Febrile infection-related epilepsy syndrome (FIRES) is a rare and catastrophic epileptic encephalopathy that predominantly affects school-aged children.Characterized by a biphasic clinical course, FIRES manifests as rapid progression to refractory status epilepticus following a preceding febrile infection. The prognosis of FIRES is dismal: the acute-phase mortality rate is approximately 10%, and survivors often develop chronic refractory epilepsy and cognitive impairment. The pathogenesis of FIRES remains unclear, but neuroinflammation involving cytokines such as IL-6 may play a key role. Tocilizumab, a humanized monoclonal antibody targeting the IL-6 receptor, exerts anti-inflammatory effects by blocking IL-6 signaling. For FIRES patients unresponsive to conventional anti-seizure medications (ASMs), first-line immunotherapies, or ketogenic diet, tocilizumab is currently recommended as a second-line immunotherapeutic option. This review summarizes the background, mechanisms, clinical applications, safety profile, and challenges associated with tocilizumab in FIRES management, aiming to update clinicians on the latest advances in this field..

Objective To analyze the clinical characteristics of pertussis in children and explore the independent risk factors for pertussis complicated by ordinary pneumonia and severe pneumonia. Methods A retrospective cohort study was conducted on the clinical data of 708 children hospitalized with pertussis in our hospital from August 2021 to June 2024. Patients were divided into three groups: pertussis without pneumonia (n=306), pertussis with ordinary pneumonia (n=316), and pertussis with severe pneumonia (n=86). Baseline clinical characteristics and laboratory indicators upon admission were compared. Multinomial logistic regression analysis (with the non-pneumonia group as the reference) was used to identify independent factors associated with ordinary and severe pneumonia. Results Among the 708 children, 400 were male (56.5%) and 308 were female (43.5%), with a median age of 4 months (1 month - 4 years), infants≤3 months accounted for 46.3%. The co-infection rate was 68.50%, with rhinovirus being the most common. Significant differences were found among the three groups in age, fever, underlying diseases, DTP vaccination status, WBC count, LYM% and Bordetella pertussis cycle threshold (BP-C_t) values (P<0.05). Post-hoc comparisons showed significant differences in these indicators for the severe pneumonia group compared to the other two groups, whereas no significant differences were observed between the ordinary pneumonia and non-pneumonia groups. Multinomial logistic regression analysis showed no statistically significant independent predictors for distinguishing ordinary pneumonia from non-pneumonia (P>0.05). However, for severe pneumonia, fever (OR=10.601, 95%CI: 5.235-21.466), underlying diseases (OR=5.576, 95%CI: 2.651-11.726), low BP-C_t value (high bacterial load) (OR=5.174, 95%CI: 1.911-14.005), and WBC>30×10⁹/L (OR=3.371, 95%CI: 1.520-7.474) were identified as independent risk factors. Conclusion Pneumonia is a common complication in hospitalized children with pertussis. While ordinary pneumonia is clinically difficult to distinguish from uncomplicated pertussis in the early stages, fever, underlying diseases, high bacterial load (low BP-C_t), and hyperleukocytosis serve as early warning indicators for the progression to severe pneumonia.

Objective To investigate the clinical features, diagnosis, treatment, and prognosis of the rare complication of infectious endocarditis (IE) in children with Mycoplasma pneumoniae pneumonia (MPP), aiming to enhance clinicians' understanding and facilitate early diagnosis of this condition. Methods A retrospective analysis was conducted on the clinical data of 5 children with MPP complicated by IE admitted to our hospital from January 2023 to November 2024. The analysis included clinical manifestations, laboratory tests, imaging findings, etiological test results, treatment, and follow-up information. Results The median age of onset was 9 years (5-9.5) years, with a male-to-female ratio of 3:2. All patients presented with fever and cough; only one exhibited concomitant subxiphoid pain. Median duration of fever was 12 (9.5-15) days, and vegetations were detected on echocardiography at a median of 10 (8-12) days after disease onset. Elevated D-dimer levels 5.09 (4.35-7.9) μg/mL and fibrin degradation products 10.56 (7.2-24.71) mg/L indicated marked hypercoagulability, while increased IL-6 55.45 (33.02-95.56) pg/mL and lactate dehydrogenase 746 (568.45-838.9) U/L suggested significant systemic inflammation and tissue injury. All children tested positive for MP nucleic acid in respiratory specimens; however, only one had MP DNA detected in blood via metagenomic next-generation sequencing (mNGS). All underwent surgical excision of vegetations, with histopathological examination confirming the diagnosis of IE. Postoperatively, all received antimicrobial therapy and anticoagulation. Among them, three patients with confirmed pulmonary embolism continued long-term anticoagulation for 1-6 months post-discharge. Follow-up echocardiography revealed no vegetation recurrence, and no patient reported symptoms such as dyspnea, chest pain, or wheezing during the monitoring period. Conclusion MPP-related IE presents with nonspecific and often insidious early manifestations, posing challenges for timely diagnosis. In pediatric patients with MPP and evidence of hypercoagulability, routine echocardiographic screening is strongly recommended to enable early detection of IE and prevent diagnostic delays. With prompt diagnosis and comprehensive management, the prognosis is favorable.

Objective To characterize the clinical features and independent risk factors for plastic bronchitis (PB) in children with pneumonia, and to develop and validate a clinically applicable nomogram for early risk stratification. Methods A retrospective analysis was conducted on the data of children hospitalized from January 2018 to January 2025, who were diagnosed with pneumonia and underwent bronchoscopy. Stratified sampling was used to divide the data into a training set and a test set at a ratio of 7∶3, ensuring that the PB incidence rate in both sets was approximately 7.0%. After collinearity analysis, variables were selected using LASSO combined with logistic regression, and then included in weighted logistic regression to establish a prediction model. A nomogram was constructed, and the model was validated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves. Results Among 2697 eligible children, 190 (7.0%) developed PB. Bootstrap aralysis of the weighted cogistic regression model identified nine independent predictors: asthma history (OR=1.67, 95% CI: 1.24-2.15, P<0.001), tachypnea (OR=2.01, 95% CI: 1.54-2.64, P<0.001), fever duration (OR=4.00, 95% CI: 3.24-5.83, P<0.001), pleural effusion (OR=1.53, 95% CI: 1.19-1.94, P<0.001), airway obstruction on CT reconstruction (OR=2.42, 95% CI: 1.77-3.87, P<0.001), neutrophil-to-lymphocyte ratio (NLR) (OR=1.63, 95% CI: 1.28-2.25, P<0.001), platelet count (OR=0.54, 95% CI: 0.33-0.72, P<0.001), fibrinogen (OR=1.48, 95% CI: 1.12-2.08, P=0.004), and D-dimer (OR=1.46, 95% CI: 1.20-1.80, P=0.006). The nomogram demonstrated good predictive performance in the test set with an AUC of =0.921,（95% CI: 0.88-0.96; P<0.05). Conclusion PB is a rare but severe complication of pediatric pneumonia, associated with distinct and quantifiable clinical and laboratory features. The validated nomogram provides a practical, interpretable, and statistically robust tool for early identification of high-risk children—enabling timely bronchoscopic evaluation and intervention.

Objective To characterize the clinical and radiological features and prognosis of children with bocavirus pneumonia complicated by plastic bronchitis. Methods A retrospective analysis was conducted on the clinical data and follow-up results of 13 children diagnosed with bocavirus pneumonia complicated with plastic bronchitis in our hospital from January 2022 to January 2024. Results A total of 13 cases were included, including 7 males and 6 females, with a median age of 3.0 (1.0-5.0) years. Eight cases (61.5%) were hospitalized during summer. All patients presented with fever and cough; 7 (53.8%) had wheezing, and 3 exhibited tachypnea. The mean duration of fever was 3.92±1.26 days, with a peak temperature of 39.24±0.40 °C. Extrapolmonary complications included one case of toxic encephalopathy and one of erythema multiforme; no other organ dysfunction was observed. Laboratory findings revealed mild elevations in C-reactive protein (CRP) in 9 patients, with PCT and LDH were slightly elevated. Chest CT predominantly showed inflammatory consolidation, with atelectasis in 9 cases (69.2%) and small pleural effusions in 4 (30.8%). Bronchoalveolar lavage fluid analysis demonstrated marked eosinophilia. All patients underwent bronchoscopic removal of intraluminal casts and improved clinically, with a median hospital stay of 5.0 (4.5-6.5) days. During follow-up, one child developed recurrent wheezing and was subsequently diagnosed with asthma; the remaining patients had favorable outcomes. Conclusion Bocavirus pneumonia complicated by plastic bronchitis in children are more frequently observed during the summer months. The disease commonly presents with high fever, cough, and wheezing, with minimal elevation in inflammatory markers such as CRP, PCT, and LDH. Radiologically, consolidation and atelectasis are the predominant findings. The disease course is relatively short, and severe multi-organ involvement is uncommon. Overall, the prognosis is favorable.

