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• An index of open-access pediatrics content relevant to primary care

   

  Analysis of Epidemiological Characteristics of 581 Children with Kawasaki Disease in Gansu　

  WU Jinzhi，DENG Haimei，MIN Li，WANG Jin，NIU Shaomin，LIU Yahong，YANG Yinan，DONG Xiangyu*   

  Department of Pediatric Cardiology，Lanzhou University Second Hospital，Lanzhou 730030，China

  *Corresponding author：DONG Xiangyu，Chief physician，Professor；E-mail：dxy0223@163.com

  Abstract: Background　Kawasaki disease （KD） is a systemic vasculitis associated with coronary artery lesion （CAL），which can lead to cardiomyopathy，myocardial infarction and death. At present，the incidence of KD is increasing year by year and has become the most common cause of acquired heart disease in children，significantly affecting the occurrence of long-term cardiovascular events during adulthood. Understanding the epidemiological characteristics and influencing factors of the disease is of great significance for reducing the incidence of the disease. Objective　To discuss the epidemiological characteristics of KD in Gansu from three aspects：demographic characteristics，time distribution and regional differences，in order to provide scientific basis for the management and prevention of KD in the western region. Methods　The 581 children with KD admitted to the Lanzhou University Second Hospital from January 2012 to December 2019 were selected as the research objects. According to the CAL status of the selected children within 1 month，the children with KD were divided into KD combined with CAL （CAL group） and without CAL （NCAL group）. According to the age of onset，they were divided into four age groups：≤1 year old，>1-3 years old，>3-6 years old and >6 years old. A unified questionnaire was used to collect general information （age，gender，ethnicity，time of onset，etc.） and thecoronary artery color Doppler ultrasound results. Results　（1）Demographic characteristics：among the 581 hospitalized children，the median age of onset of KD was 1.9 （1.2，3.2）years old. The ratio of male to female was about 1.9∶1 and the proportion of males decreased linearly with the increase of age （χ2trend=5.100，P<0.05）. （2）Temporal distribution：the overall number of KD showed an upward trend in different years （χ2trend=122.348，P<0.001）. There were significant differences in the distribution of KD cases in each season（χ2=12.418，P<0.05）. The proportion of children in spring was negatively correlated with their age groups（rs=-1，P<0.001），of which in autumn was positively correlated with the age groups（rs=1，P<0.001）. （3）Regional differences：combined with the geographical location，natural conditions and the current situation of regional economic and social development，Gansu Province was divided into five regions：Hexi，Longzhong，Longdong，Longdongnan and ethnic regions. According to the daily living expenses of urban residents，the average wage of workers and the level of social and economic development，Gansu Province was divided into four types of economic areas from high to low. The number of medical cases increased year by year in Longzhong region（χ2trend=86.011，P<0.001），Longdongnan region （χ2trend=23.848，P<0.001） and ethnic region （χ2trend=17.463，P<0.001）. The number of medical cases in economic class one （χ2trend=54.551，P<0.001），economic class two （χ2trend=20.586，P<0.001），economic class three （χ2trend=14.844，P<0.001） and economic class four （χ2trend=36.013，P<0.001） increased year by year. （4）Influencing factors：the number of KD cases of combined CAL （χ2trend=95.041，P<0.001） and NCAL （χ2trend=38.719，P<0.001） between different years showed an upward trend，especially in the CAL group （χ2trend=9.502，P<0.05）；multivariate Logistic regression analysis showed that age〔OR=3.011，95%CI（1.313，6.907）〕，gender〔OR=1.634，95%CI （1.137，2.349 ）〕and four economic areas〔OR=1.772，95%CI（1.172，2.679）〕were the independent risk factors of CAL. Conclusion　The number of patients with KD in Gansu had a tendency of growth by year，especially in the CAL group.The burden of disease was severe，especially in economically underdeveloped areas. In order to reduce the incidence of KD and its complications，it is necessary to increase public awareness of the severity of the disease，and properly increase prevention and control efforts for male infants in summer （try to intervene in advance for people at high risk of KD，such as immune regulation），establish and improve the KD follow-up mechanism，strengthen the training of primary physicians，conducting multi-center research and continuously monitorthe epidemiological characteristics of KD to obtain important information related to the best prevention strategy，early diagnosis，treatment timing and treatment choice.

   

  Epidemiological Characteristics and Influencing Factors of Low Birth Weight Infants in Hebei Province　

  LI Sisi1，JIN Ying1，DUAN Ya1，ZHANG Cui1，TIAN Meiling1，MA Xuyuan2，Wang Li1*    

  1.Department of Obstetrics and Gynecology，Hebei General Hospital，Shijiazhuang 050051，China

  2.Graduate School，North China University of Science and Technology，Tangshan 063000，China

  *Corresponding author：WANG Li，Chief physician，Professor；E-mail：wangli719@126.com

  Abstract: Background　Low birth weight infants often have chronic intrauterine hypoxia，their perinatal mortality rate is high，and the long-term physical development is backward and the risk of neurodevelopmental abnormalities is also high. Objective　To analyze the epidemiological characteristics of low birth weight infants and related factors affecting low birth weight infants in Hebei Province. Methods　The maternal and child monitoring information management system of Hebei Province was used to collect data of pregnant women at 37 weeks and above from 22 monitoring sites including 7 provincial and municipal hospitals and 15 county-level hospitals in Hebei Province from 2013 to 2017. Survey indicators included maternal age，birth year，birth season，urban-rural and rural grade distribution of birth hospitals，number of birth checkups，pregnancy times，parity times，fetal gender，the combination with gestational hypertension，gestational diabetes，heart disease and kidney disease，placental abruption，placenta previa，prolonged pregnancy and other related factors. Multivariate Logistic regression was used to analyze the influencing factors of low birth weight infants. Results　Among 250 304 full-term newborns，3 482 cases were low birth weight，with an incidence of 1.39%. There were statistically significant differences in the incidence of low birth weight infants among pregnant women of different ages，birth years，birth seasons，birth regions，urban-rural and rural grade distribution of birth hospitals（P<0.05）. The incidence of low birth weight was the highest（1.65%）among pregnant women with childbearing aged ≥40 years，and the lowest（1.29%）among women aged 30 to 34. The incidence of low birth weight infants was highest in 2015（1.56%）and lowest in 2017（1.29%）. The incidence of low birth weight infants was highest in spring（1.47%）and lowest in autumn（1.29%）. The city of Cangzhou had the highest incidence of low birth weight（1.82%），while Xingtai had the lowest incidence（0.82%）.The incidence of low birth weight infants in provincial and municipal hospitals（1.71%）was higher than that in township hospitals（1.13%）. The incidence of low birth weight infants was highest in tertiary hospitals（1.94%）and lowest in primary hospitals（0.98%）. There were statistically significant differences in age distribution，number of antenatal examinations，the number of pregnancy and parity，fetal sex，proportion of gestational hypertension，proportion of heart disease，proportion of kidney disease，proportion of placental abruption，proportion of placenta previa and proportion of prolonged pregnancy between the low birth weight group and non-low birth weight group（P<0.01）. There was no significant difference in education level and proportion of gestational diabetes mellitus（P>0.05）. Multivariate Logistic regression analysis showed that lower education level of pregnant women，fewer times of birth check-up，female fetus，delivery in provincial and municipal hospitals，gestational hypertension，heart disease，placental abruption，placenta previa were independent risk factors for low birth weight（P<0.05）. Multiple pregnancies，gestational diabetes mellitus and prolonged pregnancy were independent protective factors for low birth weight infants（P<0.05）. Conclusion　The incidence of low birth weight infants varies significantly in time，region and population. Individualized preventive measures should be taken for different regions and populations，such as timely pregnancy and standardized prenatal examination，early detection of potential high-risk factors，timely prevention and treatment to reduce the incidence of low birth weight infants.

   

  Analysis of Gene Carrier and Characteristics for Neonatal Thalassemia in Baisha Li Autonomous County，Hainan Province in 2020　

  SHI Haijie1，ZHAO Zhendong2*    

  1. Department of Gastroenterology，Hainan General Hospital，Haikou 570311，China

  2. Department of Neonatal Disease Screening Center，Hainan Womenand Children's Medical Center，Haikou 570206，China

  *Corresponding author：ZHAO Zhendong，Associate chief technologist；E-mail：43215767@qq.com

  Abstract: Background　Since 2012，Hainan Province has been committed to prenatal thalassemia screening to reduce the low birth rate of thalassemia children. However，the prevention and control of neonatal thalassemia is still a weak board in our province. Objective　To investigate the carrying status of thalassemia-causing genes and genetic characteristics of thalassemia in Baisha Li Autonomous County，Hainan Province. Methods　According to the principle of voluntary informed consent，912 newborns born in themidwifery Baisha Li Autonomous County of Hainan Province units in 2020 were collected with dried blood spots on the heels. Fluorescent PCR melting curve method was used to detect the common thalassemia genes in Chinese，and some samples were verified by PCR + flow-through hybridization method. Genetic testing kits suggested that samples with suspected new mutations were sent to the genetic company for analysis and verification. Results　（1）Among the 912 samples，608 thalassemia genes were detected，the carrying rate of thalassemia genes in the newborn population in Baisha Li Autonomous County was 66.7% （608/912）. The number of α，β，and α compound β thalassemia genes detected were 521，25，and 62，respectively. The top three genotypes of α-thalassemia gene detected were –α3.7/αα（26.3%）, -α4.2/αα（23.8%），and αWSα/αα（12.7%），respectively. Three rare genotypes of thalassemia gene，-α4.2/HKαα，c.118C>T，and c.309C>T，were also detected.（2） Divided by ethnicity groups，the thalassemia gene carrier rates in newborn populations of Han，Li and other ethnic minorities were 51.5% （175/340），76.7% （414/540） and 59.4% （19/32），respectively. Conclusion　The thalassemia gene carrier rate is high in the newborn population of Baisha Li Autonomous County，Hainan Province，and the thalassemia genotypes are abundant. The alpha thalassemia genotype is the most common，and the Li nationality newborn population has the highest carrier rate.

   

  Interpretation of Congenital Hypothyroidism：a 2020—2021 Consensus Guidelines Update——an ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology　

  DENG Chenqian1，2，CHEN Shuchun2*    

  1.Graduate School of Hebei North University，Zhangjiakou 075000，China

  2.Hebei General Hospital，Shijiazhuang 050051，China

  *Corresponding author：CHEN Shuchun，Chief physician，Professor；E-mail：guang6701@sina.com

  Abstract: Congenital hypothyroidism is defined as insufficient thyroid hormone production caused by dysfunction of hypothalamic-pituitary-thyroid axis or accompanied with mild to severe thyroid hormone deficiency at birth. The prevalence rate of congenital hypothyroidism is about 1/4 000 in newborns according to statistics，and most of the children can be born with no obvious abnormal manifestations，only no more than 10% of the children could be diagnosed according to their clinical manifestations. Typical clinical manifestations of congenital hypothyroidism mainly include special facial features and body posture，such as large head，short neck，rough skin，facial myxedema，wide interocular distance，often accompanied by nervous system symptoms（such as mental retardation，dull expression，retarded nerve reflex）and low physiological function（such as somnolence and inappetence），which may result in irreversible damage to nervous system if not treated in time. Early treatment in most children with congenital hypothyroidism may achieve the quality of life with no significant difference to normal children. This paper mainly interprets the Congenital Hypothyroidism：a 2020—2021 Consensus Guidelines Update—an ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology，facilitating the normalization of clinical diagnosis and treatment of congenital hypothyroidism.

