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世界儿科杂志（英文版）
世界儿科杂志（英文版）

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世界儿科杂志（英文版）/Journal World Journal of PediatricsCSCDCSTPCD北大核心SCI
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    Early diagnosis and management of neonatal sepsis:a perspective

    Li-Zhong Du
    303-306页
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    Severe pediatric COVID-19:a review from the clinical and immunopathophysiological perspectives

    Yi-Kan SunCan WangPei-Quan LinLei Hu...
    307-324页
    查看更多>>摘要：Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further atten-tion from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mecha-nisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included"COVID-19 in children","severe pediatric COVID-19",and"critical illness in children with COVID-19".Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvac-cinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type Ⅰ interferon and inflammasome pathways,whose dysregu-lation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
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    Treatment of multisystem inflammatory syndrome in children

    Tong TongYi-Hua JinMin WangFang-Qi Gong...
    325-339页
    查看更多>>摘要：Background Multisystem inflammatory syndrome in children(MIS-C),a relatively uncommon but severe pediatric compli-cation,is associated with coronavirus disease 2019(COVID-19).A variety of treatment approaches,including intravenous immunoglobulins(IVIGs),glucocorticoids(GCs)and biologic agents,such as anakinra and infliximab,have been described for the management of COVID-19-related MIS-C.Anticoagulant therapy is also important.However,a well-developed treatment system has not been established,and many issues remain controversial.Several recently published articles related to the treatment of MIS-C have been released.Hence,in this review,we identified relevant articles published recently and summarized the treatment of MIS-C more comprehensively and systematically.Data sources We reviewed the literature on the treatment of MIS-C through 20 September 2023.The PubMed/Medline,Web of Science,EMBASE,and Cochrane Library databases were searched with the combination of the terms"multisystem inflammatory syndrome","MIS-C","PIMS-TS","therapy","treatment","drug","IVIG","GCs","intravenous immuno-globulin","corticosteroids","biological agent",and"aspirin".Results The severity of MIS-C varies,and different treatment schemes should be used according to the specific condition.Ongoing research and data collection are vital to better understand the pathophysiology and optimal management of MIS-C.Conclusions MIS-C is a disease involving multiple systems and has great heterogeneity.With the accumulation of additional experience,we have garnered fresh insights into its treatment strategies.However,there remains a critical need for greater standardization in treatment protocols,alongside the pressing necessity for more robust and meticulously conducted studies to deepen our understanding of these protocols.
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    • NETL
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    Sex differences in the risk of retinopathy of prematurity:a systematic review,frequentist and Bayesian meta-analysis,and meta-regression

    Tamara M.HundscheidSilvia GuldenMohamad F.AlmutairiFranti?ek Barto?...
    340-352页
    查看更多>>摘要：Background Retinopathy of prematurity(ROP)is generally considered to be more frequent in males than in females.However,it is not known whether sex differences in ROP affect all degrees of the condition,are global and have changed as neonatology has developed.We aimed to conduct a systematic review and meta-analysis of studies addressing sex differ-ences in the risk of developing ROP.Methods PubMed/MEDLINE and Embase databases were searched.The frequentist,random-effects risk ratio(RR)and 95％confidence interval(CI)were calculated.Bayesian model averaged(BMA)meta-analysis was used to calculate the Bayes factors(BFs).The BF10 is the ratio of the probability of the data under the alternative hypothesis(H1)over the probability of the data under the null hypothesis(H0).Results We included 205 studies(867,252 infants).Frequentist meta-analysis showed a positive association between male sex and severe ROP(113 studies,RR=1.14,95％CI=1.07-1.22)but no association with any ROP(144 studies,RR=1.00,95％CI=0.96-1.03).BMA showed extreme evidence in favor of H1 for severe ROP(BF10=71,174)and strong evidence in favor of H0 for any ROP(BF10=0.05).The association between male sex and severe ROP remained stable over time and was present only in cohorts from countries with a high or high-middle sociodemographic index.Conclusions Our study confirms the presence of a male disadvantage in severe ROP but not in less severe forms of the dis-ease.There are variations in the sex differences in ROP,depending on geographical location and sociodemographic level of the countries.
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    • NETL
    • NSTL
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    Superior antibody and membrane protein-specific T-cell responses to CoronaVac by intradermal versus intramuscular routes in adolescents