Objective To investigate the clinical features, therapeutic strategies, and outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by intracardiac thrombosis. Methods A retrospective analysis was performed on the clinical records of 19 children diagnosed with SMPP and concurrent intracardiac thrombosis admitted between January 2020 and May 2024. Results Among the 19 children, 13 were boys and 6 were girls, with a median age of 8 (7-10) years. All children presented with fever and cough, and 11 (57.89%) exhibited additional extracardiac thrombotic events. Laboratory findings revealed elevated levels of C-reactive protein 58.91 (25.62-98.19) mg/L, lactate dehydrogenase 559 (442-791) U/L, and D - dimer 6.06 (3.44-7.52) mg/L. The median time from symptom onset to diagnosis was 12 (10-17) days, with all thrombi identified via echocardiography; the majority (n=14, 73.69%) were located in the right ventricle. Six patients underwent immediate surgical intervention due to hemodynamic instability (shock), large thrombus size (diameter>30 mm), or presence of multiple mobile thrombi with high embolic risk. Thirteen patients initially received anticoagulation therapy; seven showed marked reduction in thrombus burden, while one experienced embolization during early treatment and five required conversion to surgical thrombectomy due to inadequate response. During follow-up (3-5 months), none of the 11 surgically treated patients developed new thromboses or cardiac complications. Among the 8 non-surgical cases, 6 achieved complete thrombus resolution within 3 months, while one patient was lost to follow-up and one experienced embolization.Conclusion Pediatric SMPP with intracardiac thrombosis presents with nonspecific symptoms and carries a significant risk of systemic embolization. Dynamic monitoring of echocardiography and D-dimer levels during the first 1-2 weeks of illness is recommended for early detection. Prompt anticoagulant or surgical management is associated with favorable outcomes; however, therapeutic decisions should be individualized based on thrombus morphology, hemodynamic status, and embolic risk.

Objective To investigate the clinical characteristics and risk factors for plastic bronchitis (PB) in children with macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP). Methods A retrospective analysis was conducted on 156 children hospitalized with MRMPP in the Department of Respiratory between October 2023 and January 2024. Based on electronic bronchoscopy findings, patients were divided into a PB group (n=44) and a non-PB group (n=112). Clinical characteristics and laboratory indicators were compared between the two groups. Continuous variables showing statistical significance in univariate analysis were analyzed using receiver operating characteristic (ROC) curves to determine optimal cut-off values, which were then used to convert these variables into categorical variables. Independent risk factors were identified via multivariate binary logistic regression analysis. Results Univariate analysis revealed that the PB group had significantly higher incidences of pleural effusion, severe pneumonia, oxygen therapy support, as well as significantly longer hospitalization duration, older age, longer fever duration, and higher levels of C-reactive protein, procalcitonin, D-dimer, lactate dehydrogenase (LDH), and M. pneumoniae DNA in bronchoalveolar lavage fluid (BALF) compared to the non-PB group (all P<0.05). ROC curve analysis determined the optimal cut-off values for D-dimer, LDH, and BALF M. pneumoniae DNA to be 1.655 mg/L, 364.5 IU/mL, and 428500 copies/mL, respectively. Multivariate logistic regression analysis identified D-dimer>1.655 mg/L (OR=14.002, 95% CI: 4.063-48.251), LDH>364.5 IU/mL (OR=6.865, 95% CI: 2.251-20.933), and BALF M. pneumoniae DNA>428500 copies/mL (OR=12.306, 95% CI: 3.586-42.236) as independent risk factors for PB in MRMPP (all P<0.001). Conclusion Elevated levels of D-dimer, LDH, and M. pneumoniae DNA in BALF are independent risk factors for PB in children with MRMPP. Monitoring these indicators is crucial for the early identification of children at risk of developing PB.

Objective To explore the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of high-risk acute T-lymphoblastic leukemia (T-ALL) in children, compare the efficacy differences of different treatment regimens, and explore the influence of pretreatment regimens on allo-HSCT in T-ALL patients. To compare the effects of two conditioning regimens, one containing cladribine (Cla) and the other without (fludarabine, Flu), in umbilical cord blood transplantation (UCBT), as well as the differences between this and the peripheral blood hematopoietic stem cell transplantation (PBSCT) based on total body irradiation (TBI). Methods A retrospective analysis was conducted on the clinical data of children with high-risk T-ALL who underwent allo-HSCT from February 2017 to March 2023. The Kaplan-Meier method was used to analyze the 3-year overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of chronic graft-versus-host disease (cGVHD), cumulative incidence of relapse (CIR), and cumulative transplant-related mortality (TRM) of the children. The Log-rank test was used to analyze the factors influencing the prognosis of high-risk T-ALL children. The differences in pre-treatment related toxic reactions, post-transplant infections, and 3-year OS rates among different pre-treatment regimens (UCBT-Cla group, UCBT-Flu group, and PBSCT-TBI group) were compared. Results Among the 23 children with high-risk T-ALL, 19 were boys (82.6%) and 4 were girls (17.4%), with a median age of 9.5 (1.9-14) years, and the median time from diagnosis to transplantation was 7.5 (6-29) months. Among the 23 high-risk T-ALL children, neutrophil engraftment was successfully achieved in all cases. The median time to engraftment was 18 (12 - 38) days for UCBT patients and 12 (11 - 15) days for PBSCT patients. The median time to platelet engraftment was 36 (27-61) days in UCBT recipients, with one case failing to achieve platelet engraftment; all PBSCT recipients achieved platelet engraftment, with a median time of 13 (9-25) days. Five children (21.7%) experienced grade ≥3 conditioning-related toxicities (primarily manifested as gastrointestinal reactions, oral mucositis, and infections), 14 had grade 1-2 toxicities, and 4 had no toxicities. No deaths occurred within 100 days post-transplantation among the 23 children. The incidence of grade Ⅲ-Ⅳ aGVHD was 26.1% (6/23). The 3-year cumulative incidence of cGVHD was (27.15 ± 13.33) %. Eighteen children (78.3%) experienced infections of varying severity and locations after transplantation, primarily pneumonia (10 cases), BK polyomavirus-associated hemorrhagic cystitis (7 cases), and invasive fungal infections (6 cases). The median post-transplant follow-up time was 34 (5-92) months. LFS was observed in 18 children, and 5 children died. The 3-year OS and LFS rate were both (77.5 ± 8.9) %. The 3-year CIR and TRM were (13.04 ± 7.19) % and (9.21 ± 6.4)%, respectively. The neutrophil and platelet engraftment times in the PBSCT-TBI group were significantly shorter than those in the UCBT-Cla and UCBT-Flu groups (P<0.05). No statistically significant differences were observed among the UCBT-Cla, UCBT-Flu, and PBSCT-TBI groups in terms of conditioning-related toxicities, incidence of aGVHD and cGVHD, post-transplant infections, or 3-year OS rate (P>0.05). The log-rank test revealed that central nervous system (CNS) involvement at initial diagnosis may be a high-risk factor affecting the overall survival (OS) of children with high-risk T-ALL (P<0.05). Age≥10 years, CNS involvement at initial diagnosis, pre-transplant disease status in second complete remission (CR2), and meeting the criteria for refractory leukemia may be high-risk factors for post-transplant relapse in high-risk T-ALL (P<0.05). Conclusions Allo-HSCT can effectively improve long-term survival in children with high-risk T-ALL and is associated with low TRM. CNS involvement at initial diagnosis is an important marker of poor prognosis. The cla-containing conditioning regimen in UCBT demonstrates potential for reducing relapse rates and improving survival outcomes. The Cla-containing conditioning regimen demonstrates potential in UCBT to reduce relapse rates and improve survival. The UCBT-Cla regimen may be a promising alternative option worthy of further investigation.

The National Health Commission and the State Administration for Market Regulation jointly promulgated the "National Food Safety Standard: General Standard for Infant Formula for Special Medical Purposes" (GB 25596-2025, hereinafter referred to as the "New Standard") on March 16, 2025. The New Standard introduces comprehensive optimizations regarding the reference ranges, content requirements, and testing methods for macronutrients (proteins, carbohydrates, and fats), vitamins, minerals, and other optional components. Additionally, it expands the product categories from the original 6 to 13 types, with corresponding technical specifications established for each category. Currently, all approved infant formula products for special medical purposes (hereinafter referred to as "FSMP for infants") in the market are manufactured in compliance with the 2010 version of the standard (GB 25596-2010, "Old Standard"). This article will focus on analyzing the changes in mandatory and optional component requirements, while evaluating the compliance status of approved products with the New Standard. The findings aim to assist clinical pediatricians in accurately understanding the key revisions of the New Standard, thereby enabling more scientifically appropriate nutritional support plans for infants with special medical conditions.

Objective Antigen escape, particularly CD19 loss, limits the efficacy of CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy in children with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL). PAX5 gene variations have been shown to disrupt CD19 expression stability and increase relapse risk. This study aimed to compare the therapeutic efficacy of two CD19/CD22 dual-targeting CAR-T strategies, namely co-infusion versus bicistronic construct, in children with R/R B-ALL harboring PAX5 gene variations. Methods A retrospective analysis was conducted on the clinical data of R/R B-ALL children with PAX5 gene variation admitted to the hospital from November 5, 2019 to May 31, 2023. The patients were divided into a co-infusion group (Co group) and a bicistronic group (Bi group). All children received lymphodepletion conditioning followed by CAR-T cell infusion at a dose ranging from 2×10⁶ to 10×10⁶ cells/kg. The primary endpoints included the 30-day complete remission (CR) rate, minimal residual disease (MRD) negativity rate, relapse rate, survival outcomes, and treatment-related toxicity. The follow-up cutoff date was March 31, 2025. Results A total of 22 children with R/R B-ALL and PAX5 gene variations were included, including 18 cases (81.8%) of fusion variations, 2 cases (9.1%) of deletions, and 2 cases (9.1%) of missense variations. Six children (27.3%) had complex karyotypes (≥ 3 abnormalities). Among them, 8 patients received combined infusion of CAR-T treatment (Co group), and 14 received bicistronic CAR-T treatment (Bi group). The median age of the children at the time of treatment was 5.57 years (ranging from 1.31 to 14.85 years), and there were 13 boys and 9 girls. The CR rate of children in both the Co group and the Bi group was 100% 30 days after infusion, and the MRD was negative in both groups (MRD<0.01%). The median follow-up time was 26.5 months (range 5 to 66 months). Among the 22 patients, the 6-month, 12-month and 3-year overall survival (OS) rates were 95.45%, 90.91% and 63.64%, respectively. Meanwhile, the 6-month, 12-month and 3-year event-free survival (EFS) rates were 77.27%, 54.55% and 40.91%, respectively. The 6-month, 12-month, and 3-year OS rates in the Co group were 100%, 87.5%, and 50%, respectively, while those in the Bi group were 92.9%, 92.9%, and 71.4%, respectively. The 6-month, 12-month, and 3-year EFS rates in the Co group were 75%, 62.5%, and 37.5%, respectively, and those in the Bi group were 78.6%, 50%, and 42.9%, respectively. There were no statistically significant differences in OS and EFS rates between the two groups (P_OS=0.411, P_EFS=0.826). A total of 4 children received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CAR-T treatment. The 6-month, 12-month and 3-year OS rates in the transplantation group were 100%, 100% and 50.0%, respectively, while those in the non-transplantation group were 94.4%, 88.9% and 66.7%, respectively. The 6-month, 12-month and 3-year EFS rates in the transplantation group were 75.0%, 75.0% and 50.0%, respectively, while those in the non-transplantation group were 77.8%, 50.0% and 38.9%, respectively. There were no statistically significant differences in OS and EFS rates between the two groups (P_OS=0.693, P_EFS=0.553). Regarding toxicity, the incidence of grade ≥3 cytokine release syndrome (CRS) was 25.0% and 57.1% in the Co and Bi groups, respectively; the incidence of immune effector cell-associated neurotoxicity syndrome (ICANS) was 25.0% and 21.4%, respectively. All adverse events were manageable and no treatment-related death occurred. Conclusions Both co-infusion and bicistronic CD19/CD22 dual-targeting CAR-T strategies exhibit favorable short-term efficacy and comparable safety profiles in pediatric R/R B-ALL with PAX5 variations. However, the 3-year EFS rate remains at a relatively low level, suggesting that the long-term prognosis still needs further improvement.