   

  Changes and Significance of Serum Gastrin and Motilin in the Blood of Children in Pediatric Intensive Care Unit　

  PENG Hao*，LONG Bowen，XIAO Chen，DENG Min，ZHANG Yi    

  Pediatric Intensive Care Unit，Pingxiang Maternal and Child Care Hospital，Pingxiang 337000，China

  *Corresponding author：PENG Hao，Associate chief physician；E-mail：xpk5863@163.com

  Abstract: Background　Serum gastrin（GAS） and motilin（MTL） play important roles in regulating gastrointestinal motor function. Gastrointestinal dysfunction or gastrointestinal failure in critical illness is considered to be the inducement of multiple organ failure（MOF） after stress，so it is of great significance to monitor the levels of GAS and MTL. Objective　To analyze the concentration changes of GAS and MTL in the blood of different children in pediatric intensive care unit（PICU） and their clinical monitoring significance. Methods　Three hundred hospitalized children in Pediatric Intensive Care Unit of Pingxiang Maternal and Child Care Hospital from January 2018 to September 2019 were enrolled. The levels of GAS and MTL in the blood of children were measured by radioimmunoassay. The levels of GAS and MTL in blood of children with different disease severity（before and after treatment），different disease types and different gastrointestinal function states were compared. Results　The levels of GAS and MTL of extremely critically ill children before and after treatment were higher than those of non-critically ill and critically ill children （P<0.05）；after treatment，the GAS and MTL levels of non-critical，critically ill，and extremely critically ill children were compared with those before treatment，and the differences were statistically significant （P<0.05）. There was no significant difference in the levels of GAS and MTL in children with different disease types（P>0.05）. The level of GAS in children with gastrointestinal dysfunction and gastrointestinal failure was higher than that of children without gastrointestinal dysfunction，and the level of GAS in children with gastrointestinal failure was higher than that of children with gastrointestinal dysfunction （P<0.05）. The MTL level of children with gastrointestinal dysfunction was higher than that of children without gastrointestinal dysfunction and gastrointestinal failure，and the MTL level of children without gastrointestinal dysfunction was higher than that of children with gastrointestinal failure （P<0.05）. Conclusion　In children with different disease severity and gastrointestinal function status，the changes of GAS and MTL are different. In the clinic，it is possible to monitor the changes in the concentration of GAS and MTL in the blood of the children to assess the severity of the disease，the gastrointestinal function status and the effect of clinical treatment in the children.

   

  Meta-analysis of Vitamin D Nutritional Status of Children in Chinese Mainland　

  SU Jingying1，2，CHEN Xianrui3，LIN Gangxi1，2，3*    

  1.School of Clinical Medicine，Fujian Medical University，Fuzhou 350122，China

  2.Department of Pediatrics，Xinglin Branch of the First Affiliated Hospital of Xiamen University，Xiamen 361022，China 3.Department of Pediatrics，the First Affiliated Hospital of Xiamen University/Pediatric Key Laboratory of Xiamen/Institute of Pediatrics，School of Medicine，Xiamen University，Xiamen 361003，China

  *Corresponding author：LIN Gangxi，Chief physician；E-mail：lingangxi@qq.com

  Abstract: Background　The global vitamin D nutritional status has attracted much attention recently. Vitamin D nutritional status may differ by country or region. There are few multicenter studies with a large sample size on vitamin D nutritional status in Chinese children. Objective　To analyze the vitamin D nutritional status in children in Chinese mainland. Methods　Studies regarding vitamin D nutritional status in children in Chinese mainland were collected by searching databases of PubMed，Embase，The Cochrane Library，Wanfang Data，CNKI，SinoMed and CQVIP from database inception to 2020-04-08. Two researchers separately extracted information from the eligible studies，encompassing the first author，publication time，the region（northern or southern China）where participants live，size，sex ratio，age of the sample，and outcome indicators〔serum 25（OH）D level，rate of vitamin D deficiency serum 25（OH）D level <20 μg/L〕，and assessed the publication bias. Meta-analysis was carried out using RevMan 5.2 and Stata 14.0. Results　A total of 29 studies with 133 441 healthy children and adolescents were enrolled. The average serum 25（OH）D level was （29.62±12.45）μg/L for all participants. Meta-analysis indicated that the prevalence of vitamin D deficiency in all participants，participants from southern and northern China，was 21.4%〔95%CI（17.5%，25.4%）〕，17.5%〔95%CI（13.1%，22.0%）〕，and 29.0%〔95%CI（19.4%，38.6%）〕，respectively. No significant sex-based differences were found in the prevalence of vitamin D deficiency 〔OR=0.99，95%CI（0.95，1.03），P=0.71〕，and average serum 25（OH）D level〔SMD=0.01，95%CI（-0.24，0.26），P=0.95〕. Infants had higher average serum 25（OH）D level than young children〔SMD=0.16，95%CI（0.06，0.27），P=0.002〕，preschool children〔SMD=0.77，95%CI（0.55，1.00），P<0.000 01〕，and school-age children and adolescents〔SMD=0.65，95%CI（0.27，1.04），P=0.000 1〕. In participants from southern China，infants had higher average serum 25（OH）D level than young children〔SMD=1.51，95%CI（0.31，2.72），P=0.01〕，preschool children〔SMD=6.22，95%CI（3.97，8.47），P<0.000 01〕，and school-age children and adolescents〔SMD=6.80，95%CI（2.95，10.65），P<0.000 5〕. In those from northern China，infants had higher average serum 25（OH）D level than young children〔SMD=1.23，95%CI（0.33，2.12），P=0.007〕and preschool children〔SMD=8.41，95%CI（2.04，14.79），P=0.01〕. Young children had higher average serum 25（OH）D level than preschool children〔SMD=0.61，95%CI（0.43，0.80），P<0.000 01〕，and school-age children and adolescents〔SMD=0.65，95%CI（0.27，1.04），P=0.001〕. In those from southern China，young children had higher average serum 25（OH）D level than preschool children〔SMD=5.53，95%CI（3.57，7.49），P<0.000 01〕，and school-age children and adolescents〔SMD=6.07，95%CI（3.04，9.10），P<0.000 1〕. In those from northern China，young children had higher average serum 25（OH）D level than preschool children 〔SMD=6.56，95%CI（1.19，11.92），P=0.02〕. Preschool children had higher average serum 25（OH）D level than school-age children and adolescents〔SMD=0.33，95%CI（0.15，0.51），P=0.000 4〕. In those from southern China，the average serum 25（OH）D level in preschool children was higher than that in school-age children and adolescents〔SMD=1.89，95%CI（0.58，3.21），P<0.005〕. In those from northern China，the average serum 25（OH）D level in preschool children was higher than that in school-age children and adolescents with no statistical difference〔SMD=4.94，95%CI（1.51，8.38），P=0.005〕. Conclusion　In Chinese mainland，the prevalence of vitamin D deficiency in children was relatively high. The vitamin D level was not associated with sex，but may be closely related to age. However，our conclusion still needs to be verified by further research.

   

  Meta-analysis of the Predictive Value of Lipid Metabolism in Children with Henoch-Schonlei Purpura　

  HAN Shanshan1，2，DING Ying1，2，DAI Yanlin2，ZHANG Xia1，2*，WANG Long1，2    

  1. Department of Pediatrics，the First Affiliated Hospital of Henan University of Traditional Chinese Medicine，Zhengzhou 450003，China

  2. College of Pediatrics，Henan University of Traditional Chinese Medicine，Zhengzhou 450046，China

  *Corresponding author：ZHANG Xia，Associate professor，Associate chief physician；E-mail：ardar123@sina.com

  Abstract: Background　Henoch-Schonlein purpura （HSP） is one of the most common vasculitis in children. Some of them may involve the kidney and develop into Henoch Schonlein purpura nephritis，which affects the prognosis. Therefore，it is necessary to find the predictors of renal damage in the early stage of Henoch-Schonlein purpura. In recent years，more and more studies have shown that abnormal lipid metabolism may be a risk factor for HSP renal injury，but there is no systematic evidence-based study. Objective　To comprehensively collect relevant literature and evaluate whether lipid abnormalities in the early stage of HSP can be used as a predictor of HSPN. Methods　PubMed，EMBase，The Cochrane Library，China National Knowledge Infrastructure（CNKI），Wanfang Data Knowledge Service Platform，VIP and China Biology Medicine disc were searched by computer. The retrieval time were from the establishment of the databases to February 10，2020. The first author，publication year，country，diagnostic criteria，gender，age，number of cases（HSPN group / non HSPN group），observation indexes〔total cholesterol （TC），triglyceride（TG），high density lipoprotein （HDL），low density lipoprotein（LDL），apolipoprotein M（ApoM） in the two groups at the initial stage of onset〕，study type，occurrence （initial onset / recurrence），course of disease and follow-up time were collected to study the risk factors of HSPN in children. Newcastle Ottawa scale （NOS） was used to evaluate the quality of the included literature. Stata 15.1 software was used for Meta-analysis. Results　A total of 5 312 cases from 16 literatures were included. Excluding 26 cases lost to follow-up，there were 5 286 children with HSP，and 1 997 cases developed HSPN，with NOS scores ≥6 points. The results of meta-analysis showed that the levels of TC 〔WMD=0.72，95%CI （0.51，0.92）〕，TG 〔WMD=0.61，95%CI （0.45，0.77）〕 and LDL〔WMD=0.65，95%CI （0.41，0.89）〕 in HSPN group were higher than those in non HSPN group，and the level of ApoM 〔OR=0.32，95%CI （0.12，0.85）〕 was lower than those in non HSPN group. Conclusion　High levels of TC，TG and LDL may be predictors of HSPN development. The relationship between HDL level and HSPN is still unclear，which needs to be confirmed by further research. ApoM is expected to become a new independent predictor of HSPN.

   

  Erythropoietic Protoporphyria with Multiple Organ Failure in Children：a Case Report and Literature Review　

  MA Chunmiao1，YU Xinyou2，LU Biao3，XIE Xinbao4，LIANG Lijun3*    

  1.Ningxia Medical University，Yinchuan 750004，China

  2.Medical Experimental Center，General Hospital of Ningxia Medical University，Yinchuan 750000，China

  3.Department of Pediatrics，General Hospital of Ningxia Medical University，Yinchuan 750004，China

  4.Pediatric Liver Disease Center，Fudan University，Shanghai 201102，China

  *Corresponding author：LIANG Lijun，Professor，Chief physician；E-mail：lianglijunnx@sina.com

  Abstract: Erythropoietic protoporphyria is a rare disease characterized by impaired activity of ferrochelatase caused by FECH genetic mutations. This study reviewed the clinical data and results of gene analysis of a child with erythropoietic protoporphyria and relevant studies，and discussed the features of this disease and mutation sites of pathogenic genes，in order to improve clinical understanding of erythropoietic protoporphyria. Clinical attention should be paid to warning signs of erythropoietic protoporphyria，such as recurring rashes in the parts of the skin exposed to sunlight，especially accompanied with abdominal pain and liver damage，FECH gene test is helpful for the diagnosis of the disease.

