend to have lower incidence rate, hospitalization rate, and mortality rate of coronavirus disease 2019 (COVID-19), while the cause of such age-based differences in disease severity remains unclear. An investigation of pathogenesis in children may help to analyze the therapies for the high-risk population. Human angiotensin-converting enzyme Ⅱ is the main receptor of severe acute respiratory syndrome coronavirus 2 and can limit pulmonary capillary leakage and inflammation mediated by angiotensin 2 and exert a protective effect against acute lung injury. Its expression decreases with age. Regular vaccination and frequent upper respiratory virus infection in children can lead to regular immune activation, and its combination with strong innate immunity can help to achieve virus clearance in the early stage of infection in children with COVID-19. Meanwhile, there are strong regeneration and repair abilities of alveolar epithelial cells in children, which may help with the early recovery of infection. In addition, risk factors, such as underlying cardiopulmonary diseases, obesity, and smoking, are relatively uncommon in children. Social factors, including home quarantine and timely closure of schools, may help to reduce the infection rate in children. However, children with immunodeficiency are a high-risk population and should be closely monitored. Further studies are needed to investigate the immune and protection mechanisms against COVID-19 in children.

[Value of autism screening checklists in the early identification of autism spectrum disorder]

OBJECTIVE

To evaluate the value of autism screening checklists in the early identification of autism spectrum disorder (ASD).

METHODS

A total of 2 571 children who attended the Children's Hospital of Chongqing Medical University and completed autism screening and diagnostic test were enrolled as subjects, among whom 2 074 were diagnosed with ASD, 261 were diagnosed with global developmental delay (GDD), 206 were diagnosed with developmental language disorder (DLD), and 30 had normal development. The sensitivity, specificity, and optimal threshold value of the Modified Checklist for Autism in Toddlers (M-CHAT) and the Autism Behavior Checklist (ABC) for the early identification of ASD were evaluated by the receiver operating characteristic (ROC) curve.

RESULTS

The M-CHAT had a high sensitivity of 88.3% but a low specificity of 36.0% for the identification of ASD. Its sensitivity decreased with age, and was maintained above 80% for children aged 16 to < 48 months. The ABC had a high specificity of 87.3% but a low sensitivity of 27.2%, with an optimal cut-off value of 47.5 based on the ROC curve analysis. The multivariate linear regression model based on a combination of the M-CHAT and ABC for screening of ASD showed a specificity of 85.8% and a sensitivity of 56.6%.

CONCLUSIONS

The M-CHAT has a high sensitivity and a low specificity in the identification of ASD, with a better effect in children aged 16 to < 48 months. The ABC has a high specificity and a low sensitivity. The multiple linear regression model method based on the combined M-CHAT and ABC to screen ASD appears to be effective.

染色质重塑在小儿神经发育障碍中的遗传学机制进展

Neural development is regulated by both external environment and internal signals, and in addition to transcription factors, epigenetic modifications also play an important role. By focusing on the genetic mechanism of ATP-dependent chromatin remodeling in children with neurodevelopmental disorders, this article elaborates on the effect of four chromatin remodeling complexes on neurogenesis and the development and maturation of neurons and neuroglial cells and introduces the clinical research advances in neurodevelopmental disorders.

[Clinical features of neurogenic bladder with vesicoureteral reflux in children]

OBJECTIVE

To study the clinical features of vesicoureteral reflux (VUR) in children with neurogenic bladder (NB), and to provide a reference for its early diagnosis and treatment.

METHODS

Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019. According to the presence or absence of VUR, the children were divided into a VUR group with 11 children and a non-VUR group with 15 children. Clinical features were compared between the two groups.

RESULTS

Compared with the non-VUR group, the VUR group had a significantly higher proportion of children with non-Escherichia coli urinary tract infection, hydronephrosis (the severity of hydronephrosis increased with the grade of VUR), abnormal ^99mTc-DMSA renal scanning findings, elevated ratios of urinary albumin, urinary IgG and urinary transferrin to creatinine, increased residual urine volume, and increased detrusor leak point pressure (P < 0.05).

CONCLUSIONS

When NB children have the clinical manifestations of non-Escherichia coli urinary tract infection, hydronephrosis, abnormal ^99mTc-DMSA renal scanning findings, glomerular proteinuria, increased bladder residual urine volume, and high detrusor leak point pressure, such children may already have VUR, and so diagnosis and intervention should be performed as early as possible.

[Correlation between bronchial dilation test and asthma control level in children with asthma]

OBJECTIVE

To study the correlation between the bronchial dilation test (BDT) and asthma control level in children with asthma.

METHODS

A total of 153 children with asthma, aged 5-14 years, who attended the outpatient service from March 2016 to March 2018 were enrolled. According to the presence or absence of atopic constitution, they were divided into an allergic group with 79 children and a non-allergic group with 74 children. The correlation between BDT and Childhood Asthma Control Test (C-ACT) scores was analyzed for both groups.

RESULTS

All basic pulmonary function parameters were positively correlated with C-ACT scores in the non-allergic group (P < 0.05). Except the forced vital capacity, peak expiratory flow and maximal expiratory flow at 25% vital capacity in percent predicted values, the other pulmonary function parameters were positively correlated with C-ACT scores in the allergic group (P < 0.05). The improvement rates of all BDT parameters (except maximal expiratory flow at 25% vital capacity in the allergic group and maximal expiratory flow at 50% vital capacity in the non-allergic group) were negatively correlated with C-ACT scores in the two groups (P < 0.05).

CONCLUSIONS

The improvement rate of BDT is well correlated with C-ACT scores in children with asthma, suggesting that BDT can be used as an index for predicting asthma control level.