Objective To analyze the clinical and genetic variation characteristics of hereditary epilepsy in neonates and explore the correlation between the characteristics of genetic variations and clinical manifestations. Methods A retrospective collection was made of neonatal hereditary epilepsy cases admitted to Hebei Children's Hospital from January 2019 to December 2024. The cases were divided into KCNQ2 group and non-KCNQ2 group based on the results of gene sequencing. The clinical features of the two groups were compared, and the genotype-phenotype correlation of KCNQ2 was analyzed. Results A total of 43 cases of neonatal hereditary epilepsy were included, including 26 boys and 17 girls, with a gestational age of 39.4 (38.1-40.3) weeks and a birth weight of 3400 (3000-3400) g. There were 24 cases in the KCNQ2 group and 19 cases in the non-KCNQ2 group. The onset time of epilepsy was 3.0 (2.0-7.0) days after birth, which was earlier in the KCNQ2 group than in the non-KCNQ2 group (P<0.05). The main seizure forms were clonic (62.8%) and tonic (53.5%) seizures. The main abnormality on head MRI was abnormal brain parenchymal signal (72.1%). The most common finding on video electroencephalogram was multifocal discharges (34.9%). There were no statistically significant differences between the two groups (P>0.05). In the KCNQ2 group, there were 13 cases of self-limiting neonatal epilepsy (SeLNE) and 11 cases of developmental and epileptic encephalopathy (DEE). Among the 23 cases successfully followed up, 19 cases had seizure control, 8 cases had significant developmental delay, and 2 cases died. In the non-KCNQ2 group, there was 1 case of SeLNE, 10 cases of DEE, and 8 other cases. Among the 13 cases successfully followed up, 7 cases had seizure control, 7 cases had significant developmental delay, and 4 cases died. The proportion of SeLNE in the KCNQ2 group was higher than that in the non-KCNQ2 group (54.2% vs. 5.3%, P<0.01), and the proportion of death and significant developmental delay was lower in the KCNQ2 group (43.5% vs. 84.6%, P=0.033). There were 19 cases of KCNQ2 nucleotide sequence variations, including 10 cases of SeLNE, 5 cases of hereditary variations, and 4 cases of missense variations. Seven amino acid changes were located at the C-terminal. All 9 cases of DEE were de novo variations, including 7 cases of missense variations, and 5 amino acid changes were located at the S4, S6 and adjacent regions, and the B-helix region. Prediction of protein structural changes induced by 11 missense variants: among 4 SeLNE cases, 2 showed alterations in protein secondary structure, 3 exhibited changes in hydrogen bonds, and 4 demonstrated decreased protein stability; among 7 DEE cases, 6 displayed alterations in protein secondary structure, 4 presented changes in hydrogen bonds, and 6 manifested decreased protein stability. Conclusions KCNQ2 gene variations are the most common in neonatal hereditary epilepsy. Compared with other gene variations, KCNQ2-induced neonatal epilepsy has an earlier onset time and a lower proportion of adverse outcomes. Among them, de novo, missense, and variations at important functional domain sites, may be associated with severe phenotypes of DEE.

Lymphadenopathy, one of the most common clinical signs in pediatrics, encompasses a broad etiological spectrum, posing significant challenges in differential diagnosis. The release of the Expert consensus on the clinical diagnosis and treatment of lymphadenopathy in children (2026) has sparked extensive discussion among pediatricians across China. This review aims to provide an in-depth interpretation and expansion of the core content of the consensus, focus on the difficult issues in clinical practice, and further discuss some unfinished contents. The article will thoroughly explore the definition of lymphadenopathy, refined interpretation of imaging examinations, application of "potential diagnostic clues", recognition of "alarm signals" for malignancies, and the evolving pathogen spectrum of infectious lymphadenopathy along with corresponding diagnostic and therapeutic strategies. This paper seeks to assist clinicians in better understanding and applying the consensus, thereby enhancing the diagnostic and therapeutic standards for pediatric lymphadenopathy.

Objective To investigate the phenotypic impact of dual variations in GABRG2 and SCN1A on genetic epilepsy with febrile seizures plus (GEFS+). Methods The clinical data of a 3-year-old girl and her three generations of family members who visited the Pediatric Internal Medicine Department due to "repeated convulsions" in May 2023 were collected. The genetic variations of this family were verified by whole exome sequencing (WES) and Sanger sequencing, and the genotype-phenotypic association was analyzed in combination with the literature. Results Among the 6 members of this family, 3 patients with SCN1A (c.5621G>A) mutations presented with febrile seizures (FS) or late-onset antiseizure medication-responsive epilepsy. Two individuals with isolated GABRG2 mutations presented with FS or incomplete penetrance. The proband, carrying dual mutations, manifested early-onset refractory epilepsy and status epilepticus. Two patients with the same single variant reported in the literature also showed FS. Protein interaction analysis revealed co-expression and functional synergy between SCN1A and GABRG2 in regulating neuronal excitability. Conclusions Dual mutations in SCN1A and GABRG2 may exacerbate epilepsy phenotypes through additive functional effects and genetic modifying mechanisms. Clinicians should be vigilant for synergistic interactions of dual variations in families with heterogeneous phenotypes, and timely genetic testing is critical to guide precision therapy and genetic counseling.

Objective To investigate the clinical characteristics of Chlamydia pneumoniae pneumonia in children and enhance awareness, diagnostic accuracy, and therapeutic management of this condition. Methods A retrospective analysis was performed on clinical data from children diagnosed with Chlamydia pneumoniae pneumonia admitted to the Department of Respiratory Medicine between July 2024 and May 2025. Results A total of 39 patients were included, comprising 20 males and 19 females, with a median onset age of 10.9 years (interquartile range: 7.8-12.5). The mean duration of illness prior to admission was (11±5) days, and the median hospital stay was 6 days (range: 4-6). All patients presented with cough; fever, chest pain, and chest tightness were observed in some, while only a few exhibited abnormal pulmonary auscultation findings. Chest CT revealed round high-density opacities or patchy consolidations, predominantly subpleural in distribution. Air bronchograms and halo signs were noted in a subset of cases. Unilateral lung involvement occurred in 34 patients, bilateral in 5. Laboratory findings showed normal white blood cell count, neutrophil percentage, procalcitonin, and IL-6 levels. Elevated C-reactive protein was present in 12.8% of patients, increased erythrocyte sedimentation rate in 50%, and elevated IL-10 in 73.7%. All 39 patients had positive serum IgM antibodies against Chlamydia pneumoniae; among them, 7 had positive Chlamydia pneumoniae nucleic acid detected by next-generation sequencing in bronchoalveolar lavage fluid, and 1 had a positive nucleic acid test in sputum obtained from an outside institution. Most patients received azithromycin monotherapy, followed by doxycycline; 5 patients additionally received glucocorticoids. Clinical recovery was achieved in all 36 follow-up cases. Conclusions Pediatric Chlamydia pneumoniae pneumonia may manifest without fever, with cough as the sole presenting symptom. Characteristic imaging features include subpleural, mass-like consolidations often accompanied by peripheral air bronchograms and occasionally halo signs. Definitive diagnosis relies on serological IgM detection or nucleic acid testing. Treatment with azithromycin or doxycycline is effective.

Delayed screening, diagnosis, and intervention for hearing impairment can significantly hinder the development of speech-language, cognitive, and communication abilities in children. Over the past two decades, China has made substantial progress in establishing a comprehensive system for pediatric hearing screening, diagnosis, treatment, and rehabilitation (referred to as the “screen-diagnose-treat-rehabilitate” system). This review focuses on national policies, key technologies, and service models across the entire continuum of care for childhood hearing impairment—from early screening and diagnosis to intervention and rehabilitation, as well as emerging roles of artificial intelligence, telemedicine, and genetic screening in improving screening efficiency and enhancing service accessibility. The paper further proposes a future-oriented pediatric hearing healthcare system characterized by interdepartmental coordination, intelligent and precise service delivery, scalability, and full-process management.