   

  Inflammatory Indicators and Pathogenic Bacteria of Urinary Tract Infections with Convulsion in Children　

  YAO Yao，ZHAO Liping*，ZHOU Hongxia，GE Tingting，ZHANG Lin，LIU Yuli，ZHU Guoqin，XU Jinwen，LIU Xunwei，WU Qing，CHENG Yun，YANG Lingyun    

  Department of Pediatric Nephrology，Wuxi Children's Hospital，Wuxi 214023，China

  *Corresponding author：ZHAO Liping，Chief physician；E-mail：Kew-2000@126.com

  Abstract: Background　Urinary tract infections（UTIs） are common in children，mostly caused by Escherichia coli. Some children with UTIs may have convulsion，which aggravates the condition and prolongs the treatment time. However，there have been no studies comparing inflammatory indicators and pathogenic bacteria between UTIs children with and without convulsion. Objective　To perform a comparative analysis of inflammatory indicators，common pathogenic bacteria and antibiotic resistance between UTIs children with and without convulsion，providing evidence for clinical treatment. Methods　We enrolled 181 children with UTIs from Wuxi Children's Hospital during 2010 to 2019，including 81 with convulsion（convulsive group），and 100 without （non-convulsive group） . Data about sex，age，results of routine blood test （WBC，CRP，PCT），urine culture test and sensitivity test of two groups were collected. Results　Convulsive group had higher average PCT level （P<0.05）. Forty species of pathogenic bacteria（49.4%） were isolated from the samples of convulsive cases，47.5% of which（19/40） were gram-negative bacteria，and 52.5%（21/40） were gram-positive bacteria. Twenty-seven species of pathogenic bacteria（27.0%） were isolated from the samples of non-convulsive cases，85.2% of which（23/27） were gram-negative bacteria，and 14.8%（4/27） were gram-positive bacteria. No fungus was isolated from samples of both groups. Escherichia coli was the most common bacterium infected in both groups. The difference in the prevalence of infected Escherichia coli and non-Escherichia coli between the two groups was statistically significant （P < 0.05）. Escherichia coli had a high resistance rate to ampicillin（93.3%），cefazolin（86.7%） and ceftriaxone（73.3%），and a low resistance rate to imipenem（0），cefotetan（0），ertapenem（0）. Enterococcus faecium had a high resistance rate above 80.0% to ampicillin（92.3%），clindamycin（100.0%），erythromycin（84.6%），and penicillin G（92.3%），and a low resistance rate to vancomycin（0），linezolid（0） and nitrofurantoin（23.1%）. Conclusion　For children with UTIs，attentions should be given to the detection of PCT and timely assessment of infection level，to guide clinical treatment of controlling infection，and reducing the risk of convulsion promptly. For those also with convulsion，clinical focus should be given to midstream urine culture and sensitivity test，and appropriate selection of effective antibiotics to control the disease progression in time.

   

  Capability of Community Health Centers in Cities to Provide Childcare Services　

  WANG Xi，YIN Tao，YANG Huimin，ZHENG Xiaoguo，LI Ruili，WANG Lihong，YIN Delu*    

  Department of Health Development，Capital Institute of Pediatrics，Beijing 100010，China

  *Corresponding author：YIN Delu，Professor，Master supervisor；E-mail：deluyin@126.com

  Abstract: Background　The implementation of universal two-child policy has brought a significant increase in the number of children in China. The needs of childcare services are increasing rapidly，but the capability of community health centers（CHCs） to provide such services is still unclear. Objective　To investigate the capability of CHCs in some cities of China to provide childcare services. Methods　In April 2020，by use of multi-stage stratified sampling，we selected 35 CHCs in 14 cities of China，and conducted two online surveys using self-developed questionnaires，one with administrators of the CHCs for investigating the general status，personnel，equipment and facilities allocation，and implementation regarding childcare services，and one with childcare staff of the CHCs for investigating their knowledge regarding childcare services and job satisfaction. Results　The survey included 35 community health service centers in 14 cities across the country，and the total number of health technicians in the sample center was 8 009. Among the health technicians，191（2.38%） were pediatricians（including licensed physicians and assistant physicians with pediatrics included in their scope of practice），154 of them（80.63%） had a bachelor degree or above，and 112（58.64%） had intermediate or above professional title；488（6.09%） were general practitioners（received post-shift training with pediatrics before being a childcare provider），293 of them（65.37%） had a bachelor degree or above，and 355（79.30%） had intermediate or above professional title；320（4.00%） were pediatric preventive healthcare physicians，and more than 80.00% of them had the national physician license and pediatric training certificate. A total of 999 people accepted the survey of satisfaction and knowledge level. The job satisfaction level of the childcare providers and the accuracy of the pediatric knowledge test performed by them was（61.38±9.11）%，and （50.40±21.93）% on average，respectively. The pediatric consulting room accounted for less than 1% of the total consulting rooms of the CHCs on average. More than 90% of the CHCs were equipped with 8 kinds of common equipment and facilities for providing childcare services. More than 50% of the CHCs were equipped with less than 7 kinds of common pediatric diagnostic and therapeutic equipment and facilities. Only 10 of the 23 common pediatric medicines could be accessible in more than 50% of the CHCs. In 2019，the number of visits of children to the CHCs accounted for 2.91% of the total visits. And the number of admissions of children to the CHCs accounted for 1.48% of the total admissions. Over 85 percent of the national essential public health projects have been carried out. Simple obese children accounted for the highest number of children receiving management while those with congenital dislocation of the hip accounted for the lowest. Conclusion　Overall，the number of childcare providers in the CHCs was insufficient，with relatively high education level and professional title，but unsatisfactory level of pediatric knowledge，and low job satisfaction. The CHCs were equipped with insufficient equipment and facilities as well as pediatric drugs. The spatial distribution of children's health service level was not balanced. To improve the capability of CHCs to provide childcare services，it is suggested to strengthen guidance and training to improve the ability level of primary childcare providers，establish an effective performance assessment mechanism to improve their job satisfaction，increase types and quantity of pediatric drugs，and reasonably allocate pediatric diagnostic and therapeutic equipment and facilities.

   

  Recurrent Purulent Meningitis in Children：an Analysis of 15 Cases　

  LI Xin1，SUN Suzhen1*，PANG Lingyu1，WEN Xin2，WANG Weixiu3    

  1.Neurology Department 1，Hebei Children's Hospital，Shijiazhuang 050000，China

  2.ENT Department，Hebei Children's Hospital，Shijiazhuang 050000，China

  3.Department of Imaging，Hebei Children's Hospital，Shijiazhuang 050000，China

  *Corresponding author：SUN Suzhen，Professor，Doctoral supervisor，Chief physician；E-mail：sunsuzhen2004@126.com

  Abstract: Background　Recurrent purulent meningitis（RPM）is a rare disease in children，which is easily missed due to the complex and insidious etiology. So early detection and diagnosis in time has a positive impact on improving the prognosis. But there are few clinical studies and etiological analyses on RPM in children. Objective　To study the clinical characteristics，possible causes and treatments of RPM. Methods　Clinical data of 15 pediatric inpatients with RPM were collected retrospectively from Hebei Children's Hospital from 2012 to 2018. All cases underwent brain and spinal cord MRI，temporal bone CT scan，hearing screening or immune function test according to different possible causes of RPM，and received normal cerebral therapy（including antibiotic and dehydration treatment and so on），and treatment targeting the possible cause，as well as a post-discharge telephone follow-up ranging from 6 to 36 months. Results　Of the 15 cases，8 were male and 7 female，with an age of first onset of 24 days to 9 years old，and an average age of onset of（3.1±2.6）years old. The time to onset ranged from 4 hours to 7 days，with presentations of fever and poor mental health status in all cases. Headache and jet vomiting were found in older children，while babies had irritability and bulging of the anterior fontanelle. Cerebrospinal fluid culture was positive in 15 cases，and blood culture was positive in 8 cases. The underlying causes of 15 cases of RPM：structural abnormality in 7 cases （46.7%）〔internal ear dysplasia（4 cases），pilonidal sinus（2 cases），discontinuous cortex of skull base ethmoid plate（1 case）〕，purulent meningitis after craniofacial trauma in 3 cases (20.0%)〔brain contusion and laceration（1 case），traumatic cerebrospinal fluid rhinorrhea（1 case），traumatic tympanic membrane perforation with humoral immunodeficiency（1 case）〕，adjacent tissue inflammation in 2 cases (13.3%)〔local inflammation of sphenoid bone caused by cellulitis（1 case），cerebrospinal fluid otorrhea（1 case）〕，serious complications（2 cases）and unknown cause（1 case）. In the acute stage，the anti-infective therapy was used，and then in convalescent stage，stereotactic abscess resection，cerebrospinal fluid rhinorrhea and otorrhea repair，skull base repair，pilonidal sinus resection，regular intravenous immunoglobulin therapy or conservative treatment was used. There was no recurrence in 6 to 36 months of follow-up. Conclusion　The RPM onset in children may occur during neonatal stage to childhood stage，the etiology is complex and diverse，and structural abnormality is a main contributing factor. Timely identifying RPM，and finding and removing the possible cause，may prevent the recurrence of RPM.

   

  Research Progress in High-risk Infants Follow-up after Discharge　

  WANG Peiyue1，2，SHEN Fang3，ZENG Lin4，HAN Tongyan1，2*    

  1.Department of General Practice，Peking University Third Hospital，Beijing 100191，China

  2.Pediatric Department，Peking University Third Hospital，Beijing 100191，China

  3.Beijing Haidian maternal and child health care hospital，Beijing 100080，China

  4.Clinical Epidemiology Center，Peking University Third Hospital，Beijing 100191，China

  *Corresponding author：HAN Tongyan，Associate professor，Chief physician；E-mail：tongyanhan@qq.com

  Abstract: High-risk neonatal survival rate is obviously increased with the development of technology in Neonatal Intensive Care Unit （NICU），and the number of preterm infants also increases. Compared with normal newborns，high-risk infants are at great risk for developmental problems and poor outcomes. Follow-up of high-risk infants after hospital discharge is of great significance for early detection of developmental delay and early intervention，to improve of long-term prognosis and enhance the life quality. This article introduces the definition and classification of high-risk infants，and the research progress for follow-up of high-risk infants after discharge in China and in the world，so as to provide the information for management of high-risk infants follow-up.

   

  Interpretation of Guidelines for the Rational Use of Antiviral Drugs in Children with Respiratory Viral Infectious Diseases　

  HUANG Huan1，ZHANG Fangxia1，DUAN Miao2*，HUANG Bo3*    

  1.The Third Affiliated Hospital of Zunyi Medical University（the First People's Hospital of Zunyi），Zunyi 563000，China

  2.Department of Neonatology，the Third Affiliated Hospital of Zunyi Medical University（the First People's Hospital of Zunyi），Zunyi 563000，China

  3.Department of Pediatric Intensive Care Unit，the Third Affiliated Hospital of Zunyi Medical University（the First People's Hospital of Zunyi），Zunyi 563000，China

  *Corresponding authors：HUANG Bo，Doctoral supervisor，Master supervisor，Professor，Chief physician；E-mail：672879381@qq.com

  DUAN Miao，Master supervisor，Associate chief physician；E-mail：duanmiao@zmu.zdu.cn

  Abstract: Many recent studies have reported the rational use of common antiviral drugs mostly for viral infectious diseases，yet there is no study comprehensively elaborating appropriate use of such drugs for respiratory viral infectious diseases in children. In 2020，the Chinese Hospital Association，united with National Center for Children's Health，National Medical Quality Control Center Infectious Disease，National Clinical Research Center for Respiratory Disease and other academic institutions jointly formulated the "Guidelines for the Rational Use of Antiviral Drugs in Children with Respiratory Viral Infectious Diseases "，whose publication has important guiding significance for the treatment of children with respiratory viral infectious diseases. This article interprets the guideline from the aspects of diagnosis and pathogenic testing，infection control，selection and use of antiviral drugs，etc，and aims to provide help for domestic pediatric colleagues to understand the guideline.

