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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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    Exclusive enteral nutrition for treating pediatric Crohn's disease

    Yu YuJie Chen
    869-871页
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    Global public concern of childhood and adolescence suicide:a new perspective and new strategies for suicide prevention in the post-pandemic era

    Soeun KimJaeyu ParkHyeri LeeHayeon Lee...
    872-900页
    查看更多>>摘要：Background Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years.Familial,social,psychological,and behavioral factors play important roles in suicide risk.As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people,there is a need to understand the current status of suicide in adolescents,including its epidemiology,associ-ated factors,the influence of the pandemic,and management initiatives.Data sources We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2019.The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization(WHO)regions.Additionally,we utilized electronic databases,including PubMed/MEDLINE and Scopus,and employed various combina-tions of terms such as"suicide","adolescents","youth","children","risk factors","COVID-19 pandemic","prevention",and"intervention"to provide a narrative review on suicide within the pediatric population in the post-pandemic era.Results Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019,it remains high.The mortality rates from suicide by firearms or any other specified means were both greater in males.Additionally,Southeast Asia had the highest suicide rate among the six WHO regions.The COVID-19 pandemic seems to contribute to suicide risk in young people;thus,there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic.Conclusions The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic,risk factors,and intervention strategies.Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era,further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era.It is necessary to identify effective prevention strategies targeting young people,particularly those at high risk,and successful treatment for individuals already manifesting suicidal behaviors.Care for suicidal children and adolescents should be improved with parental,school,community,and clinical involvement.
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    Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

    Ying-Shuo WangYun-Lian ZhouGuan-Nan BaiShu-Xian Li...
    901-914页
    查看更多>>摘要：Background Mycoplasma pneumoniae(M.pneumoniae)is a significant contributor to community-acquired pneumonia among children.Since 1968,when a strain of M.pneumoniae resistant to macrolide antibiotics was initially reported in Japan,macrolide-resistant M.pneumoniae(MRMP)has been documented in many countries worldwide,with varying incidence rates.MRMP infections lead to a poor response to macrolide antibiotics,frequently resulting in prolonged fever,extended antibiotic treatment,increased hospitalization,intensive care unit admissions,and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics.Since 2000,the global incidence of MRMP has gradually increased,especially in East Asia,which has posed a serious challenge to the treatment of M.pneumoniae infections in children and attracted widespread attention from pediatricians.However,there is still no global consensus on the diagnosis and treatment of MRMP in children.Methods We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia,based on evidence collection.The evidence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,CNKI,Medline,and the Cochrane Library.We used variations in terms for"macrolide-resistant","Mycoplasma pneumoniae","MP","M.pneumoniae","pneumonia","MRMP","lower respiratory tract infection","Mycoplasma pneumoniae infection","children",and"pediatric".Results Epidemiology,pathogenesis,clinical manifestations,early identification,laboratory examination,principles of anti-biotic use,application of glucocorticoids and intravenous immunoglobulin,and precautions for bronchoscopy are highlighted.Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens.Although the resistance rate to macrolide remains high,it is fortunate that M.pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones,making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics.Conclusions This consensus,based on international and national scientific evidence,provides scientific guidance for the diagnosis and treatment of MRMP in children.Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development.Additionally,developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.
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    • NSTL
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    Feasibility,efficacy,and safety of animal-assisted activities with visiting dogs in inpatient pediatric oncology