Oxazolidinone antibiotics, due to their high antimicrobial activity against Gram-positive bacteria and Mycobacterium tuberculosis, are increasingly used in clinical practice, leading to a rise in off-label use. While substantial clinical research data exist in adult populations, pediatric evidence remains limited, with significant physiological and pharmacokinetic differences compared to adults. Addressing the rational use of these agents in pediatric patients has emerged as a critical clinical challenge. To address this, a multidisciplinary working group comprising experts in pediatric infectious diseases, critical care, hematology-oncology, and clinical pharmacy from 34 hospitals nationwide developed this consensus. The primary objectives are to standardize linezolid use in pediatric infections, emphasize therapeutic drug monitoring for precise administration, and provide recommendations for special populations (e.g., children with hepatic/renal dysfunction or ECMO therapy) as well as adverse event monitoring. This consensus aims to offer evidence-based decision support for clinicians and promote rational medication use in pediatric patients.

Objective Comorbid autonomic nervous system dysfunction affects the overall prognosis of children with Guillain-Barré syndrome (GBS), whereas systematic research on the course of autonomic nervous system dysfunction and the process of neurological function recovery in these children remains scarce. This study aims to investigate the clinical characteristics and neurological function recovery of GBS children complicated with autonomic nervous system dysfunction. Methods A retrospective analysis was conducted on the clinical data of children with GBS who visited Wuhan Children’s Hospital, Tongji Medical College from May 2017 to August 2023. The children were divided into two groups, with and without autonomic dysfunction, and a comparative analysis of key clinical indicators between the two groups were conducted. Results A total of 92 children with GBS were enrolled, including 58 boys (63.0%), with a median age of 5.0 (3.4-8.4) years. None of the children presented with autonomic nervous system dysfunction as the initial symptom. Autonomic nervous system dysfunction developed in 40 cases (43.5%) during the disease course, with the median time from disease onset to the occurrence of autonomic nervous system dysfunction being 9 (4-13) days. Cardiovascular complications were the most common autonomic symptoms, including 16 cases of tachycardia, 12 cases of arrhythmia, 5 cases of hypertension, 4 cases of atrioventricular block, 3 cases of orthostatic hypotension, and 2 cases of bradycardia. Other symptoms included 4 cases of diarrhea, 2 cases of constipation, 7 cases of urinary retention, and 3 cases of hyperhidrosis. Compared with GBS children without autonomic nervous system dysfunction, those with this complication had significantly higher proportions of assisted ventilation requirement and combined immunotherapy plus plasma exchange, longer hospital stays, and longer time to recovery of independent ambulation (P<0.05). Autonomic nervous system function recovered within 3 months in all children. At the 3-month follow-up, among all children with abnormal nerve conduction, only 39.0% (30/77) achieved recovery of nerve conduction velocity, while the recovery rate of clinical symptoms was 67.5% (52/77). Conclusions Autonomic nervous system dysfunction affects the treatment and prognosis of children with Guillain-Barré syndrome (GBS). However, autonomic nervous system dysfunction in these children achieves a favorable recovery, and its recovery time precedes that of nerve conduction impairment.

Objective To investigate the factors influencing weight catch-up growth in very preterm infants (VPIs) from discharge to corrected age 6 months. Methods A retrospective analysis was conducted on 124 VPIs (gestational age <32 weeks) admitted to the Department of Neonatology between August 2019 and June 2022. Catch-up growth was defined as Z-score of weight-for-age (WAZ) increase of ≥0.67 from discharge to corrected age 6 months. Infants were divided into catch-up and non-catch-up groups on this criterion. A forward stepwise logistic regression model was used to identify independent predictive factors. Results Among the 124 VPIS, there were 70 males (56.5%), with a median gestational age of 30.14 (28.86-31.11) weeks, birth weight of 1330.0 (1170-1607) g, birth WAZ of 0.10 ± 0.61, and a catch-up growth rate of 62.1% (77/124) at corrected 6 months. Compared to the non-catch-up infants, the catch-up group exhibited significantly lower birth weight, WAZ at day 7, day 14 and discharge, and serum alkaline phosphatase (ALP) at corrected 40 weeks (P<0.05), while showing longer hospital stay, greater postmenstrual age at discharge, and higher daily weight gain post-discharge (P<0.05). Multivariate regression analysis identified multiple pregnancy (OR=0.294, 95%CI: 0.088-0.982), hospital stay (OR=1.082, 95% CI: 1.032-1.134), WAZ at discharge (OR=0.385, 95%CI: 0.167-0.890), daily weight gain post-discharge (OR=1.928, 95% CI: 1.483-2.506), and ALP at corrected 40 weeks (OR=0.995, 95% CI: 0.990-0.999) as independent influencing factors for post-discharge catch-up growth. Conclusion Post-discharge weight catch-up growth in VPIs is synergistically modulated by multiple pregnancy, WAZ at discharge, growth rate post-discharge, hospital stay duration and ALP at corrected 40 weeks.

Functional constipation is one of the most common digestive system diseases in children, which can cause symptoms such as reduced defecation, hard and dry stools, abdominal distension, and abdominal pain. Long-term constipation can also lead to related problems such as delayed growth and development, urinary retention, and anxiety in children, seriously affecting their quality of life. However, at present, there is a lack of evidence-based research on the long-term hazards of functional constipation in children. Some clinicians have insufficient understanding of it, and the poor compliance of children and their parents often leads to delays in diagnosis and treatment. In view of this, this article systematically reviews the potential hazards of functional constipation to children and the progress in its diagnosis and treatment, with the aim of enhancing the attention of clinical workers and families of affected children to this disease, optimizing management strategies and improving prognosis.

Growth curves are indispensable for monitoring children's growth in child health care and pediatrics. In our article, we traces growth curves ranging over 200 years, from the hand-drawn charts in the early 18th century to algorithmic modeling in modern ages, highlighting their crucial role in assessing child health. China has made progress in growth curves research, with localized versions better reflecting domestic children's growth patterns, especially in detecting growth retardation in rural populations. In this article we also introduce growth curves construction methods, including non - parametric approaches (e.g., cubic spline, penalized splines, kernel estimation, LOWESS/LOESS) and parametric approaches (e.g., LMS, GAMLSS), comparing their merits, limitations, and applicability. Future research will focus on creating individualized growth curves and building localized standards to enhance assessment accuracy, thereby better supporting child health monitoring and disease prevention.

Systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are chronic systemic autoimmune conditions marked by aberrant immune activation. The pathogenesis of both diseases is multifactorial, involving a complex interplay between genetic susceptibility and environmental influences. Although the simultaneous presence of SLE and IBD is uncommon in clinical practice, this report describes a pediatric female patient who presented with abdominal pain as the primary manifestation and was ultimately diagnosed with both SLE and ulcerative colitis. Treatment with infliximab (IFX), a tumor necrosis factor-α inhibitor, in combination with immunosuppressive therapy led to significant alleviation of her autoimmune and gastrointestinal symptoms. This case highlights the importance of maintaining a high index of suspicion for underlying IBD when evaluating SLE patients with unexplained gastrointestinal complaints—particularly abdominal pain or diarrhea—that do not correlate with typical disease flares.

Objective White-Sutton syndrome (WHSUS) is a monogenic genetic disorder with significant phenotypic differences. This study aims to further expand the clinical phenotypic spectrum of WHSUS and explore potential treatment methods for improving symptoms. Methods A retrospective analysis was conducted on the clinical data of four WHSUS patients who visited Children's Medical Center from July 2018 to February 2023. Results The age range of the first diagnosis of the 4 patients was 1-9 years old, 2 boys and 2 girls, all of whom had delayed language and motor development. Patient 1, a girl, exhibited a previously unreported clinical phenotype, tethered cord syndrome (TCS), and concurrent insulin resistance. Patient 2, a girl, visited the doctor due to short stature and poor academic performance. She received growth hormone treatment for 3.5 years. At the age of 12 years and 1 month during the follow-up, her height was 152 cm (P₅₀), and her menstruation was normal. Patient 3, a boy, was treated for delayed language development. Patient 4 was a boy with delayed language development and autistic tendency. All four patients had de novo mutations in the POGZ gene and were diagnosed with WHSUS. Conclusions This study detailedly reported the clinical features of 4 patients with WHSUS, expanding the phenotypic spectrum of WHSUS. Meanwhile, it was the first to report the treatment attempt of growth hormone for a child with WHSUS and short stature, providing a new idea for the symptomatic treatment of this kind of disease.

Objective Clinical manifestations of left ventricular noncompaction (LVNC) in children lack specificity. At present, there are relatively few systematic studies on the prognostic risk factors of LVNC, and clear evidence for risk stratification is still lacking in clinical practice. This study aimed to analyze the clinical characteristics, genetic variations, and prognostic factors of LVNC in children. Methods Clinical data of 42 children diagnosed with LVNC from June 2018 to June 2024 were retrospectively analyzed. According to the occurrence of adverse cardiovascular events during follow-up, they were divided into an adverse event group (15 cases) and a non-adverse event group (27 cases). Clinical and laboratory indicators were compared between the two groups, and multivariate Logistic regression was used to analyze prognostic risk factors. Results Among the 42 children, 24 were males (57.1%), with a median age of 92.5 months at diagnosis. The common initial symptoms were poor appetite accompanied by shortness of breath (19.0%), chest tightness or chest pain (19.0%), and palpitations (16.7%). At the initial diagnosis,children with cardiac function class III/IV accounted for 35.7% (15/42).92.9% (39/42) of the children had abnormal electrocardiograms (ECG), with tachyarrhythmia being the most common (14/42). Echocardiography revealed left atrial and left ventricular enlargement in 71.4% (30/42) and 80.9% (34/42) of patients, respectively. The median left ventricular ejection fraction (LVEF) was 52.0% (41.8-62.0), and the median non-compacted to compacted (NC/C) ratio was 2.5 (2.1-3.0). Four children had a family history of sudden death or cardiomyopathy in first-degree relatives. 16 children underwent genetic testing, and pathogenic gene mutations were detected in 10 cases. The median follow-up duration was 30 months, the fatality rate was 9.5%, and symptoms improved in 45.2% (19/42) of children. The group with adverse events exhibited a significantly higher incidence of tachyarrhythmia, a greater proportion of patients with cardiac function class III/IV, and higher NC/C ratios compared to the group without adverse events (P<0.05). Multivariate logistic regression analysis demonstrated that cardiac function class Ⅲ/IV (OR=13.55, 95% CI: 1.87~98.39, P= 0.01), tachyarrhythmia (OR=19.73, 95% CI: 2.28~170.47, P=0.007), and an elevated NC/C ratio (OR=5.19, 95% CI: 1.20~22.40, P=0.027) as independent risk factors for an unfavorable prognosis. Conclusions Children with LVNC exhibit strong heterogeneity in clinical manifestations and are often associated with a genetic background. Poor cardiac function, tachyarrhythmia, and a high NC/C ratio are independent risk factors for poor prognosis, so intensive monitoring and intervention for highrisk children are required in clinical practice.