   

  Regional Disparities in Under-five Mortality and Potential Years of Life Lost in Yunnan，China，2015—2019　

  YE Qingyun1，2，QIN Mingfang3，YANG Zhongting1，DENG Rui1，JIAO Feng1，LI Benyan1，ZHANG Yi2，HUANG Yuan1*    

  1.School of Public Health，Kunming Medical University，Kunming 650500，China

  2.Medical Management Office，the Affiliated Children's Hospital of Kunming Medical University/Yunnan Children's Medical Center，Kunming 650100，China

  3.Yunnan Institute of Endemic Diseases Control ＆Prevention，Dali 671000，China

  *Corresponding author：HUANG Yuan，Lecture；E-mail：huangyuan@kmmu.edu.cn

  Abstract:

  Background　In the last several decades，the Chinese Government has made substantial progress in reducing under-five mortality rate（U5MR），but the disparity in U5MR between urban and rural areas still exists. Objective　To identify the main causes of death and potential years of life lost among children under 5 years old across different regions of Yunnan Province from 2015 to 2019. Methods　According to the poverty headcount ratio in 2017，a total of 129 districts and counties in Yunnan were categorized into severely impoverished，poor，and non-poor areas. Data about reported death among children under 5 years old in these areas during 2015—2019 were collected，and described statistically using the mortality rate，proportion of deaths by cause，potential years of life lost，potential years of life lost rate，and average years of life lost. Poisson regression model was adopted to estimate the trend in U5MR and its 95%CI during 5 years for three types of areas. Chi-square test was chosen to analyze the changes in death places during 5 years. The data source came from "population death information registration management system" of "China Disease Control and prevention information system" of Yunnan Center for Disease Control and Prevention. Results　U5MR in Yunnan had decreased by -28.23% for 5 years，at -7.60% per year on average〔95%CI（-8.52%，-6.76%）〕. The same decline trends happened in severely impoverished areas｛-29.51% for 5 years，-6.95% per year on average〔95%CI（-8.51%，-5.45%）〕｝，poor areas｛-13.34% for 5 years，-3.15% per year on average〔95%CI（-4.59%，-1.69%）〕｝，and non-poor areas｛-42.66% for 5 years，-13.76% per year on average〔95%CI（-15.38%，-12.10%）〕｝. The majority of under-5 deaths took place at home in severely impoverished areas，but the proportion had reduced by year. By contrast，the majority of under-5 deaths took place at hospital in poor areas and non-poor areas，and the proportions had reduced by year as well. The differences in death places among children under 5 years old in poor areas were statistically significant across years （P<0.05）. The top three causes of death were birth trauma and asphyxia，lower respiratory tract infection，and congenital heart disease in both 2015 and 2019. Low birth weight and birth trauma and asphyxia caused the highest average years of life lost. Conclusion　In Yunnan Province，the reported mortality rate of children under 5 years old showed a significant decrease in all three regions with different levels of poverty. Given that the disparities in child health between poor and non-poor areas have remained，and the massive loss of life years have caused due to early death，substantial efforts are needed in future to strengthen the capacity to provide perinatal care and to end preventable deaths among children under 5 years old in those underdeveloped areas that have been lifted out of poverty currently.

   

  Effects of Gestational Diabetes on Glycolipid Levels and Macrosomia Incidence in Late Pregnancy　

  YANG Jie，HOU Shanshan*，ZHAO Lizheng，WANG Yutong    

  Tongzhou Maternal & Child Health Hospital of Beijing，Beijing 101100，China

  *Corresponding author：HOU Shanshan，Associate chief physician；E-mail：673004319@qq.com

  Abstract: Background　Great attention has been paid to lifestyle intervention such as diet and exercise in pregnant women with gestational diabetes mellitus（GDM） clinically. Recent studies have found that glycemic control in pregnant women with GDM is satisfactory，but the incidence of macrosomia has not decreased significantly. Objective　To investigate the effects of GDM on glycolipid levels and macrosomia incidence in the third trimester of pregnancy. Methods　Through the hospital information system of Tongzhou Maternal & Child Health Hospital of Beijing，we retrospectively selected 16 134 women with full-term delivery in the hospital from 2014 to 2018，and divided them into GDM group〔including those with a delivered baby with macrosomia（GM subgroup） and with a delivered baby with normal birth weight（GN subgroup）〕and non-GDM group 〔including those with a delivered baby with macrosomia（NM subgroup） and with a delivered baby with normal birth weight（NN subgroup）〕by GDM prevalence. We compared total cholesterol （TC），triglyceride （TG），high-density lipoprotein cholesterol （HDL-C），low-high lipoprotein cholesterol （LDL-C），and fasting blood glucose（FBG） at the third trimester between GDM and non-GDM groups，GM and GN subgroups，NM and NN subgroups，NM and GM subgroups，and NN and GN subgroups，respectively. Multivariate Logistic regression analysis was used to explore the associated factors of macrosomia. Results　There were 3 834 cases in GDM group（411 in GM subgroup，and 3 423 in GN subgroup），and 12 300 in non-GDM group（898 in NM subgroup，and 11 402 in NN subgroup）. GDM group showed higher mean TG and FBG levels and lower mean TC，HDL-C and LDL-C levels than non-GDM group （P<0.05）. GN subgroup had lower mean TG and FBG levels and higher mean HDL-C level than GM subgroup （P<0.05）. NM subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GM subgroup （P<0.05）. NN subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GN subgroup （P<0.05）. NN subgroup had higher mean HDL-C level and lower mean TG and FBG levels than NM subgroup （P<0.05）. Multivariate Logistic regression analysis found that GDM〔OR=1.338，95%CI（1.158，1.547）〕，and pre-pregnancy BMI 〔emaciated：OR=0.476，95%CI（0.361，0.626）；overweight：OR=1.770，95%CI（1.537，2.039）；obesity：OR=2.854，95%CI（2.282，3.568）〕，weight gain during pregnancy 〔OR=1.100，95%CI（1.087，1.113）〕，gestational age at delivery 〔OR=1.728，95%CI（1.622，1.841）〕，TC in late pregnancy 〔OR=0.705，95%CI（0.514，0.966）〕，TG in late pregnancy 〔OR=1.282，95%CI（1.153，1.425）〕，LDL-C in late pregnancy 〔OR=1.487，95%CI（1.094，2.021）〕，and FBG in late pregnancy 〔OR=1.692，95%CI（1.482，1.933）〕 were associated with the delivery of a baby with macrosomia （P<0.05）. Conclusion　Elevated TG and FBG and decreased TC，HDL-C and LDL-C were found in pregnant women with GDM. GDM，blood lipid and blood glucose in late pregnancy may be associated factors of delivering a baby with macrosomia. To reduce macrosomia incidence，it is suggested to strengthen the monitoring of blood lipid and blood glucese（especially TG and FBG levels） as well as weight management in pregnancy.

   

  Hypertriglyceridemic Pancreatitis Caused by Lipoprotein Lipase Gene Mutation in Children：a Case Report and Literature Review　

  XU Jinping，BAI Haitao，YAO Yonghua，CHEN Xianrui*    

  Department of Pediatrics，the First Affiliated Hospital of Xiamen University/Pediatric Key Laboratory of Xiamen/Institute of Pediatrics，School of Medicine，Xiamen University，Xiamen 361003，China

  *Corresponding author：CHEN Xianrui，Attending doctor；E-mail：chenxianruimiao@163.com

  Abstract: Hypertriglyceridemic pancreatitis（HTGP）often occurs in patients with dyslipidemia（including types Ⅰ，Ⅳ and Ⅴ） or secondary to other diseases.Although the clinical symptoms of HTGP are similar to those of acute pancreatitis caused by other etiologies，HTGP is often associated with more severe clinical symptoms and complications，thus it is necessary to improve the awareness of this disease.In this paper，we reported a child with HTGP caused by lipoprotein lipase gene mutation and reviewed relevant studies，and recommended that genetic testing should be performed early for patients with suspected HTGP，to provide a reference for clinical early diagnosis and treatment，as well as the improvement of prognosis of this disease.

   

  Analysis and Reflection on Hospital-based Rehabilitation and Postdischarge Community-based Intelligent Cloud Rehabilitation Mode for Spinocerebellar Ataxia Type 2 in a Child　

  QIAN Xue，ZHUANG Ren，HE Jun*，YANG Ling    

  Rehabilitation Center of Dean Hospital，Changzhou 213000，China

  *Corresponding author：HE Jun，Associate chief physician；E-mail：hj197874@126.com

  Abstract: Background　Childhood onset of spinocerebellar ataxia type 2（SCA-2）is very rare.Currently，in addition to symptomatic drug treatment，active rehabilitation treatment is the key to possibly maintaining the self-care ability and improving quality of life in SCA-2 patients.Objective　To analyze the hospital-based rehabilitation and postdischarge community-based intelligent cloud rehabilitation for a child with SCA-2，to provide a reference for the delivery of rehabilitation treatment for such patients.Methods　Retrospective analysis was conducted on the clinical data，hospital-based rehabilitation treatment strategies and effect of postdischarge community-based intelligent cloud rehabilitation treatment for a child with SCA-2 who was admitted to the Rehabilitation Center of Changzhou Dean Hospital in 2018.Results　After 30 days of in-hospital systematic rehabilitation treatment，the child showed significant improvement in coordination，balance，feeding ability and other functions，indicating that he could take care of himself basically.After 1 year of postdischarge community-based intelligent cloud rehabilitation treatment，the child’s memory and attention showed a declining trend，but there was no significant decline in his coordination，balance，transfer，feeding and walking abilities，and he was able to complete the indoor 10-meter walk，take care of himself basically，and manage to attend school normally.And family and social supports for him are continuing to improve.Conclusion　This pediatric case of SCA-2 presented significant improvement in coordination，balance，eating and walking abilities and could basically take care of himself after in-hospital systematic rehabilitation treatment delivered based on precise assessment，and postdischarge community-based intelligent cloud rehabilitation treatment.Postdischarge community-based intelligent cloud rehabilitation mode may be as a new mode of continuing rehabilitation by community physicians to deliver home-based rehabilitation trainings and to deliver rehabilitation treatment for patients with lifelong diseases.

   

  Research Progress on Prognosis of Children with Autoimmune Epilepsy Encephalopathy　

  ZHANG Kai，LU Hongru，SUN Suzhen*    

  Children's Hospital of Hebei Province，Hebei Medical University，Shijiazhuang 050000，China

  *Corresponding author：SUN Suzhen，Chief physician；E-mail：sunsuzhen2004@126.com

  Abstract: Autoimmune epileptic encephalopathy（AEE） is a potentially treatable neurological disease.It usually refers to acute or subacute seizures that occur in the presence of encephalopathy.The neuronal targets of autoimmune epilepsy encephalopathy related to children mainly include NMDA receptor，GABA receptor，LGI1 receptor，AMPA receptor，glycine receptor，MOG and so on.At present，the main prognosis of children's AEE is through the modified Rankin Scale（mRS） and Pediatric Cerebral Performance Category（PCPC）.According to the scale evaluation，85% of the children have a good prognosis，but some studies have shown that some children have sequelae such as decreased learning ability，cognitive impairment，and social impairment，but there is no obvious manifestation in the scale.This article will review the latest research progress in children's AEE prognosis，aiming to provide a theoretical basis for clinicians' early follow-up，identification and prevention.