    Katja SteffMaximilian GrasemannKira OstermannSarah Christina Goretzki...
    915-924页
    查看更多>>摘要：Background Childhood cancer entails a heavy burden for patients and their families.Recent advances in overall survival rates have increasingly brought long-term quality of life into focus.Animal-assisted activities(AAAs)have long been hypothesized to alleviate the burden on pediatric patients and their peers in the hospital setting.However,their use in inpatient pediatric oncology has been a sensitive issue mainly due to the fear of infections,resulting in a lack of studies.This study presents data on the feasibility,safety,and efficacy of AAAs from a single German center.Methods Between 2018 and 2022,60 patients(median age=10.3 years)diagnosed with malignancy and undergoing treat-ment were visited by an intervention dog(total visits=100).Patients were screened for infections as per hospital policy,with additional microbiological testing performed based on symptoms.The dog was screened for human pathogens and zoonoses.Microbial data and hospitalizations were analyzed from two months prior to the first visit until two months after the last visit.Acceptance of being in the hospital,both with and without planned animal-assisted interventions and pre-and post-intervention state stress,were measured using a validated visual analogue scale(0-10).Results Patients benefited from AAAs,showing increased acceptance of being in the hospital(median:7.25 vs.4.50,P＜0.001)and decreased median state stress ratings one hour after the visit compared to one hour before the visit(1.00 vs.4.25,P＜0.001).The intervention did not result in an increased number of infections or unplanned hospitalizations,and no zoonoses were detected.All microbial screening tests of the dog were negative.Conclusions AAAs with visiting dogs in inpatient pediatric oncology are feasible and safe.Although they hold promise for enhancing patients'well-being,further prospective studies are needed.
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    Remote ischemic conditioning prevents ischemic cerebrovascular events in children with moyamoya disease:a randomized controlled trial

    Shuang-Feng HuangJia-Li XuChang-Hong RenNathan Sim...
    925-934页
    查看更多>>摘要：Background Moyamoya disease(MMD)is a significant cause of childhood stroke and transient ischemic attacks(TIAs).This study aimed to assess the safety and efficacy of remote ischemic conditioning(RIC)in children with MMD.Methods In a single-center pilot study,46 MMD patients aged 4 to 14 years,with no history of reconstructive surgery,were randomly assigned to receive either RIC or sham RIC treatment twice daily for a year.The primary outcome measured was the cumulative incidence of major adverse cerebrovascular events(MACEs).Secondary outcomes included ischemic stroke,recurrent TIA,hemorrhagic stroke,revascularization rates,and clinical improvement assessed using the patient global impres-sion of change(PGIC)scale during follow-up.RIC-related adverse events were also recorded,and cerebral hemodynamics were evaluated using transcranial Doppler.Results All 46 patients completed the final follow-up(23 each in the RIC and sham RIC groups).No severe adverse events associated with RIC were observed.Kaplan-Meier analysis indicated a significant reduction in MACEs frequency after RIC treatment[log-rank test(Mantel-Cox),P=0.021].At 3-year follow-up,two(4.35％)patients had an ischemic stroke,four(8.70％)experienced TIAs,and two(4.35％)underwent revascularization as the qualifying MACEs.The clinical improve-ment rate in the RIC group was higher than the sham RIC group on the PGIC scale(65.2％vs.26.1％,P＜0.01).No statistical difference in cerebral hemodynamics post-treatment was observed.Conclusions RIC is a safe and effective adjunct therapy for asymptomatic children with MMD.This was largely due to the reduced incidence of ischemic cerebrovascular events.
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    • NSTL
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    National trends in sexual intercourse and usage of contraception among Korean adolescents