Objective Both preterm and postterm pregnancies can adversely affect neonatal outcomes; however, research on the differences in neonatal outcomes across various gestational ages within the full-term range (37⁺⁰ to 41⁺⁶ weeks) remains limited. Therefore, this study aims to explore the potential association between the gestational week of delivery within full-term pregnancy and adverse perinatal outcomes using a retrospective pregnancy cohort from a single center. Methods A retrospective cohort of pregnant women who delivered at hospital between January 2023 and December 2024, and their neonates, was included. Maternal and neonatal characteristics, as well as adverse outcomes [including large for gestational age (LGA), small for gestational age (SGA), low birth weight (LBW), macrosomia, 5-minute Apgar score≤7, and stillbirth], were compared across different gestational weeks. Restricted cubic spline (RCS) models and multivariable logistic regression were employed to analyze the association between gestational week at delivery and adverse perinatal outcomes. Results A total of 13,123 singleton full-term natural delivery cases were included from 43,502 parturients. They were included and categorized into five groups according to gestational week at delivery: the 37⁺⁰-37⁺⁶ weeks group (n=952), the 38⁺⁰-38⁺⁶ weeks group (n=2,707), the 39⁺⁰-39⁺⁶ weeks group (n=4,920), the 40⁺⁰-40⁺⁶ weeks group (n=4,164), and the 41⁺⁰-41⁺⁶ weeks group (n=380). The proportion of advanced maternal age (≥35 years) decreased with increasing gestational age, declining from 18.2% in the 37⁺⁰-37⁺⁶ weeks group to 10.0% in the 41⁺⁰-41⁺⁶ weeks group. The distribution of pre-pregnancy BMI categories differed significantly among the gestational age groups (P<0.001), with the 37⁺⁰-37⁺⁶ weeks group having higher proportions of overweight and obesity (10.7% and 1.7%, respectively). Gestational weight gain also varied significantly across groups (P<0.001), with the 41⁺⁰-41⁺⁶ weeks group exhibiting greater weight gain during pregnancy. The incidence of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy/preeclampsia differed significantly among gestational age groups (P<0.001), both being most prevalent in the 37⁺⁰-37⁺⁶ weeks group (27.2% and 4.3%, respectively). There were 15 stillbirths (0.1%), 13,108 surviving newborns, among whom 423 newborns (3.2%) were LGA, 799 (6.1%) were SGA, 166 (1.3%) were macrosomia, 180 (1.4%) were LBW, and 9 (0.1%) had a low Apgar score at 5 minutes. Restricted cubic spline analysis initially suggested that 39⁺⁰-40⁺⁶ weeks of gestation might represent a window of lower risk for adverse neonatal outcomes. Multivariate logistic regression further confirmed that, compared with delivery at 39⁺⁰-39⁺⁶ weeks, delivery at 37⁺⁰-37⁺⁶ weeks and 38⁺⁰-38⁺⁶ weeks was associated with a significantly increased risk of SGA (P<0.01); delivery at 40⁺⁰-40⁺⁶ weeks and 41⁺⁰-41⁺⁶ weeks was associated with a significantly increased risk of macrosomia (P<0.001); delivery at 37⁺⁰-37⁺⁶ weeks and 38⁺⁰-38⁺⁶ weeks was associated with a significantly increased risk of LBW (P<0.001); the 41⁺⁰-41⁺⁶ weeks group had an increased risk of a 5-minute Apgar score≤7 (P=0.029); and delivery at 37⁺⁰-37⁺⁶ weeks and 38⁺⁰-38⁺⁶ weeks was associated with a significantly increased risk of stillbirth (P<0.01). Conclusions The timing of delivery in full-term pregnancies may affect neonatal outcomes. The period from 39⁺⁰ to 40⁺⁶ weeks of gestation is a window during which the risks of various adverse outcomes are at relatively low levels. This study may have potential value for further optimizing clinical pregnancy monitoring and perinatal management.

Objective To analyze clinical trials for pediatric rare diseases registered in the Chinese Clinical Trial Registry (ChiCTR) and reveal their characteristics and development trends. Methods Based on China's first and second lists of rare diseases, pediatric rare disease clinical trials registered in ChiCTR from the establishment of the database to February 7, 2025, were retrieved. And then data organization and statistical analysis was carried out. Results A total of 225 registered clinical trials for pediatric rare diseases were included, encompassing 61 distinct disease categories. The leading units of 75.11% of the registered clinical trials were located in developed regions, and 76.00% trails were single-center studies. Fundings were primarily originated from self-raised funds and government sources (67.11%). Exploratory/pilot studies and Phase IV trials constituted 56.73% of the trails. Among interventional studies, non-randomized methods were most frequently employed (53.85%). And drug therapy was utilized in 29.33% of trials. Trials conducted between 2008-2017 were more likely to be multi-center (P=0.03) and randomized (P=0.002), while the trials conducted during 2018-2025 showed greater adoption of preregistration (P=0.002) and more tend to set up data monitoring committees (DMCs) (P<0.001). Conclusions Registered pediatric rare disease studies in China show sustained growth with getting increased attention on preregistration and data management; however, challenges still remain, such as incomplete information, methodological deficiencies, and uneven resource allocation, et al. Standardized trial management, along with high-quality and large-scale multicenter research are well recommended, which should be paid more efforts to in the future.

Collagen Ⅳ is the core structural protein of the glomerular basement membrane, composed of α chains encoded by the COL4A3, COL4A4, and COL4A5 genes, which assemble into the α3α4α5 trimer. It plays a crucial role in maintaining the structural integrity and filtration function of the glomerular basement membrane. Variations in these three genes can lead to a spectrum of inherited kidney diseases, with Alport syndrome being the most representative. Clinically, Alport syndrome is characterized by hematuria, progressive renal dysfunction, sensorineural hearing loss, and ocular abnormalities, with inheritance patterns including X-linked, autosomal recessive, and autosomal dominant. Additionally, variations in the COL4A3-COL4A5 genes are closely associated with various kidney diseases, such as thin basement membrane nephropathy (TBMN), familial IgA nephropathy, focal segmental glomerulosclerosis (FSGS), steroid-resistant nephrotic syndrome (SRNS), and end-stage renal disease (ESRD) of unknown etiology. In recent years, with the widespread application of high-throughput sequencing technologies, genetic testing has increasingly demonstrated its value in disease diagnosis, prognosis assessment, and precision medicine. This article systematically reviews the clinical manifestations, molecular genetic mechanisms, and clinical management strategies of COL4A3-COL4A5-related kidney diseases, aiming to provide a theoretical foundation and practical guidance for early diagnosis and individualized treatment of these conditions.

Objective To evaluate the efficacy and safety of modified percutaneous peritoneal dialysis (PD) catheterization techniques in pediatric uremic patients, and to compare the clinical advantages and limitations of three distinct modified approaches. Methods A single-center retrospective cohort study was conducted, enrolling pediatric patients who underwent their first percutaneous PD catheterization for uremia at the department of nephrology between January 1, 2017 and December 31, 2024. Patients were stratified into three groups based on the catheterization technique: Group A (puncture cannula combined with rigid guidewire-guided technique), Group B (peel-away sheath combined with rigid guidewire-guided technique), and Group C (pneumoperitoneum-assisted trocar combined with rigid guidewire-guided technique). Baseline characteristics, procedural duration, incidence of intraoperative incision bleeding, time to initiation of dialysis, and incidences of catheter dysfunction and PD-related infections within 1 year of regular PD initiation were collected and analyzed statistically. Results A total of 98 patients were included, with well-balanced baseline characteristics across groups. All patients received regular PD for≥1 month; 75 completed≥6 months of PD, and 53 completed≥12 months. Procedural duration differed significantly among the three groups (P<0.05), with Group C having the shortest duration (significantly shorter than Group A, P<0.01). Cross-sectional analyses at postoperative time points revealed no significant differences in incision bleeding, time to dialysis initiation, poor drainage, leakage, or PD-related infections (P>0.05). Kaplan-Meier survival analysis showed 1-year catheter survival rates of 0.89, 0.79, and 0.96 in Groups A, B, and C, respectively. However, Cox proportional hazards regression demonstrated no significant difference in 1-year catheter survival among the three techniques. Further survival analyses for key catheter-related adverse events showed no significant intergroup differences in 1-year tunnel infection or peritonitis rates. Notably, Group C had a significantly higher incidence of poor drainage than Group A (P=0.034). Conclusion Modified percutaneous PD catheterization is a safe, effective, and technically feasible approach suitable for dissemination among pediatric nephrologists. The peel-away sheath combined with rigid guidewire technique exhibits the most balanced performance in terms of procedural efficiency and complication control. While the pneumoperitoneum-assisted trocar technique significantly shortens procedural duration, it may increase the risk of postoperative poor drainage, warranting selective application in centers with proficient technical expertise.