    Jaime S.Rosa DuqueSamuel M.S.ChengCarolyn A.CohenDaniel Leung...
    353-370页
    查看更多>>摘要：Background Optimising the immunogenicity of COVID-19 vaccines to improve their protection against disease is neces-sary.Fractional dosing by intradermal(ID)administration has been shown to be equally immunogenic as intramuscular(IM)administration for several vaccines,but the immunogenicity of ID inactivated whole severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)at the full dose is unknown.This study(NCT04800133)investigated the superiority of antibody and T-cell responses of full-dose CoronaVac by ID over IM administration in adolescents.Methods Participants aged 11-17 years received two doses of IM or ID vaccine,followed by the 3rd dose 13-42 days later.Humoral and cellular immunogenicity outcomes were measured post-dose 2(IM-CC versus ID-CC)and post-dose 3(IM-CCC versus ID-CCC).Doses 2 and 3 were administered to 173 and 104 adolescents,respectively.Results Spike protein(S)immunoglobulin G(IgG),S-receptor-binding domain(RBD)IgG,S IgG Fcγ receptor Ⅲa(FcγRⅢa)-binding,SNM[sum of individual(S),nucleocapsid protein(N),and membrane protein(M)peptide pool]-specific interleukin-2(IL-2)+CD4+,SNM-specific IL-2+CD8+,S-specific IL-2+CD8+,N-specific IL-2+CD4+,N-specific IL-2+CD8+and M-specific IL-2+CD4+responses fulfilled the superior and non-inferior criteria for ID-CC compared to IM-CC,whereas IgG avidity was inferior.For ID-CCC,S-RBD IgG,surrogate virus neutralisation test,90％plaque reduction neutralisation titre(PRNT90),PRNT50,S IgG avidity,S IgG FcγRⅢa-binding,M-specific IL-2+CD4+,interferon-γ+CD8+and IL-2+CD8+responses were superior and non-inferior to IM-CCC.The estimated vaccine efficacies were 49％,52％,66％and 79％for IM-CC,ID-CC,IM-CCC and ID-CCC,respectively.The ID groups reported more local,mild adverse reactions.Conclusion This is the first study to demonstrate superior antibody and M-specific T-cell responses by ID inactivated SARS-CoV-2 vaccination and serves as the basis for future research to improve the immunogenicity of inactivated vaccines.
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    • NETL
    • NSTL
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    Unveiling the silent crisis:global burden of suicide-related deaths among children aged 10-14 years

    Irmina Maria MichalekPawel KoczkodajMarzena MichalekFlorentino Luciano Caetano dos Santos...
    371-391页
    查看更多>>摘要：Background The rise in suicides among children aged 10-14 years demands urgent attention globally.This study aims to assess the global burden of suicide-related deaths in this age group from 1990 to 2019,considering factors such as sex,geography,and sociodemographics,to inform prevention strategies and interventions.Methods The data from Global Burden of Disease 2019,encompassing 204 countries and territories,were analyzed to investigate deaths and years of life lost(YLLs)due to suicide among children aged 10-14 years.Statistical analyses,includ-ing mortality rates,YLLs,and the sociodemographic index(SDI),were conducted using standardized tools.Results In 2019,a total of 8327[95％uncertainty interval(UI)=7073-9685]children aged 10-14 years died globally due to suicide,with a mortality rate of 1.30(95％UI=1.10-1.51)per 100,000.The rates varied across countries/territories rang-ing between 0.05(95％UI=0.02-0.10)in South Africa and 7.49(95％UI=5.13-10.57)in Greenland.The contribution of suicide-related deaths to all-cause mortality ranged from 0.07％(95％UI=0.04％-0.15％)in South Africa to 33.02％(95％UI=24.36％-4 1.53％)in Greenland.Worldwide,there were approximately 636,196(95％UI=540,383-740,009)YLLs due to suicide,with a rate of 99.07(95％UI=84.15-115.23)per 100,000.The association between SDI and suicide-related deaths was evident,with higher contributions observed in countries with higher SDI.Conclusions This study reveals a concerning global burden of suicide-related deaths among children aged 10-14 years.Despite progress in reducing mortality rates,suicide remains a significant issue.While overall rates have declined,the per-centage of deaths caused by suicide in this age group is increasing.
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    • NETL
    • NSTL
    • 万方数据

    Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

    Li-Wang GaoYi-Wen HuangHong ChengXi Wang...
    392-403页
    查看更多>>摘要：Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8-18 years from the 2013-2015 China Child and Adolescent Cardiovascular Health study and the 2011-2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5％in China(CN)and 4.6％in the United States(US),whereas the obesity prevalence was 7.4％and 18.6％,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95％CI=0.78-0.88;US:OR=0.72,95％CI=0.64-0.81);ISH(CN:OR=0.87,95％CI=0.80-0.94;US:OR=0.71.95％CI=0.62-0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN was higher in the US than in CN.Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations.Optimizing body composition positively influences blood pressure in children and adolescents,particularly those with high-level physical activity.
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    • NETL
    • NSTL
    • 万方数据

    Height and body mass index trajectories from 1975 to 2015 and prevalence of stunting,underweight and obesity in 2016 among children in Chinese cities:findings from five rounds of a national survey