   

  Evaluation of Pediatric Clinical Competency Training Program for Community General Practitioners and Its Impact on the Operation of Community Pediatric Clinic　

  LOU Rongrong1，CHEN Liang1*，LI Qiang1，ZHOU Jing2*，ZHU Shanzhu2    

  1.Huangdu Community Health Center/Jiading General Medical Training Center，Shanghai 201804，China

  2.Department of General Practice，Zhongshan Hospital，Fudan University，Shanghai 200032，China

  *Corresponding author：ZHOU Jing，Associate chief physician；E-mail：dreamingkoala@126.com

  Abstract: Background　In China，the contradiction between supply and demand of pediatric services is increasingly prominent，and the development of general pediatrics may be the most likely breakthrough to alleviate the shortage of pediatric resources. In Jiading District，community hospitals were incapable to deliver pediatrics services to satisfy residents' needs. To rationally allocate pediatrics resources，and address the issue of too many resources used by common pediatric illnesses and frequently-occurring pediatric diseases in children's hospitals，Jiading District Health and Family Planning Commission（now known as Jiading District Health Commission） has initiated Shanghai's Jiading pediatric clinical competency training program for general practitioners（GPs） in 2017. Objective　To investigate the influence of the implementation of Shanghai's Jiading pediatric clinical competency training program for GPs for the first time on the operation of pediatric clinic in 13 community health centers（CHCs） in this district. Methods　From January to March 2018，we conducted a survey with 14 GPs with an experience of attending Shanghai's Jiading pediatric clinical competency training program for GPs and other GPs without from 13 CHCs. A self-designed 49-item questionnaire was used to collect the general personal data，status of the operation of community pediatric clinic and suggestions for pediatric training. Results　All the 207 cases participating in the survey handed in responsive questionnaires including 14 trained GPs and 193 untrained GPs. Among the trained GPs，50.0%（7/14） reported that they were capable to deliver pediatric outpatient services，78.6%（11/14） reported that they could master the emergency treatment of some common critical pediatric diseases，and 71.4%（10/14） believed that they had mastered the rules in pediatric drug therapies. Compared with untrained GPs，the willingness of trained GPs to carry out pediatric diagnosis and treatment and carry out pediatric outpatient service time were different（P<0.05）. A few months of operating a pediatric clinic showed that the visits for the clinic in most CHCs were less than 5 in half a day. 64.3%（9/14） of the GPs were willing to participate in more pediatric trainings. Conclusion　The trained GPs thought that their competencies for delivering outpatient pediatric services were increased by training，but they had insufficient experience in pediatric consultations. Further improvement will be needed in introducing more pediatric medicines，increasing pediatric laboratory testing programs and promoting more clinical visits.

   

  Demand for Pediatric Care Based on Analyzing Pediatric Disease Spectrum in the Community：Data from Shanghai's Chongming District　

  ZHU Dehao1，SHI Jianwei1，HUANG Jiaoling1，ZHOU Liang1，YANG Yan2，CHEN Ning3，LIU Qian2，YU Wenya1*    

  1.Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China

  2.School of Economics and Management，Tongji University，Shanghai 200092，China

  3.Tongji University School of Medicine，Shanghai 200092，China

  *Corresponding author：YU Wenya，Assistant professor；E-mail：jsjyyuwenya@sina.cn

  Abstract: Background　Identifying the characteristics of disease spectrum will help to triage patients more rationally，promoting the sound development of different types of hospitals. Objective　To understand the percentage and features of diseases in the pediatric disease spectrum in healthcare institutions in Shanghai's Chongming District，providing scientific basis for rationally guiding the tiered diagnosis and treatment of pediatric diseases and community pediatric care development in this district. Methods　Data about diseases suffered by children and adolescents（0-18 years old） were collected from the hospital health information system of all hospitals in Chongming District from 2016 to 2018. The diseases were analyzed，and ranked by their percentage of the spectrum. Changes in the disease spectrum were analyzed by year，age group，and level of hospitals. Results　In these three years，the outpatient and inpatient visits in the 21 hospitals in Chongming District numbered 410 711，and 15 665，respectively. Among all diseases，the first and third major diseases in each year were respiratory diseases，and digestive diseases，respectively. In diseases treated with outpatient care，skin and subcutaneous tissue diseases accounted for a large proportion，ranking in the top third. Of the diseases treated with inpatient care，the top third was diseased conditions of perinatal origin，and the sufferers were mainly aged 0-5 years. The visits in the tertiary hospitals were much more than those in community hospitals. Moreover，the visits showed a year-to-year growth in tertiary hospitals while demonstrated a year-to-year decline in community hospitals. Conclusion　The spectrum of pediatric diseases in Chongming District is not significantly different from that in other regions. In the prevention and treatment of such diseases，attention should be paid to the local special conditions，such as high-incidence skin and subcutaneous tissue diseases and diseased conditions of perinatal origin in children aged 0-5 years. Furthermore，to achieve tiered diagnosis and treatment for pediatric diseases in this district，it is urgent to develop community pediatric care to improve the diagnosis and treatment level of common pediatric diseases in community hospitals.

   

  Developing Community Pediatrics in China：Necessity，Feasibility，and Recommendations Derived from the US Training System for Community Pediatricians　

  CHEN Chen1，PENG Qihua2，SHI Jianwei2，HUANG Jiaoling2，ZHOU Liang2，LIU Qian3，YANG Yan3，CHEN Ning4，LIU Xiang5，YU Wenya2*    

  1.Jing'an District Jiangning Road Community Health Center，Shanghai 200040，China

  2.Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China

  3.School of Economics and Management，Tongji University，Shanghai 200092，China

  4.Tongji University School of Medicine，Shanghai 200092，China

  5.The 903rd Hospital of PLA，Hangzhou 310013，China

  *Corresponding author：YU Wenya，Assistant professor；E-mail：jsjyyuwenya@sina.cn

  Abstract: Considering the increasing demand for children's health care，including preventive care，and the prominent difficulty of caring children with special health care needs，the development of community pediatrics is the key to dealing with these problems. We discussed the feasibility of developing community pediatrics in China from aspects of national political direction，actual demand for community pediatric care in care needers，and expected development of community pediatric care of the care providers. Moreover，seeing that the US experience of developing community pediatrics is quite quotable，after reviewing the US development of training system for community pediatricians，we put forward suggestions on developing community pediatrics in China，including the training patterns，goals，contents and settings as well as types of educators.

   

  Predictive Value of 20-week Ultrasound Scan of Fetal Bowel Diameter for Adverse Pregnancy Outcome　

  LI Na1，SU Jianqiang2*，SUN Congxin1，ZHANG Yanhong1，ZHAO Wei1，GENG Xuna1，WANG Weijing1    

  1.Department of Ultrasound，the Fourth Hospital of Shijiazhuang，Shijiazhuang 050000，China

  2.Department of Medical Affairs，the Fourth Hospital of Shijiazhuang，Shijiazhuang 050000，China

  *Corresponding author：SU Jianqiang，Attending physician；E-mail：Linawenzhang@163.com

  Abstract: Background　Fetal bowel abnormalities are associated with various adverse pregnancy outcomes，severely threatening the safety of newborns.Objective　To explore the predictive value of 20-week ultrasound scan of fetal bowel diameter for adverse pregnancy outcomes.Methods　150 women with a singleton pregnancy who underwent 20-week scan by Doppler ultrasound at the Fourth Hospital of Shijiazhuang from January 1，2019 to May 3，2020 were selected，by which 50 cases of fetal bowel dilatation and 100 cases of normal fetal bowel were found.Adverse pregnancy outcomes in this study were defined as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，fetal skin edema，and premature delivery.The value of this scan in predicting adverse pregnancy outcomes was estimated.The association of the location of fetal bowel diameter dilation and incidence of adverse pregnancy outcomes was examined.And the association of the fetal bowel diameter with the Apgar score was analyzed.Results　In total，47 women had adverse pregnancy outcomes.The 20-week scan demonstrated 93.6% sensitivity，94.2% specificity，97.0% negative predictive value，88.0% positive predictive value，and 94.0% diagnostic accuracy.The 50 cases of fetal bowel dilatation included 23 cases of duodenal dilatation，15 of jejunum and ileum dilatation，and 12 of colon dilatation.Women with fetal duodenal dilatation had higher incidence of polyhydramnios，induced labor，and premature delivery than those with fetal jejunum and ileum dilatation or fetal colon dilatation（P<0.05）.The inner diameter of the fetal duodenum，jejunum and ileum，and colon was negatively correlated with the Apgar score （r= -0.740，-0.721，-0.659，P<0.05）.Conclusion　The 20-week ultrasound scan of fetal bowel diameter may has good predictive value for adverse pregnancy outcomes，such as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，and premature delivery.Moreover，fetal bowel diameter may be associated with Apgar score.

   

  Pediatric Healthcare Providers' Awareness of Dyslipidemia Incidence in Children and Adolescents and Willingness to Get Their Child（ren） Screened for Lipid Level：a Survey from Beijing　

  YAN Hui1，ZHAO Jie2，LIU Ying2，LI Xueying3，ZHANG Xin1，QI Jianguang1*    

  1.Department of Pediatrics，Peking University First Hospital，Beijing 100034，China

  2.Beijing Maternal and Child Health Institute of Eugenics，Beijing 100069，China

  3.Department of Statistics，Peking University First Hospital，Beijing 100034，China

  *Corresponding author：QI Jianguang，Chief physician；E-mail：qjg2006@126.com

  Abstract: Background　Dyslipidemia is a major cause of atherosclerosis.The incidence of dyslipidemia in Chinese children is rising recently.As a basis for early detection，correct diagnosis and treatment of childhood dyslipidemia，and a key to developing children's appropriate dietary habit and healthy lifestyle，pediatric healthcare providers and parents' appropriate awareness levels of dyslipidemia play an important role in early detection，prevention and control of dyslipidemia in childhood and adolescence.Objective　To explore Beijing pediatric healthcare providers' awareness of dyslipidemia incidence in childhood and adolescence and their willingness to get their child（ren） screened for lipid level，providing a reference for early detection，prevention and control of dyslipidemia in children and adolescents.Methods　A questionnaire survey was conducted among pediatric healthcare providers with a child or children younger than 20 years who attended Beijing Projects for Comprehensive Early Childhood Development and Scientific Rearing from April to September 2019，mainly focusing on their awareness levels of dyslipidemia incidence in childhood and adolescence and willingness to get their child（ren） screened for lipid level，specifically including their child（ren）'s gender and age，awareness of dyslipidemia incidence in children and adolescents，residential area（rural or urban），workplace，occupation，family history of early-onset cardiovascular and cerebrovascular diseases in first-and second-degree relatives，awareness level of lipid in their child（ren） and willingness to get him（them） screened for lipid level，as well as education level of their own and their spouse.Those who chose “children have a dyslipidemia incidence greater than 5%”，and those who chose “children have a dyslipidemia incidence less than 5%” or “children have unstable lipid level” were assigned to correct and incorrect knowledge groups，respectively.Multivariate Logistic regression analysis was used to explore the influencing factors of pediatric healthcare providers' knowledge of dyslipidemia in children and adolescents.Results　There were 247 cases（46.2%） in correct knowledge group，and 288（53.8%） in incorrect knowledge group〔including 109（20.4%） and 179（33.5%） who chose “children have a dyslipidemia incidence less than 5%” or “children have unstable lipid level”〕．Two groups had significant differences in workplace and education level（P<0.05）.Multivariate Logistic regression analysis showed that education level was associated with awareness of dyslipidemia in children and adolescents （P=0.042）.Of the respondents，the rates of knowing their child（ren）'s blood lipid level，knowing the importance of screening for lipid level and willing to get their child（ren） screened for lipid level were 8.2%（n=45），90.4%，and 95.4%（n=523），respectively.Conclusion　More than half of these pediatric healthcare providers had insufficient knowledge of the incidence of dyslipidemia in children and adolescents.Education level may be associated with their awareness level.The overwhelming majority of them did not know their children's blood lipid levels，but thought that dyslipidemia in children was noteworthy and supported the screening for lipid level in children and adolescents.