    Jun Hyuk LeeMyeongcheol LeeHojae LeeJaeyu Park...
    935-948页
    查看更多>>摘要：Background The exact influence of the COVID-19 pandemic on sexual intercourse and usage of contraception remains largely uncharted territory.To bridge this gap in knowledge,we conducted a comprehensive,cross-sectional examination of long-term trends in the prevalence of sexual intercourse and usage of contraception among South Korean adolescents from 2006 to 2022.Methods In our research,we drew upon data encompassing 1,138,799 South Korean adolescents aged 12 to 18 years,derived from the Korean Youth Risk Behavior Web-based Survey(KYRBS)over a period spanning from 2006 to 2022.We focused on the prevalence of sexual intercourse,contraception utilization,and the underlying associated factors among this demo-graphic.The KYRBS data was collected using a complex sampling strategy to determine the national prevalence estimates and shifts in prevalence before(2006-2019)and during(2020-2022)the COVID-19 pandemic era.Results During the pre-pandemic period,a decrease in adolescent sexual intercourse was observed(6.34％in 2006,5.53％in 2012,and 5.87％in 2019).However,in the post-pandemic period(2020-2022),there was a surge in sexual intercourse(4.55％in 2020 and 6.20％in 2022).This evident alteration in sexual intercourse trajectory between pre-and post-pandemic periods was statistically significant[βdiff,0.950;95％confidence interval(CI),0.756-1.144].Regarding contraceptive use among South Korean adolescents,there was an increase in the pre-COVID-19 pandemic phase across all demographic seg-ments(14.61％in 2006,22.30％in 2012,and 47.69％in 2022)but a notable decline when compared with the pre-and post-pandemic periods(βdiff,-0.319;95％CI,-0.454 to-0.184).Additionally,during the study period,a decrease in sexual intercourse was observed in the pre-pandemic period(β,-0.129;95％CI,-0.148 to-0.110),followed by an increase in the post-pandemic period(β,0.821;95％CI,0.627 to 1.014).This shift is highlighted by an effect size of 0.96[weighted odds ratio(wOR);95％CI,0.92 to 1.00],indicating a substantial change in adolescent sexual behaviors across study periods.Conclusions The increase in sexual intercourse and decrease in usage of contraception observed in our study between the pre-and post-COVID-19 periods suggests a potential threat to sexual health among South Korean adolescents.This trend emphasizes the ongoing necessity of raising awareness about adolescent sexual behavior in South Korea.
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    Continuous age-and sex-specific reference ranges of liver enzymes in Chinese children and application in pediatric non-alcoholic fatty liver disease

    Zhao-Yuan WuSi-Wei ChiLiu-Jian OuyangXiao-Qin Xu...
    949-956页
    查看更多>>摘要：Background Alanine aminotransferase(ALT)is widely used to screen patients with hepatic diseases.However,the current reference ranges(＜50 U/L)were developed by laboratories and have not been validated in populations with a large number of healthy individuals.Methods This study collected venous blood and anthropometric data from a total of 13,287 healthy children aged 3 months to 18 years who underwent routine physical examinations in the Department of Pediatric Healthcare.We applied the least mean square algorithm to establish age-and sex-related reference percentiles of serum levels of transaminases.For valida-tion,we recruited 4276 children and adolescents with obesity/overweight who underwent evaluation and metabolic tests in the hospital.Using receiver operating characteristic curves,we determined age-and sex-specific upper limit percentiles of liver enzymes for fatty liver diseases.Results This study revealed a significant correlation between serum transaminase levels and age and sex(P＜0.01).These transaminase levels exhibited age-and sex-specific patterns.Among individuals in the non-alcoholic fatty liver disease(NAFLD)cohort,elevated ALT levels displayed a positive association with clinical markers of disease severity,including homeostatic model assessment of insulin resistance,waist-hip ratio,and serum uric acid levels(P＜0.01).According to the receiver operating characteristic curves,ALT levels at the 92.58th percentile for boys and the 92.07th percentile for girls yielded the highest accuracy and specificity.Conclusions This study provides age-and sex-specific reference ranges for ALT,aspartate aminotransferase,and y-glutamyltransferase in Chinese children and adolescents,making it the largest population study to date.Furthermore,the study establishes a precise upper limit for ALT levels,facilitating their use in NAFLD screening.
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    Age and mean platelet volume-based nomogram for predicting the therapeutic efficacy of metoprolol in Chinese pediatric patients with vasovagal syncope