    Xin-Nan ZongHui LiYa-Qin Zhang
    404-412页
    查看更多>>摘要：Background A more comprehensive assessment of growth and nutrition in children is required in China due to rapid socio-economic processes.We aimed to investigate height and body mass index(BMI)trajectories from 1975 to 2015 and the prevalence of stunting and obesity in 2016 among children in Chinese cities.Methods A total of 904,263 children from birth to 6.9 years were collected from a series of nationally representative sur-veys in China.Height and BMI trajectories and prevalence of stunting,underweight,overweight and obesity were assessed.Results The average height level of Chinese urban children under 7 years presented a positive secular trend from 1975 to 2015;however,a slowing tendency occurred in 2005-2015.An apparent increase was observed at the 5th,50th and 95th percentiles of BMI in urban children aged 3 years and older,with a more prominent increase at the 95th percentile.The total prevalence of stunting and underweight under 7 years was 1.4％and 2.0％,respectively.The total prevalence of overweight and obesity under 7 years was 12.6％and 4.3％,respectively,with 12.7％and 4.9％for boys,12.6％and 3.6％for girls,12.1％and 4.0％in urban areas and 13.1％and 4.5％in suburban rural areas.Conclusions The average height level of Chinese urban children has reached World Health Organization child growth stand-ards since 2005 and presented a slowing tendency in secular trend in 2005-2015.More attention and efforts and public health interventions should be urgently made to combat overweight and obesity among preschool children.
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    • NETL
    • NSTL
    • 万方数据

    Development and validation of a novel non-invasive test for diagnosing nonalcoholic fatty liver disease in Chinese children

    Zhe-Wen QinQian-Nan RenHong-Xi ZhangYa-Ru Liu...
    413-421页
    查看更多>>摘要：Background With the exploding prevalence of obesity,many children are at risk of developing nonalcoholic fatty liver dis-ease.Using anthropometric and laboratory parameters,our study aimed to develop a model to quantitatively evaluate liver fat content(LFC)in children with obesity.Methods A well-characterized cohort of 181 children between 5 and 16 years of age were recruited to the study in the Endo-crinology Department as the derivation cohort.The external validation cohort comprised 77 children.The assessment of liver fat content was performed using proton magnetic resonance spectroscopy.Anthropometry and laboratory metrics were measured in all subjects.B-ultrasound examination was carried out in the external validation cohort.The Kruskal-Wallis test,Spearman bivariate correlation analyses,univariable linear regressions and multivariable linear regression were used to build the optimal predictive model.Results The model was based on indicators including alanine aminotransferase,homeostasis model assessment of insulin resistance,triglycerides,waist circumference and Tanner stage.The adjusted R2 of the model was 0.589,which presented high sensitivity and specificity both in internal[sensitivity of 0.824,specificity of 0.900,area under curve(AUC)of 0.900 with a 95％confidence interval:0.783-1.000]and external validation(sensitivity of 0.918 and specificity of 0.821,AUC of 0.901 with a 95％confidence interval:0.818-0.984).Conclusions Our model based on five clinical indicators was simple,non-invasive,and inexpensive;it had high sensitivity and specificity in predicting LFC in children.Thus,it may be useful for identifying children with obesity who are at risk for developing nonalcoholic fatty liver disease.
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    • NETL
    • NSTL
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    Clinical and molecular characterization of 10 Chinese children with congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency

    Wen-Li LuXiao-Yu MaJiao ZhangJun-Qi Wang...
    422-433页
    查看更多>>摘要：Background The clinical manifestations of nonclassical 11beta-hydroxylase deficiency are very similar to those of non-classical 21-hydroxylase deficiency.For this study,we investigated the relationship between the clinical and molecular fea-tures of congenital adrenal hyperplasia caused by 11beta-hydroxylase deficiency and reviewed the related literature,which are expected to provide assistance for the clinical diagnosis and analysis of congenital adrenal hyperplasia.Methods Clinical data for 10 Chinese patients diagnosed with congenital adrenal hyperplasia in our hospital from 2018 to 2022 were retrospectively analyzed.We examined the effects of gene mutations on protease activity and constructed three-dimensional structure prediction models of proteins.Results We describe 10 patients with 11 beta-hydroxylase gene mutations(n=5,46,XY;n=5,46,XX),with 10 novel muta-tions were reported.Female patients received treatment at an early stage,with an average age of 2.08±1.66 years,whereas male patients received treatment significantly later,at an average age of 9.77±3.62 years.The most common CYP11B1 pathogenic variant in the Chinese population was found to be c.1360C＞T.All mutations lead to spatial conformational changes that affect protein stability.Conclusions Our study found that there was no significant correlation between each specific mutation and the severity of clinical manifestations.Different patients with the same gene pathogenic variant may have mild or severe clinical manifes-tations.The correlation between genotype and phenotype needs further study.Three-dimensional protein simulations may provide additional support for the physiopathological mechanism of genetic mutations.
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    • NETL
    • NSTL
    • 万方数据