Objective To investigate the dynamic changes and correlation between splanchnic tissue oxygen saturation (SrSO₂) and superior mesenteric artery (SMA) hemodynamic parameters in neonates during red blood cell (RBC) transfusion. Methods A total of neonates who required RBC transfusion and were admitted to the neonatal intensive care unit between October 2024 and October 2025 were enrolled in this study. Synchronous monitoring of SrSO₂ and SMA hemodynamic parameters — including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) — was performed at eight predefined time points: 1 hour before transfusion (t_-1h), mid-transfusion (t_m), end of transfusion (t_e), and 2, 4, 12, 24, and 48 hours after transfusion completion (t_2h, t_4h, t_12h, t_24h, and t_48h). Spearman correlation, generalized estimating equations (GEE), and cross-lagged correlation analyses were used to examine the associations among the indicators. Results A total of 43 neonates were included, with 26 boys (60.5%). The median gestational age was 31.1 (29.0-36.0) weeks and the median birth weight was 1750 (1255-2600) g. During the observation period, the median PSV ranged from 33.4 to 46.9 cm/s, median EDV from 9.6 to 11.5 cm/s, median RI from 0.73 to 0.77, and median SrSO₂ from 49.8% to 56.5%. Correlation analysis revealed a significant negative correlation only at t4h between RI and SrSO₂ (r_s=-0.52, P_adjusted=0.048); no significant correlations were found at other time points (all P>0.05). GEE showed that time had no significant effect on PSV (β=0.003, P=0.992), EDV (β=-0.073, P=0.449), or RI (β=0.002, P=0.324), but had a statistically significant positive effect on SrSO₂ (β=0.776, P=0.004). The absolute values of the mean cross-correlation function (CCF) between PSV, EDV, RI and SrSO₂ were all small (the highest was 0.151 for PSV at lag-1), indicating no clear lagged relationship. Conclusions During RBC transfusion in neonates, the SMA hemodynamic parameters remain relatively stable, whereas the SrSO₂ shows an overall increasing trend. There is no significantly synchronous or lagged correlation between the changes in these two measures, suggesting that macrohemodynamics and microcirculatory oxygenation may be regulated by different mechanisms.

This review aims to systematically evaluate the therapeutic role of infliximab in patients with Kawasaki disease (KD) who are resistant to intravenous immunoglobulin (IVIG), with a focus on its mechanism of action, clinical efficacy, and safety profile. By synthesizing recent advances in both domestic and international research, we provide a comprehensive assessment of the benefits and current limitations of infliximab therapy. Evidence indicates that infliximab significantly shortens fever duration, reduces levels of inflammatory biomarkers, and lowers the risk of coronary artery lesions. As understanding of the etiology and immunopathogenesis of KD continues to evolve, infliximab is emerging as a promising therapeutic option for IVIG-resistant cases. This review highlights its potential to inform optimized clinical management strategies and improve long-term outcomes in affected patients.

With advances in perinatal medicine and improved care for extremely preterm infants, the incidence of severe respiratory complications—such as neonatal respiratory distress syndrome (NRDS)—has risen in recent years. Although the diagnosis and management of NRDS in China have made substantial progress, rates of severe complications, including severe intracranial hemorrhage and bronchopulmonary dysplasia (BPD), remain markedly higher than those observed in high-income countries in Europe and North America. Current clinical practice faces several critical challenges, including difficulties in the early differentiation of NRDS from neonatal acute respiratory distress syndrome (NARDS), which may delay timely and appropriate interventions. Furthermore, key therapeutic decisions lack robust evidence or consensus, such as the optimal timing of pulmonary surfactant administration, selection of invasive ventilation strategies, and post-extubation respiratory support approaches—some guidelines exist but are often based on limited or low-quality data. Leveraging national strategic initiatives and multicenter collaborative platforms like the China Neonatal Network (CHNN), Chinese researchers have recently published a series of high-impact studies on NRDS in leading journals including The BMJ, directly addressing these unresolved clinical questions and generating high-quality, context-specific evidence to improve outcomes. This article reviews the current landscape of NRDS management, highlights pivotal recent findings, and outlines future research priorities, in order to enhance the cognitive level of chinical physicians.

Single-sided deafness (SSD) refers to severe to profound sensorineural hearing loss in one ear, with normal or only mildly impaired hearing in the contralateral ear. Although affected children can maintain a certain level of daily communication through the normal-hearing ear, unilateral hearing presents significant limitations in sound localization and speech understanding in noisy environments. Over time, this can lead to delayed language development, reduced learning ability, and social difficulties. However, there is still insufficient awareness of SSD in children, and many children miss the critical window for intervention. This review summarizes the clinical manifestations and various intervention strategies for single-sided deafness in children, aiming to provide a reference for early diagnosis and clinical management.

The incidence of acute pancreatitis (AP) in children has shown a yearly increasing trend. Currently, standardized and definitive diagnosis and treatment protocols for severe acute necrotizing pancreatitis in children are lacking, and clinical practice often relies on adapting adult guidelines. Continuous regional arterial infusion of medication has been applied in the treatment of early-stage acute necrotizing pancreatitis in adults. However, the etiology, pathophysiological processes, and pharmacokinetics of AP differ in children compared to adults, with certain individual variations also present. Consequently, reports on its application specifically in children with AP are scarce. This article presents a case of severe acute necrotizing pancreatitis in a child treated via continuous regional arterial infusion, where medication was administered to a specified site through an indwelling catheter. Furthermore, the applicability of continuous regional arterial infusion therapy in pediatric AP is discussed, aiming to contribute to advancements in the diagnosis and management of AP in children.

Pediatric short bowel syndrome (SBS) is defined as a clinical condition characterized by impaired intestinal absorptive capacity resulting from extensive small bowel resection, bypass, or congenital short bowel, which fails to meet the nutritional requirements for normal growth and development, necessitating parenteral nutrition (PN) support for a duration exceeding 42 days. Owing to significant structural and functional abnormalities of the small intestine, pediatric SBS patients exhibit intestinal microecological dysbiosis, as evidenced by reduced microbial diversity and aberrant metabolic pathways. Key factors influencing the intestinal microbiota profiles in these patients include nutritional support modalities, prophylactic antibiotic administration, anatomical configuration, and growth and developmental status. Maintenance of intestinal microbiota diversity and stability is of paramount importance for enhancing intestinal barrier function, facilitating intestinal adaptation, and mitigating complications in pediatric SBS patients.

Objective To summarize the clinical characteristics, treatment, and prognosis of 65 pediatric cases of Chikungunya fever. Methods Clinical data from 65 pediatric patients with Chikungunya fever at the department of pediatrics between August 2025 and October 2025, were retrospectively analyzed. Results Pediatric Chikungunya cases accounted for 15.9% (65/408) of all hospitalized Chikungunya patients during the study period. The male-to-female ratio was 1:0.80. Age distribution: 0-3 years: 8 cases (12.3%); 3-6 years: 11 cases (16.9%); 6-11 years: 36 cases (55.4%); and 10 cases (15.4%) aged >11 years. The mean age at onset was (7.9±3.4) years, with all cases presenting as mild. Fever was present in 58 cases (89.2%), with a fever peak of (38.8±0.67) °C and fever duration of (3.5±2.2) days. Rashes were present in 59 cases (90.8%), including generalized rashes in 38 cases (64.4%). Skin itching occurred in 35 cases (59.3%), with rashes resolving in (5.5±2.0) days. Arthralgia was reported in 32 cases (49.2%), with pain locations including: ankles in 24 cases (75.0%), knees in 11 cases (34.3%), wrists in 7 cases (21.9%), fingers in 7 cases (21.9%), and heels in 1 case (3.1%). The duration of joint pain was (3.19±1.65) days, with joint swelling occurring in 2 cases (6.2%). Twenty-nine cases (44.6%) concurrently presented with fever, rash, and joint pain. Other clinical manifestations included headache, dizziness, cough, producing sputum, sore throat, and decreased appetite, with one case (1.5%) that developed pneumonia. All children tested negative for dengue virus antigen DEVN-NS1, and a few had elevated inflammatory markers; 2 cases (3.1%) had elevated alanine aminotransferase, and 19 cases (29.2%) had elevated creatine kinase isoenzyme. Most children received symptomatic treatment, and the medications didn’t really affect how long the symptoms lasted. All cases improved or were discharged in good condition during the isolation period. Conclusion Most kids with Chikungunya showed unusual clinical symptoms, with very few severe cases.

The article of "The association of gestational age at term and adverse perinatal outcomes: a retrospective study based on 43502 Chinese pregnant women" by Liu Xiaoyang and co-authors published in this issue, was based on the clinical data of 13,123 singleton full-term and natural delivery mothers from West China Second University Hospital of Sichuan University. It systematically analyzed the impact of different delivery timings within 37⁺⁰ to 41⁺⁶ weeks on neonatal outcomes, and pointed out that 39⁺⁰ to 40⁺⁶ weeks is a "window period" with a relatively low risk of adverse outcomes. This study had a clear research idea and advanced statistical methods, especially in handling the non-linear relationship between gestational age and outcomes, it adopted the restricted cubic spline model, which had high clinical reference value. However, as a retrospective study, it also had certain limitations in causal inference, confounding control, and generalizability. This article, in combination with the review of this research report, makes a summary analysis of the value and limitations of retrospective studies.