   

  Parental Intentions and Associated Factors of Contracting Pediatric Oral Healthcare Services Delivered by Family Doctors　

  YANG Mei，JIANG Changyong，SHEN Haiying，HU Wei*    

  Jinyang Community Health Center of Wuhou District，Chengdu 610041，China

  *Corresponding author：HU Wei；E-mail：1532537413@qq.com

  Abstract: Background　The dental caries prevalence rate in children is high，posing a serious challenge to healthcare system. In China，the number of oral healthcare providers is insufficient and unevenly distributed，and the supply of oral health care for a special group is inadequate. Objective　To study parental intentions and associated factors of contracting pediatric oral healthcare services delivered by family doctors，providing a reference for promoting the delivery of comprehensive，continued and coordinated pediatric oral healthcare services and for containing pediatric dental caries. Methods　October 2019 to January 2020，a random sample was selected from the children receiving oral healthcare in six community health centers extracted from Chengdu's Wuhou District by use of stratified sampling. The children's parents（one parent of each child） were invited to attend a questionnaire survey for investigating their and their children's information about basic demographics，children's oral health status and history of using oral healthcare，and choice of institutions for oral healthcare. Results　A total of 311 parents（of 311 children） attended the survey，and 303 of them（97.4%） who responded effectively were finally included. According to the survey results，39.6%（120/303） of children had had oral health problems，11.6%（35/303） of children had received pit and fissure sealing or fluoridation for the prevention of dental caries，36.3%（110/303） of children had received guidance on pediatric oral health，and 68.3%（207/303） of children's parents were willing to accept contracted pediatric oral healthcare services. The parents' intention to contract pediatric oral healthcare services delivered by family doctors differed significantly by whether they had received professional guidance on pediatric oral health，their awareness of oral health knowledge，and whether their children had received pit and fissure sealing or fluoridation for the prevention of dental caries（P<0.05）. Multivariate analysis showed that the parents' intention to contract pediatric oral healthcare services delivered by family doctors was associated with whether their children had received preventive interventions for dental caries such as pit and fissure sealing or fluoridation（P<0.05）. Conclusion　Parents who have oral health knowledge，have received professional oral health guidance and their children have received pit and fissure sealing or fluoridation for the prevention of dental caries are more likely to contract pediatric oral healthcare services delivered by family doctors. So during vigorously carrying out comprehensive intervention projects for children's oral diseases in schools，primary medical institutions should deliver management services involving both pediatric health and school health with priority given to health education and outpatient preventive interventions，and actively deliver contracted pediatric oral healthcare services to all school-age children to reduce dental caries prevalence rate.

   

  Clinical Diagnostic and Therapeutic Approaches in Primary Care Practice：a Case Study of an Infant with Fever and Rash　

  PAN Shanshan，WANG Jing*    

  Teaching-Research Office of General Practice，Department of Clinical Medicine，Hangzhou Medical College，Hangzhou 310053，China

  *Corresponding author：WANG Jing，Professor；E-mail：wj631001@qq.com

  Abstract: We reported an infant with fever with rash encountered by a general practitioner.The diagnostic procedure was carried out from a general practice approach with John Murtagh's safe diagnostic strategy-a method of five clinical questions was adopted：（1）What common diseases may manifest cause fever with rash？（2）What serious disorders must not be missed？（3）Could the patient have a masquerading illness？（4）What conditions are often missed？（5）Is the patient's family member trying to say something？Besides detailed consultation，careful physical examination and auxiliary examination were also carried out，and the infant was eventually diagnosed with Kawasaki disease.The implications of this case are:（1）Kawasaki disease may be considered if the infant has fever with lymphadenopathy，and bacterial infection suggested by routine blood test as well as poor responses to antibiotic therapy.（2）Infantile febrile disease with rash following medication should not be simply attributed to drug allergy，which may be alerted to the possibility of Kawasaki disease.（3）Attention should be paid to distinguish facial manifestations，such as conjunctival hyperemia，erythema and cracking of lips，erythema of oral mucosa and “strawberry” tongue of Kawasaki disease from those of acute febrile disease during asking medical history and conducting physical examination.At the same time，psychological counseling should be given to the family members of the infant，based on the view of individual-centered and family-based general practice.

   

  Clinical Characteristics of Hospitalized Children with Hand-foot-mouth Disease in Kunming from 2008 to 2017　

  WANG Meifen 1，FU Tiantian2，LUO Yunjiao1，PENG Junchao1，DU Lijiang1，DU Zengqing1，GAN Quan1，MA Wei1，LU Zhiying1，LIU Chunli1，JIANG Hongchao1*    

  1.Kunming Children's Hospital/Yunnan Key Laboratory of Children's Major Disease Research，Kunming 650034，China

  2.Department of Pediatrics，Luoyang Central Hospital Affiliated to Zhengzhou University，Zhengzhou 471003，China

  Corresponding author:JIANG Hongchao，Associate chief physician，Master supervisor；E-mail：jianghongchao@etyy.cn

  Abstract: Background　Hand-foot-mouth disease（HFMD） is a global infectious disease caused by more than 20 kinds of enterovirus infections.Since 2008，HFMD has been a high-incidence acute infectious disease in China，with a high prevalence of severe cases，endangering children's health.Objective　To study the clinical characteristics and influencing factors of hospitalized pediatric HFMD cases using the data of a large clinical sample collected from Yunnan Province during 2008 to 2017.Methods　A retrospective design was used.Data of HFMD children with hospitalization experience during 2008 to 2017 were collected through the electronic medical record system of Kunming Children's Hospital，including number of cases，onset time，age，gender，clinical classification and staging of HFMD，and were analyzed using statistical methods.Results　（1）A total of 11 510 HFMD cases were hospitalized in this hospital during this 10-year period.The disease was prevalent throughout the year，and showed a single peak pattern，with a peak period from April to August.（2）Boys outnumbered girls，with a male to female ratio of 1.13:1.The children had an average age-of-onset of（2.37±1.50） years，but showed an uneven age-of-onset distribution，the youngest was 37 days，and the oldest was 14 years old，and those under 3 years had the highest incidence rate，accounting for the largest percentage of the total〔86.72%（9 982/11 510）〕.There were 3 368 common cases（29.26%），and 8 142 severe cases （70.74%）.Of the severe cases，intermediate-to-severe and critical cases accounted for 40.75%（4 690/8 142），and 29.99%（3 452/8 142），respectively，and the percentage of cases aged less than 3 years accounted for 88.02%.The incidence of severe and critical HFMD differed significantly across all age groups（P<0.05）.（3）In the early stage of critical HFMD，the prevalence of hypertension，increased heart rate，accelerated respiration，poor blood circulation in tips of fingers and toes，limb paralysis，and urinary retention was 100.00%（3 452/3 452），94.84%（3 273/3 452），86.44%（2 983/3 452），69.76%（2 408/3 452），1.83%（63/3 452），and 0.41%（14/3 452），respectively.（4）The examination of stool samples from 88.91%（10 234/11 510） of the cases revealed the presence of EV71 in 3 843 cases（33.39%），COA16 in 1 112 cases（9.66%），and other enteropathogens in 3 560 cases（30.93%）.The main pathogens were EV71 and COA16 in 2008—2013，and were EV71 and other enteroviruses in 2014—2017.EV71 was the major pathogen for critical HFMD.Conclusion　The hospitalized children with HFMD and severe cases were mainly under 3 years old.EV71 was the main pathogen causing severe HFMD.Hypertension，increased heart rate，accelerated respiration，and poor circulation in tips of fingers and toes may be the early signals of critical HFMD，which should be controlled and treated.actively.

   

  Protein-energy Malnutrition Prevalence and Influencing Factors in Rural Left-behind Children under 1 Year Old in Zunyi Area　

  ZHANG Fangxia1，HU Ying1，SONG Yanan1，CHENG Yu1，XIANG Yunfeng1，JIN Hongjiao2，LEI Li2，GOU Enjin2，LI Qing2，WANG Xuqin2，LUO Limei2，LIN Yong2，QU Tingnian2，HUANG Bo2*    

  1.Graduate School of Zunyi Medical University，Zunyi 563000，China

  2.Department of Pediatric，the Third Affiliated Hospital of Zunyi Medical University（the First People's Hospital of Zunyi City），Zunyi 563000，China

  *Corresponding author：HUANG Bo，Doctoral supervisor，Master supervisor，Professor，Chief physician；E-mail：672879381@qq.com

  Abstract: Background　Protein-energy nutrition plays an important role not only in cognitive development，but also in the nervous system，growth and development，cardiovascular system，and its influence on physical and intellectual development of 0-1-year-old children may be long-term，unrecoverable.Therefore，research and analysis of children's protein-energy malnutrition（PEM）status and influencing factors are of great significance for preventing PEM and related diseases in left-behind children.However，there is no detailed information on the PEM and health problems of left-behind children（≤1 year old）in rural Zunyi City.Objective　To investigate the PEM prevalence and influencing factors in rural left-behind children under 1 year old in Zunyi area.Methods　From August 2017 to September 2019，a random stratified sampling method was used to select rural left-behind children under 1 year old in Zunyi area for PEM screening.An interview-based or telephone-based questionnaire survey was conducted with the caregivers of the children to collect the sex，age in months，absorption status，diet structure，measured height and weight of the children，and average height of their parents，annual household income per capita，as well as their caregivers' education level.Multivariate Logistic regression analysis was used to explore the influencing factors of PEM in these children.Results　A total of 700 questionnaires were distributed and 650（92.9%）responsive ones were returned.The prevalence of PEM in the children was 32.5%（211/650）.PEM prevalence differed obviously in the children by their age in months，absorption status，diet structure，and their parents' average height，annual household income per capita，as well as their caregivers' education level（P<0.05）.The results of multivariate Logistic regression analysis showed that children's age in months〔OR=9.562，95%CI（4.737，19.299）〕，absorption status〔OR=2.508，95%CI（1.678，3.747）〕，diet structure〔OR=0.298，95%CI（0.196，0.453）〕，average height of children's parents〔OR=0.317，95%CI（0.208，0.481）〕，annual household income per capita〔OR=0.367，95%CI（0.240，0.561）〕and education level of their caregivers 〔OR=0.482，95%CI（0.330，0.704）〕were associated with PEM（P<0.05）.Conclusion　The prevalence of PEM in rural left-behind children under 1 year old in Zunyi area was relatively high.Children's age in months，absorption status，diet structure，average height of children's parents，annual household income per capitaand education level of their caregivers may be associated with  PEM.