    Xiao-Juan DuYa-Qian HuangXue-Ying LiYing Liao...
    957-965页
    查看更多>>摘要：Background Vasovagal syncope(VVS)is the most common type of orthostatic intolerance in children.We investigated whether platelet-related factors related to treatment efficacy in children suffering from VVS treated with metoprolol.Methods Metoprolol-treated VVS patients were recruited.The median duration of therapy was three months.Patients were followed and divided into two groups,treament-effective group and treatment-ineffective group.Logistic and least absolute shrinkage selection operator regressions were used to examine treatment outcome variables.Receiver-operating character-istic(ROC)curves,precision-recall(PR)curves,calibration plots,and decision curve analyses were used to evaluate the nomogram model.Results Among the 72 patients who complete the follow-up,treatment-effective group and treatment-ineffective group included 42(58.3％)and 30(41.7％)cases,respectively.The patients in the treatment-effective group exhibited higher mean platelet volume(MPV)[(11.0±1.0)fl vs.(9.8±1.0)fl,P＜0.01]and platelet distribution width[12.7％(12.3％,14.3％)vs.11.3％(10.2％,12.2％),P＜0.01]than those in the treatment-ineffective group.The sex ratio was significantly different(P=0.046).A fit model comprising age[odds ratio(OR)=0.766,95％confidence interval(CI)=0.594-0.987]and MPV(OR=5.613,95％CI=2.297-13.711)might predict therapeutic efficacy.The area under the curve of the ROC and PR curves was computed to be 0.85 and 0.9,respectively.The P value of the Hosmer-Lemeshow test was 0.27.The decision curve analysis confirmed that managing children with VVS based on the predictive model led to a net advantage ranging from 0.01 to 0.58.The nomogram is convenient for clinical applications.Conclusion A novel nomogram based on age and MPV can predict the therapeutic benefits of metoprolol in children with VVS.
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    • NSTL
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    Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children undergoing hematopoietic stem cell transplant

    Yue TaoCheng-Juan LuoBing-Hua ZhangXin-Yan Shen...
    966-975页
    查看更多>>摘要：Background Diarrhea is a common complication of hematopoietic stem cell transplantation(HSCT)and is associated with substantial morbidity,but its etiology is often unknown.Etiologies of diarrhea in this population include infectious causes,chemotherapy-or medication-induced mucosal injury and graft-versus-host disease(GVHD).Distinguishing these poten-tial causes of diarrhea is challenging since diarrheal symptoms are often multifactorial,and the etiologies often overlap in transplant patients.The objectives of this study were to evaluate whether the FilmArray gastrointestinal(GI)panel would increase diagnostic yield and the degree to which pre-transplantation colonization predicts post-transplantation infection.Methods From November 2019 to February 2021,a total of 158 patients undergoing HSCT were prospectively included in the study.Stool specimens were obtained from all HSCT recipients prior to conditioning therapy,28±7 days after trans-plantation and at any new episode of diarrhea.All stool samples were tested by the FilmArray GI panel and other clinical microbiological assays.Results The primary cause of post-transplantation diarrhea was infection(57/84,67.86％),followed by medication(38/84,45.24％)and GVHD(21/84,25.00％).Ninety-five of 158 patients were colonized with at least one gastrointestinal patho-gen before conditioning therapy,and the incidence of infectious diarrhea was significantly higher in colonized patients(47/95,49.47％)than in non-colonized patients(10/63,15.87％)(P＜0.001).Fourteen of 19(73.68％)patients who were initially colonized with norovirus pre-transplantation developed a post-transplantation norovirus infection.Twenty-four of 62(38.71％)patients colonized with Clostridium difficile developed a diarrheal infection.In addition,FilmArray GI panel testing improved the diagnostic yield by almost twofold in our study(55/92,59.78％vs.30/92,32.61％).Conclusions Our data show that more than half of pediatric patients who were admitted for HSCT were colonized with vari-ous gastrointestinal pathogens,and more than one-third of these pathogens were associated with post-transplantation diarrhea.In addition,the FilmArray GI panel can increase the detection rate of diarrheal pathogens in pediatric HSCT patients,but the panel needs to be optimized for pathogen species,and further studies assessing its clinical impact and cost-effectiveness in this specific patient population are also needed.
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    FLNB haploinsufficiency-related short stature:a new syndrome or an expanded spectrum of Larsen syndrome

    Qing WangHong-Ying WangShui-Yan WuXue-Qian Wang...
    976-980页
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