Objective To investigate the clinical characteristics of patients with combined oxidative phosphorylation deficiency type 35(COXPD35) caused by TRIT1 gene mutations, in order to enhance clinicians' understanding of this disease. Methods A retrospective analysis was conducted on three patients diagnosed with COXPD35 resulting from compound heterozygous variants in the TRIT1 gene. Clinical data, auxiliary examinations results, genetic findings, and diagnostic courses were summarized and reviewed alongside relevant literature. Results All three patients were male children, with onset ages ranging from 5 months to 2 years and 3 months. They all presented initially with febrile seizures, which were later followed by myoclonic seizures and eventually progressed to refractory epilepsy. Common clinical features included microcephaly, intellectual disability, and pyramidal tract signs. Blood lactate levels were not significantly elevated. Genetic testing identified three TRIT1 mutation sites, among which c.172-2A>T and c.741G>A have not been previously reported in the literature. Conclusions COXPD35 caused by TRIT1 mutations typically begins with febrile seizures, followed by various seizure types, predominantly difficult-to-control myoclonic seizures. Patients may achieve normal developmental milestones during infancy, but experience psychomotor regression after seizure onset. Microcephaly and pyramidal tract signs are common, while lactate levels often remain normal.

Objective To understand the influenza vaccination situation of children under 16 years old in Shanghai and parents' awareness of influenza and influenza vaccines, analyze the influencing factors of influenza vaccination, and provide a reference basis for improving the influenza vaccination rate and preventing the prevalence of influenza among children. Methods A total of 527 subjects from Yangpu District and Baoshan District in Shanghai were selected from September 2024 to February 2025, by convenience sampling for a questionnaire survey. The questionnaire included an influenza vaccination status survey and a self-made survey on knowledge about influenza and the influenza vaccine. Multivariate logistic regression was used to analyze factors associated with childhood influenza vaccination. Results A total of 527 questionnaires were distributed, 525 were collected, and 506 were valid, yielding an effective rate of 96.4%. Among the 506 children, 244 (48.2%) were boys and 262 (51.8%) were girls, with a median age of 8 (5-11) years. A total of 287 children (56.7%) had been vaccinated against influenza, of whom 133 had received at least one dose, 76 were vaccinated only during the flu season, and 78 were vaccinated annually; 219 children (43.3%) had never been vaccinated. The main reason why parents are willing to have their children vaccinated against the flu is to prevent flu infection, while concerns about vaccine safety were the main reasons parents were unwilling to vaccinate their children or reluctant to vaccinate again. Multivariate logistic regression showed that history of preterm birth (OR=0.38, 95% CI: 0.18-0.83), parents working in government agencies, enterprises, or institutions (OR=2.03, 95% CI: 1.06-3.86), parents engaged in social production and living services (OR=3.22, 95% CI: 1.40-7.40), and the influenza knowledge (OR=1.24, 95% CI: 1.08-1.44) were all correlated with childhood influenza vaccination status (P<0.05). Conclusions The childhood influenza vaccination rate still needs improvement, especially for special groups such as preterm infants; vaccine safety remains a major concern for parents.

Objective To investigate the application of drug-induced sleep endoscopy (DISE) in pediatric obstructive sleep apnea (OSA). Methods The clinical data of children diagnosed with OSA by polysomnography (PSG) and DISE examination were retrospectively analyzed from June 1, 2023 to June 1, 2024 in the Department of Otorhinolaryngology. The NAVOTEL scoring system was used to score DISE, and the correlation between DISE score and apnea-hypopnea index (AHI) and minimum arterial oxygen saturation (SaO₂) was analyzed. Results DISE tests were performed in 163 children (114 boys and 49 girls), and the median age was 7.0 (5.0-9.0) years. The most common obstructive site was the velopharynx (137 cases, 84.0%), followed by the lateral oropharynx (124 cases, 76.1%), nasal cavity (95 cases, 58.3%), adenoid (92 cases, 56.4%), base of the tongue (52 cases, 31.9%), epiglottis (30 cases, 18.4%), and larynx (3 cases, 1.8%). The most common obstruction site in children of different age groups (≤5 years old, 6~10 years old and 11~18 years old) was velopharynx, accounting for 81.0%, 86.2% and 83.3%, respectively. Spearman rank correlation analysis showed that the total NAVOTEL score of 163 children was significantly positively correlated with AHI (r_s=0.48, P<0.01), and significantly negatively correlated with the lowest SaO₂ (r_s=-0.35, P<0.01). The NAVOTEL score of palatopharyngeal obstruction was positively correlated with AHI (r_s=0.33, P<0.01) and negatively correlated with the lowest SaO₂ (r_s=-0.48, P<0.01). Conclusions DISE can be used to evaluate the site and severity of upper airway obstruction in children with OSA, and its score is correlated with AHI and minimum SaO₂, which can cooperate with PSG to improve the diagnosis and treatment level of OSA in children.

Atopic dermatitis (AD), a chronic and recurrent inflammatory skin disorder, has witnessed a sustained global and domestic upward trend in incidence since the 21st century, emerging as a critical public health concern. The comprehensive management framework for AD encompasses two core pillars: pharmacotherapy and non-pharmacological interventions. Despite the expanding armamentarium of AD pharmacotherapies in recent years, the intricate pathogenesis and marked clinical heterogeneity of AD render monotherapy insufficient for optimal disease control. Non-pharmacological interventions thus remain an indispensable cornerstone in AD prevention and management. However, existing domestic and international AD treatment consensus and guidelines are predominantly structured around pharmacotherapy, with a notable paucity of systematic attention and integration of non-pharmacological strategies. Against this backdrop, the Children’s Allergy Committee of the China Maternal and Child Health Association, the Dermatology and Venereology Group of Pediatric Branch Society, Chinese Mechical Association and Editorial Board of the Journal of Clinical Pediatrics convened 33 dermatology experts from 30 medical institutions to formulate this consensus, drawing on the latest domestic and international research advances and clinical practice experience. This consensus systematically delineates non-pharmacological management strategies for AD, with core recommendations including avoidance of triggering factors, standardized skin care to maintain skin barrier homeostasis, and implementation of health education and psychological support. It emphasizes the pivotal role of non-pharmacological interventions as foundational measures in AD management, aiming to reduce disease recurrence and enhance the quality of life of affected children. Additionally, it clarifies the applicable scenarios and key implementation points for each measure, providing systematic and practical guidance for clinicians, caregivers of affected children, and health managers.

Inflammatory bowel disease (IBD) is a chronic, recurrent inflammatory disease involving the entire gastrointestinal tract. Nutrient deficiencies are common in IBD patients, and zinc, as an important nutrient for the body to maintain the physiological cellular functions, is widely recognized as beneficial in the treatment of many gastrointestinal diseases. In recent years, research on the mechanism of zinc and IBD has been emerging continuously. More and more studies have revealed that zinc deficiency is common among children with IBD. Zinc deficiency is associated with disease recurrence in children with IBD, as well as the occurrence of complications such as malnutrition, growth retardation, and anemia. This article will review the progress of basic and clinical researches related to zinc and IBD, providing references for the mechanism research and optimized treatment of IBD.

Takotsubo cardiomyopathy in children is an acute, reversible form of cardiomyopathy characterized by transient left ventricular systolic dysfunction. It exhibits distinct epidemiological, etiological, and clinical features compared to the adult population, with differences also evident in management strategies and prognostic outcomes. Although the incidence in pediatric patients is low, the condition is associated with substantial mortality. Neurological disorders are frequently identified as precipitating factors in this age group. Catecholamine excess is considered a central mechanism in the pathophysiology of the disease. Clinical presentation may mimic that of fulminant myocarditis, dilated cardiomyopathy, or sepsis-induced myocardial dysfunction, posing significant diagnostic challenges. Accurate differentiation among these entities is critical for optimizing patient outcomes. Echocardiography serves as a pivotal diagnostic tool, enabling real-time evaluation of regional wall motion abnormalities and ventricular morphology essential for differential diagnosis. This article aims to review key aspects of Takotsubo cardiomyopathy in children, clarify current understanding of its clinical spectrum, and enhance awareness and diagnostic precision among pediatric clinicians.

Objective This study aimed to analyze the risk factors for extrauterine growth restriction (EUGR) in premature infants with necrotizing enterocolitis (NEC) after surgery and to explore preventive measures. Methods A total of 72 premature infants with NEC who underwent surgical treatment and were hospitalized in the neonatal department from 2018 to 2024 were selected. They were divided into EUGR and non-EUGR groups based on the relationship between their weight at discharge and the average growth indicators for corrected gestational age. Results The incidence of EUGR in NEC premature infants after surgery was 65.28%, with a severe EUGR incidence of 33.33%. Univariate analysis found that birth gestational age, birth weight, 1-minute Apgar score, weight at the onset of NEC, proportion of oxygen therapy methods, length of intestine resected during surgery, duration of postoperative intravenous nutrition, and the maximum amount of amino acids in intravenous nutrition within one week after surgery were statistically significant factors associated with the occurrence of EUGR. Multivariate logistic regression analysis showed that a high 1-minute Apgar score and a larger weight at the onset of NEC were protective factors for EUGR, while a longer length of intestine resected during surgery was a risk factor for EUGR. Conclusion Clinical physicians should pay attention to premature infants with low Apgar scores at birth and low weight at the onset of NEC, reduce the length of intestine resected during surgery, strengthen perioperative nutritional assessment, and adjust nutritional support plans individually to reduce the incidence of EUGR.