   

  Factors Associated with Rotavirus Enteritis with Convulsions in Infants　

  HU Shuying1，WANG Liying1，LI Minglei2，PAN Yuyu2，LIU Xiaoyu3，LYU Zufang2*    

  1.Weifang Medical University，Weifang 261000，China

  2.Department of Pediatric Medicine，Weifang People's Hospital，Weifang 261041，China

  3.Department of Anesthesiology，People's Hospital of Weifang，Weifang 261041，China

  *Corresponding author：LYU Zufang，Chief physician；E-mail：LZF7900@163.com

  Abstract: Background　Rotavirus enteritis is a main cause of diarrhea among infants.It is an epidemic more commonly happened in autumn and winter，which can cause damage to the digestive system such as the gastrointestinal tract and liver，and to multiple systems such as breathing，circulation，and nerves，and can lead to death in severe cases.Rotavirus enteritis with central nervous system damage can cause symptoms such as convulsion，coma，and limb paralysis，of which convulsion is the most common，but the pathogenesis is not fully clear.To reduce the possibility of developing convulsion and brain damage associated with rotavirus enteritis，it is of great clinical significance to identify high risk factors of convulsion and timely deliver interventions based on analyzing its causes and clinical manifestations.Objective　To explore the influencing factors of rotavirus enteritis complicated with convulsions in infants.Methods　One hundred and thirty-four infants with rotavirus enteritis（including 47 with convulsions and 87 without）were recruited from Department of Pediatric Medicine，Weifang People's Hospital from January 2018 to December 2019.After admission，fecal sample was collected for performing rotavirus antigen test using ELISA.Fasting venous blood sample was collected for performing routine and biochemical blood tests.Mid-stream urine sample was collected for performing routine urine test.Information was recorded，including sex，age，vomiting frequency，diarrhea frequency，status of fever and dehydration，levels of serum sodium，potassium，chlorine and calcium，glucose，CO2-binding capacity，creatine kinase isoenzyme MB（CK-MB）and other indicators.Multivariate logistic regression analysis was used to explore the influencing factors of rotavirus enteritis complicated with convulsions.Results　Rotavirus enteritis infants with convulsions had much more diarrhea frequencies and higher serum CK-MB，and lower fever prevalence，and lower levels of serum calcium，glucose and CO2-binding capacity compared to those without（P<0.05）.Multivariate logistic regression analysis showed that fever 〔OR=0.131，95%CI（0.045，0.383）〕，serum calcium 〔OR=66.923，95%CI（5.630，795.468）〕，serum glucose 〔OR=1.958，95%CI（1.316，2.915）〕，and CK-MB〔OR=0.989，95%CI（0.979，1.000）〕 were associated with rotavirus enteritis complicated with convulsions（P<0.05）.Conclusion　Diarrhea frequency，status of fever，serum levels of calcium，glucose，CO2-binding capacity and CK-MB，especially status of fever，serum calcium，glucose and CK-MB，may affect the occurrence of convulsions in rotavirus enteritis in infants.To prevent convulsion incidence，it is suggested to analyze the patient's detailed medical history and biochemical examination results to early identify risk factors for convulsions and deliver targeted interventions timely.

   

  Clinical Characteristics and Risk Factors for Critical-ill Events in Children with Severe Influenza　

  WANG Yakun1，HOU Wei1，JIA Meixuan1，WANG Qian1，ZHANG Wenchao2，TIAN Liyuan1*    

  1.No.1 Respiratory Department，Hebei Children's Hospital，Shijiazhuang 050031，China

  2.Clinical Laboratory，Hebei Children's Hospital，Shijiazhuang 050031，China

  *Corresponding author：TIAN Liyuan，Chief physician；E-mail：443554276@qq.com

  Abstract: Background　 Influenza is an acute respiratory infectious disease caused by influenza virus，which can cause outbreaks and epidemics in the world，and may result in serous outcomes in children。But the mechanism for critical-ill events occurring in children is still under exploration.Objective　To explore the clinical characteristics and risk factors of critical-ill events in children with severe influenza.Methods　We selected 76 children with severe influenza who were admitted to Hebei Children's Hospital from December 2018 to March 2019，and divided them into severe group（52 cases）and critically ill group（24 cases）according to disease severity.We collected their general clinical data（gender，months of age，influenza type，presence or absence of underlying diseases，complication involved system，white blood cell count，neutrophil count，hemoglobin，platelet count，C-reactive protein（CRP），calcitonin，lactate dehydrogenase（LDH），imaging findings，etiological results and other information，and compared the differences between severe and critically ill cases.Results　Nineteen of 76 cases（25.0%）had underlying diseases.The most common complication of severe influenza was respiratory system involvement（100.0%），followed by nervous system involvement（28.9%），and digestive system involvement（15.8%）.Critically ill cases had higher incidence of nervous system involvement and LDH level and lower hemoglobin level than severe cases（P<0.05）.Chest imaging found 56 cases of pulmonary light or patchy shadows，30 cases of lung consolidation，9 cases of pleural effusion，10 cases of uneven light transmittance in both lungs and 8 cases of air leak syndrome.All the decreased had lung consolidation，among whom 3 also had air leak syndrome，and 2 also had pleural effusion.The incidence of lung consolidation in critically ill group was higher than that in severe group（P<0.05）.Sixty-seven of the 76 cases（88.2%）were detected with other pathogenic microorganisms.A total of 67 cases（88.2%）were found with virus infection，among whom 59（77.6%）mainly with adenovirus.A total of 23 cases（30.3%）were found with bacteria infection，and 11（14.5%）of them mainly with Haemophilus influenzae.Ten cases（13.2%）were found with Mycoplasma pneumoniae infection.The detection rate of bacteria as the cause of influenza in critically ill group was higher than that of severe group（P<0.05）.Conclusion　Most children with severe influenza will suffer from respiratory system involvement.Lung consolidation，nervous system involvement，anemia，increased LDH，and bacterial infections may increase the risk of critical illness.

   

  Interpretation of Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery：Enhanced Recovery After Surgery （ERAS?） Society Recommendations　

  SHI Zeyao，WU Yang，LI Xiaowen，WAN Xingli，CHEN Qiong，HU Yanling*    

  West China Second University Hospital，Sichuan University，Chengdu 610066，China

  *Corresponding author：HU Yanling，Nurse-in-charge；E-mail：14023913@qq.com

  Abstract: Enhanced Recovery After Surgery （ERAS） refers to a series of optimized management measures taken during the perioperative period under the guidance of evidence-based medicine.Since the concept of ERAS was proposed in 2001，the ERAS? Society has issued more than 10 surgical guidelines，covering various fields such as obstetrics and gynecology，orthopedics，and cardiovascular surgery.In May 2020，the ERAS? Society issued its first neonatal surgical guidelines，which provides multiple evidence-based recommendations for neonatal perioperative management.This article interprets the guidelines，aiming to offer evidence-based suggestions for physicians and nurses to improve the quality of perioperative care in neonatal intestinal surgery，thereby enhancing the survival quality of the neonates.

   

  Primary Hyperoxaluria Type 1：Report of One Pediatric Case and Literature Review　

  ZHOU Xudong，ZHAO Xinghua*，XU Changbao，LI Wuxue，ZHAO Yongli    

  The Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450000，China

  *Corresponding author：ZHAO Xinghua，Chief physician；E-mail：xiaoxin2199@2126.com

  Abstract: Primary hyperoxaluria type 1 （PH1） is an autosomal recessive genetic disease，with clinical manifestations of repeated kidney stones and progressive renal calcification，usually starting in childhood，and eventually developing to end-stage renal disease as the progressive deterioration of the disease.Currently，AGXT gene sequencing has gradually substituted liver biopsy，and become a first diagnostic method for PH1.And early treatment options of PH1 are mainly conservative therapies.We reported a pediatric case of PH1，with detailed analysis and summary of the clinical characteristics and management methods，aiming to provide a reference for clinicians to diagnose and treat the disease.

   

  Clinical Effect of Hewei-acupuncture Manipulation as an Adjuvant Therapy for Sleep Disorder in Children with Cerebral Palsy　

  XU Xia1，CONG Yan1，HE Kelin2，3，MA Ruijie2，3*    

  1.Yiwu Maternity and Children Hospital，Yiwu 322000，China

  2.The Third Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310053，China

  3.Zhejiang Chinese Medical University，Hangzhou 310053，China

  *Corresponding author：MA Ruijie，Chief physician；E-mail：maria7878@sina.com

  Abstract: Background　Acupuncture，a therapy of traditional Chinese medicine，has unique advantages on sleep disorder in children with cerebral palsy，but there is no clinical study about Hewei-acupuncture manipulation in treating this disease.Objective　To explore the clinical effect of Hewei-acupuncture manipulation as an adjuvant therapy for sleep disorder in children with cerebral palsy.Methods　A total of 80 cerebral palsy children with sleep disorders were selected from Child Rehabilitation Department of Yiwu Maternity and Children Hospital from January to December 2019 and equally divided into conventional treatment group and Hewei-acupuncture manipulation group using a computer-based random allocation algorithm，receiving scalp acupuncture，and scalp acupuncture with Hewei-acupuncture manipulation，respectively，once daily，for a total of 30 times（a course of treatment）in addition to the conventional rehabilitation treatment.Sleep status was assessed by the Children's Sleep Habits Questionnaire（CSHQ）before，during and after one month of treatment.Responses to the treatment were assessed at the end of treatment.The incidence of acupuncture-related complications was recorded.Results　Eight dropouts in each group were excluded，the remaining 32 cases were finally included.The average scale and factor scores of CSHQ were similar in both groups at baseline（P>0.05）.They decreased significantly during and at the end of one month of treatment in both groups（P<0.01），but demonstrated no obvious intergroup differences（P>0.05）.The Hewei-acupuncture manipulation group had a much higher rate of response to treatment〔87.5%（28/32）vs 65.6%（21/32），P<0.05 〕.No acupuncture-related complications occurred in both groups.Conclusion　Hewei-acupuncture manipulation has partial clinical effects and advantages in cerebral palsy children with sleep disorder，which may effectively improve the sleep habits and quality，and thus provide a new idea for acupuncture and moxibustion therapy and acupoint selection in treating this disease.

   

  Chromosome Detection Results and Related Factors in Second-trimester Fetuses with Nasal Bone Abnormalities　

  HOU Dongxia，HOU Liqing，WUYUNTANA，JI Yunpeng，WANG Xiaohua*，JI Xiaoping*    

  Department of Genetic Eugenics，Inner Mongolia Maternal and Child Care Hospital，Hohhot 010060，China

  *Corresponding authors：WANG Xiaohua，Chief physician；E-mail：wangxiaohua2222@163.com

  JI Xiaoping，Chief physician；E-mail：xp_0902@sina.com

  Abstract: Background　Fetal nasal bone development，an item assessed by routine prenatal ultrasound，is often used as a key ultrasound marker for assessing fetal chromosomal anomalies.With recent application of chromosomal microarray analysis（CMA），prenatal fetal chromosomal diseases have been detected in a wider range and with higher accuracy.So it is necessary to re-summarize the correlation between nasal bone abnormalities and chromosomal abnormalities，to provide evidence for clinical practice.Objective　To investigate the predictive value of fetal nasal bone abnormalities or its combination with other prenatal risk factors for chromosomal abnormalities，and to evaluate the application value of CMA in the genetic examination of fetal nasal bone abnormalities.Methods　92 pregnant women with fetuses with prenatal ultrasound-suggested nasal bone abnormalities were recruited from Inner Mongolia Maternal and Child Care Hospital from December 2016 to January 2020.Prenatal examination information，prenatal genetic test results（including karyotype analysis and CMA） and pregnancy outcomes were collected.Results　Karyotype analysis detected chromosome abnormalities in 19 cases （20.7%），all of which were trisomy 21.CMA detected chromosomal abnormalities in 25 cases （27.2%），including 19 cases of trisomy 21 and 6 cases of chromosomal microdeletions and microduplications.There was no statistical difference in the rate of chromosome abnormalities between fetuses with isolated and non-isolated nasal bone abnormalities （P>0.05）.Compared with fetuses with isolated nasal bone abnormalities，the incidence of chromosomal abnormalities in those with isolated nasal bone abnormalities with increased nuchal translucency thickness，isolated nasal bone abnormalities with high risk for chromosomal abnormalities suggested by maternal serum screening，isolated nasal bone abnormalities with high risk for chromosomal abnormalities suggested by non-invasive prenatal testing，or isolated nasal bone abnormalities with 2 or more high-risk factors for chromosomal abnormalities was increased（P<0.05）.Conclusion　The incidence of chromosomal abnormalities in fetuses with nasal bone absence or hypoplasia was higher，which was related to copy number variations.Karyotype analysis and CMA in combination with other prenatal examinations may effectively improve the detection rate of chromosomal abnormalities.The application of CMA technology provides more information on chromosome variation for prenatal diagnosis，and it is recommended that all fetuses with nasal bone absence or hypoplasia should be tested by karyotype analysis and CMA.