Objective To summarize the clinical characteristics of five children with Schimke immunoosseous dysplasia (SIOD) and analyze the variants in the SMARCAL1 gene, aiming to enhance the understanding of SIOD and underscore the significance of genetic diagnosis. Methods Clinical data and genetic testing results were retrospectively collected from five SIOD patients who presented to the Nephrology Department between 2016 and 2024. Results Patients 1, 2, and 3 died after 1 year, 1 year and 3 months, and 8 months of follow-up, respectively. Patient 4 exhibited progressive proteinuria during 9 months of follow-up but maintained normal renal function. Patient 5 was followed for 9 years; bilateral hip dislocation occurred at the age of 18, for which hip replacement surgery was performed. At 19 years of age, he presented with short stature, stable urinary protein levels, and preserved renal function. All patients underwent sequencing of the SMARCAL1 gene. No pathogenic variant was identified in patient 1. Patient 2 was compound heterozygous for the splice variants c.1334+1G>A and c.1335-2A>C. Patient 3 was homozygous for the missense variant c.2425G>A (p.G809R). Patient 4 was homozygous for the frameshift variant c.1071delT (p.F357LfsTer26). Patient 5 was compound heterozygous for the variants c.445C>T (p.Q149X) and c.1933C>T (p.R645C). Among these, c.1334+1G>A, c.2425G>A, c.445C>T, and c.1933C>T are known pathogenic or likely pathogenic variants, while c.1335-2A>C and c.1071delT represent novel variants not previously reported in the literature. Conclusions SIOD presents with characteristic multisystem clinical features, yet exhibits marked phenotypic variability. The genotype-phenotype correlation remains poorly defined. Early diagnosis enables avoidance of unnecessary immunosuppressive therapies, including corticosteroids, and supports timely symptomatic management. Despite advances in supportive care, the overall prognosis remains poor.

Vancomycin is a key glycopeptide antibiotic for the treatment of Gram-positive bacterial infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). However, significant pharmacokinetic (PK) heterogeneity in pediatric patients makes it difficult for traditional dosing regimens to balance efficacy and nephrotoxicity risk. Model-Informed precision dosing (MIPD) strategies provide a novel approach for individualized, AUC_0-24h/MIC-guided therapy by integrating quantitative pharmacological models (such as PPK, PBPK, and machine learning models) with individual patient data. Compared to conventional TDM, MIPD strategies significantly enhance the attainment rate of pharmacokinetic/pharmacodynamic (PK/PD) target concentrations (e.g., AUC), shorten the time to target attainment, especially in neonates and critically ill patients, and effectively reduce the risk of nephrotoxicity. This review summarizes the clinical value of MIPD-guided vancomycin application in neonates, critically ill children, and children with special disease conditions, intending to provide a reference for clinical practice.

Objective To investigate the clinical phenotypes, pathological characteristics, genetic variants, and treatment outcomes in children with C3 glomerulopathy (C3G), and to provide evidence for precise diagnosis and management. Methods Clinical, pathological, and genetic data from four pediatric patients diagnosed with C3G at the Department of Nephrology between July 2021 and March 2024 were retrospectively analyzed. Additionally, published cases of C3G in Chinese children from both domestic and international literature were systematically reviewed and summarized to contextualize our findings. Results Four pediatric patients with C3G were included in the study, comprising two boys and two girls aged 10 to 12 years. All presented with nephrotic syndrome and hematuria, and three exhibited renal insufficiency at initial presentation. Laboratory evaluation revealed reduced serum complement C3 levels (0.9-1.8 g/L) in all patients, decreased C4 in two, and elevated membrane attack complex (C5b-9) in all. Renal histopathology demonstrated diffuse mesangial cell and matrix proliferation in all cases. Immunofluorescence showed predominant C3 deposition, and electron microscopy confirmed a diagnosis of C3 glomerulonephritis (C3GN) in three patients and dense deposit disease (DDD) in one. Whole exome sequencing was performed in three patients, identifying a single missense variant in the C3 gene (c.4887G>C, p.Glu1629Asp) inherited from a phenotypically healthy mother; this variant was classified as having uncertain clinical significance according to ACMG criteria. All patients received immunosuppressive therapy combining glucocorticoids with other agents; eculizumab was added in two refractory cases. With follow-up of 3 to 8 months, all three patients with initial renal insufficiency achieved normalization of renal function, and proteinuria decreased in all four. Two patients attained complete remission, one achieved partial remission, and one showed no response. Conclusions Pediatric C3G predominantly manifests as nephrotic syndrome with persistent hypocomplementemia. Key pathological features include diffuse mesangial proliferation and dominant C3 deposition on immunofluorescence. Genetic variants are infrequently detected, suggesting potential non-monogenic mechanisms in many cases. Immunosuppressive regimens based on glucocorticoids remain the mainstay of therapy, while eculizumab may offer therapeutic benefit in selected refractory cases. Early integration of renal biopsy, complement profiling, and genetic analysis facilitates timely and accurate diagnosis. Long-term outcomes require further assessment through extended follow-up and larger cohort studies.

Objective To explore the changing trend of the incidence of singleton small vulnerable neonates (SVN) and its influencing factors, and to analyze the association between parental factors and SVN. Methods A retrospective cohort study was conducted, recruiting 13,020 pregnant women who established prenatal records before 14 weeks of gestation between January 2019 and December 2023 and received standardized antenatal care until delivery. Based on neonatal outcomes, those meeting the SVN criteria were assigned to the SVN group, with the remaining assigned to the control group. SVN encompassed three phenotypes: preterm birth (PT), small for gestational age (SGA), and low birth weight (LBW). Baseline maternal characteristics, pregnancy complications, paternal anthropometric parameters, and pregnancy outcomes were compared between the two groups. Logistic regression analysis was employed to identify parental influencing factors for SVN. Results During the study period, the overall SVN incidence was 12.73% (1658/13020), comprising PT (3.16%, 412/13020), LBW (2.53%, 329/13020), and SGA (9.57%, 1246/13020). The incidence rates of PT and LBW decreased by 49.12% and 29.73% respectively in 2023 compared with 2019, but the incidence rate of SGA increased by 37.04% in 2023 compared with 2019. Among all pregnant women, the Zhuang ethnic group accounted for 37.55% of all ethnic groups, those with a bachelor's degree or above accounted for 82.33%, and multiparous women accounted for 48.21%. A total of 719 pregnant women (5.52%) had a history of diseases before pregnancy, and abnormal thyroid function was the most common (4.21%, 548/13020). A total of 3,582 pregnant women underwent pre-pregnancy genetic testing related to thalassemia, and 1,864 cases were detected positive (detection rate 52.04%), among which the detection rate of alpha thalassemia minor was the highest (674 cases, 18.82%). The proportion of fathers aged 35 or above was 37.08%, while the proportion of those who were overweight or obese (BMI ≥ 24 kg/m²) was 50.53%, and the proportion of those who were underweight was only 2.73%. Multivariate logistic regression analysis revealed that maternal pre-pregnancy overweight, multiparity, and AB blood type were protective factors for SVN (P<0.05); whereas maternal pre-pregnancy underweight, pregnancy complicated by polycystic ovarian syndrome (PCOS), and gestational hypertensive disorders (HDP) were identified as risk factors for SVN (P<0.05). Neonates in the SVN group exhibited significantly smaller gestational age, shorter body length, lower birth weight, and higher rates of neonatal asphyxia and mortality, with statistically significant differences (P<0.05). Conclusions The three phenotypic subtypes of SVN exhibited divergent incidence trends over the five-year period, with the incidence of SGA demonstrating an upward trajectory warranting focused attention. The occurrence of SVN showed strong associations with maternal pre-pregnancy nutritional status, comorbid PCOS, and HDP, highlighting the necessity for enhancing antenatal care and preventing HDP during pregnancy. This study did not identify significant impacts of paternal age or BMI on SVN.

Neonatal acute kidney injury (AKI) predominantly occurs in critically ill infants, with an incidence rate of approximately 30% in neonatal intensive care units. It is associated with a significantly increased risk of mortality and a high propensity to progress to chronic kidney disease. This review mainly summarizes recent advances in the risk factors and emerging biomarkers for neonatal AKI. Besides, this review summarizes the clinical characteristics associated with different risk factors and the sensitivity and specificity of corresponding biomarkers. The occurrence of neonatal acute kidney injury is characterized by multifactorial interactions, and the pathological mechanisms vary depending on the underlying risk factors. The use of specific biomarkers facilitates early diagnosis and precise intervention. Combined monitoring of risk factors and biomarker levels enables early identification of acute kidney injury, guiding individualized treatment and prognosis assessment.

In May 2023, a series of thematic articles published in The Lancet introduced a novel concept—small vulnerable neonates (SVN) which categorizes preterm, small for gestational age (SGA), and low birth weight (LBW) neonates under a unified framework. Preterm birth, SGA, and LBW have their respective definitions and have long been considered distinct populations in different clinical practices. However, there is considerable overlap among these three categories, and their pathophysiological mechanisms interact. Isolated definitions fail to capture the full picture of these neonates, potentially leading to an underestimation of the number of high-risk newborns and affecting clinical decision-making. The introduction of the SVN concept aims to increase attention to this group through a new perspective, comprehensively reflect the overall issues of high-risk newborns, and promote the health and sustainable development of perinatal medicine, neonatology, pediatrics, and even society as a whole. In the future, SVN is poised to become a core concept in disciplinary advancement and clinical practice. Therefore, this review elaborates on the background of the SVN concept, its implications for epidemiological research, as well as prevention and intervention strategies, to help clinicians and medical researchers understand this new concept and appreciate the rationale behind SVN and its significance for future development.

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder defined by developmentally inappropriate inattention and/or hyperactivity-impulsivity that impairs daily functioning. Mood disorders are highly prevalent comorbidities in ADHD, exacerbating treatment complexity and exerting adverse effects on core symptom severity and long-term prognosis. This review synthesizes the latest research advances in the epidemiology, pathophysiological mechanisms, assessment-diagnostic strategies, and therapeutic interventions for ADHD comorbid with mood disorders, aiming to provide an evidence-based theoretical foundation for comprehensive clinical diagnosis and integrated management.