   

  Predictive Value of Daily Fetal Movement Count Chart for the Fetal Safety of Fetus with Umbilical Cord around Neck　

  YE Aimei，LI Zijun*，AI Xiaoyu    

  Zhejiang Quhua Hospital，Quzhou 324004，China

  *Corresponding author：LI Zijun，Chief physician；E-mail：lizijunclark@126.com

  Abstract: Background　Fetal movement is the only index that is assessed by pregnant women subjectively，but can objectively reflect the safety of fetus.How to quantify fetal movement and make it be a relatively objective evaluation index has been a research focus of obstetricians.Objective　To predict the fetal safety of fetus with umbilical cord around neck by using the daily fetal movement count chart （DFMC）.Methods　A retrospective design was used.Participants were 100 pregnant women who were hospitalized in Zhejiang Quhua Hospital for a full-term delivery from January 2010 to January 2016.Their babies had antepartum B-mode ultrasound suggested umbilical cord around neck，which was confirmed at birth.The DFMC of 24 hours before delivery was collected and used to predict the fetal safety （fetal safety and unsafety were defined as normal fetal movement，and abnormal，decreased or disappeared fetal movement，respectively）.Other clinical data were collected，including maternal age，gestational week，systolic-diastolic（S/D） ratio in the umbilical artery measured by Doppler ultrasound，amniotic fluid index，modified Fischer score of the results of non-stress test performed 24 hours before delivery，neonatal outcome after delivery（44 with safety and 56 without），delivery mode（vaginal，cesarean or forceps）.Stepwise multiple Logistic regression was used to analyze influencing risk factors of fetal safety of fetus with umbilical cord around neck.Results　There were significant differences in the S/D ratio，the gestational week at which umbilical cord to be found around the baby's neck，fetal movement，modified Fischer score and delivery mode between the two groups （P<0.05）.Stepwise multiple Logistic regression analysis showed that fetal movement and mode of delivery were independently associated with fetal safety of fetus with umbilical cord around neck（P<0.05）.The sensitivity，specificity and Youden's index of DFMC were 86.5%，90.0%，and 0.77，respectively in predicting the fetal safety of a baby vaginally born with umbilical cord around neck，and were 66.7%，94.6% and 0.61，respectively in predicting that of a baby cesarean delivered with umbilical cord around neck.Abnormal, decreased or disappeard fetal movement was accounting for 87.5% （35/40） of the cesarean delivered babies.Conclusion　DFMC may effectively predict the fetal satety of fetus with umbilical cord around neck，and may be used as a clinical indicator for the selection of an appropriate delivery mode in pregnant women with a fetus with umbilical cord around neck.

   

  The Prevalence of Cerebral Palsy in Children Aged 0-6 Years in China：a Meta-analysis　

  FENG Yuxia1，2，PANG Wei1，2，3*，LI Xin1，2，3，YANG Shunbo1，2，LIU Shiyu1，2，LU Shuqing1，2    

  1.Rehabilitation Medicine of Jiamusi University，Jiamusi 154003，China

  2.Children Neural Rehabilitation Laboratory of Jiamusi University，Jiamusi 154003，China

  3.The Third Affiliated Hospital of Jiamusi University/Rehabilitation Center for Child Cerebral Palsy of Heilongjiang Province，Jiamusi 154003，China

  *Corresponding author：PANG Wei，Chief physician；E-mail：363406153@qq.com

  Abstract:BackgroundAs one of the main causes of children's disability, cerebral palsy (hereinafter referred to as CP) affects the improvement of our population quality. At present, the results of researches on the prevalence of children suffering from CP in our country are quite different, and there is a lack of epidemiological studies based on larger sample sizes and the current prevalence of CP. ObjectiveTo learn about the prevalence of CP in children aged 0~6 years in China. MethodsLiteratures on the prevalence of CP in children aged 0~6 years in China were retrievaled through computer in PubMed, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service System, VIP Database (VIP), and China Biology Medicine disc(CBM), and the publication date limited from January 1st to January 1st, 2020. Based on established inclusion criteria, literatures were screened. Meta-analysis was performed on the included literatures with Stata 12.0 software, the prevalence was quantitatively combined, and subgroup analysis was carried out on classification indicators, such as gender and age. ResultsThis study finally included 8 papers of medium or above quality, with a total of 527,758 people, including 1,022 CP children.The results of meta-analysis proved that the overall prevalence of CP in children aged 0 to 6 in China was 0.23%〔95%CI(0.17%, 0.29%)〕. The subgroup analysis results revealed that the prevalence of boys was 0.22%〔95%CI(0.14%, 0.29%)〕, the prevalence of girls was 0.12%〔95%CI(0.06 %, 0.19%)〕. The prevalence of CP among children at the ages of below one years, one years, two years, three years, four years, five years, and six years was 0.21%〔95%CI(0.02%, 0.40%)〕, 0.20%〔95%CI(0.10%, 0.30%)〕, 0.19%〔95%CI(0.08%, 0.30%), 0.21%〔95%CI(0.09%, 0.32%)〕, 0.13%〔95%CI(0.02%, 0.24%)〕, 0.20%〔95%CI(0.09 %-0.32 %)〕, 0.32 %〔95%CI(0.14 %-0.50 %)〕, respectively. ConclusionThe prevalence of CP in children aged 0 to 6 in China was 0.23%, and the prevalence of gender and age was different, guiding significance for policy formulation and clinical intervention. It is recommended to conduct more cross-sectional investigations based on the new classification of CP.

   

  Risk Factors Associated with Perinatal Respiratory Complications in Late Preterm Small for Gestational Age Infants　

  YUAN Erwei*，GUO Huaxian，XU Jinli，ZHAO Wenhui，ZHAO Meilin，WANG Lingling    

  Department of Pediatrics，the First Affiliated Hospital of Hebei North University，Zhangjiakou 075000，China

  *Corresponding author：YUAN Erwei，Attending physician；E-mail：13931306056@163.com

  Abstract: Background　The physical development of small-for-gestational-age（SGA） infants is poorer than that of appropriate-for-gestational-age（AGA） infants，and they are prone to complications such as respiratory distress syndrome，pulmonary infection，feeding intolerance，cerebral palsy，growth and development retardation.In particular，late preterm SGA infants are more susceptible to respiratory diseases.However，there are relatively few studies on the risk factors of perinatal respiratory complications in late preterm SGA infants.Objective　To investigate the occurrence and risk factors of perinatal respiratory complications in late preterm SGA infants.Methods　A retrospective analysis was conducted on the clinical data of late preterm infants（n=100）admitted to the First Affiliated Hospital of Hebei North University from January 2015 to January 2017 except large-for-gestational-age infants.They were then divided into SGA infants（n=45）and AGA infants（n=55）based on birth weight and were compared in terms of perinatal respiratory complications incidence.Univariate analysis was used to screen maternal and infant-related factors possibly associated with infant respiratory complications by comparing SGA infants with respiratory complications（n=28）and those without（n=17），and the identified high-risk factors were further analyzed with multivariate Logistic regression.Results　The incidence of perinatal respiratory complications in SGA infants was significantly higher than that of AGA infants（62.2% vs. 41.8%，χ2=4.122，P<0.05）.SGA infants with respiratory complications had higher prevalence of maternal-related factors associated with infant respiratory complications，including pregnancy-induced hypertension，multiple pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of membranes，history of asphyxia，and placental abruption，and higher prevalence of neonatal sepsis compared with those（P<0.05）.Multivariate Logistic regression analysis showed that pregnancy-induced hypertension，multiple pregnancy，infection during pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of fetal membranes，history of asphyxia，and neonatal sepsis were significantly associated with perinatal respiratory complications in late preterm SGA infants（P<0.05）.Conclusion　 Late preterm SGA infants may have higher incidence of perinatal respiratory complications than late preterm AGA infants，which may be closely associated with maternal pregnancy-induced hypertension，multiple pregnancy，infection during pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of membranes，history of asphyxia，and neonatal sepsis.

   

  Effect of Glucocorticoids on Changes of Automatic Nerve Function in Children with Kawasaki Disease and Intravenous Immunoglobulin Resistance　

  FU Qiang1，2*，HUANG Huali1，LI Aimin1，2    

  1.Department of Pediatrics，Jingzhou Central Hospital，Jingzhou 434020，China

  2.Institute of Pediatrics，Yangtze University，Jingzhou 434020，China

  *Corresponding author：FU Qiang，Associate chief physician，Master supervisor；E-mail：fuqiang5918@163.com

  Abstract: Background　Children with acute kawasaki disease（KD） have reduced parasympathetic nerve function，and mainly treated with aspirin and intravenous immunoglobulin（IVIG） currently.Glucocorticoids are required for ineffective treatment in the early stage，but the conventional view is that glucocorticoids could change the excitability of vagus nerve and promote blood coagulation，increasing the risk of coronary artery tumor formation.Therefore，early application is not recommended.For children with early signs of IVIG resistance，if glucocorticoids are not applied，the disease may be further aggravated.However，there is no report about the relationship between glucocorticoids and the changes of automatic nerve function in KD children at present.Objective　To analyze the effect of glucocorticoids on changes of autonomic nerve function in children with KD and IVIG resistance.Methods　We selected 40 KD children in the Department of Pediatrics of Jingzhou Central Hospital from January 1 in 2017 to June 30 in 2019.According to the presence and absence of the coronary artery lesion（CAL），patients were divided into CAL group（n=14） and non-CAL group（n=26）.Fifteen healthy children admitted to the hospital for physical examination during the same period were selected as the control group.The changes in heart rate variability（HRV） of 24-hour ambulatory electrocardiogram in three groups were observed，including the standard deviation of normal-to-normal intervals（SDNN），standard deviation of the averages of normal-to-normal intervals in 5-minute segments（SDANN），the percentage of successive NN intervals>50 ms（pNN50） and the root-mean square of successive R-R differences as time-domain analysis（RMSSD）.We also assessed the HRV changes of 24-hour dynamic electrocardiogram in KD children with IVIG resistance before and after methylprednisolone treatment when their body temperature stabilized for 48 hours.Results　There was no significant difference in SDANN among three groups（P>0.05）.There were significant differences in SDNN，pNN50，and RMSSD among three groups（P<0.05）.The SDNN，pNN50，and RMSSD in CAL group and non-CAL group were lower than those in the control group，and CAL group had the lowest SDNN，pNN50，and RMSSD（P<0.05）.There were six cases of KD patients with IVIG resistance，all of whom were combined with CAL.There was no significant difference in SDNN，SDANN，pNN50，and RMSSD among KD patients with IVIG resistance before and after the methylprednisolone treatment（P>0.05）.Conclusion　Autonomic dysfunction exists in children with KD in acute phase.Reduced excitability of vagus nerve may be related to coronary artery dilatation.Glucocorticoids have no significant effect on the autonomic nervous function of KD children with IVIG resistance.

   

  Value of Intra-abdominal Pressure Measurement in Mechanically Ventilated Children with Severe Pneumonia　

  WANG Xiaodong1*，LUO Jiaxin2，HUO Ximin1，CAO Lijing1，XU Meixian1，GENG Wenjin1，GUO Yanmei1，LI Jun'e1    

  1.ICU，Hebei Children's Hospital，Shijiazhuang 050031，China

  2.University of California San Diego，San Diego 92092，United States of America

  *Corresponding author：WANG Xiaodong，Chief physician，Associate professor，Master supervisor；E-mail：864267051@qq.com

  Abstract: Background　Severe pneumonia in children，which is often accompanied by organ damage，needing mechanical ventilation.Therefore，early and effective intra-abdominal pressure（IAP） monitoring is the key to rescuing children with critical respiratory illness，but there are few reports.Objective　To evaluate the role of IAP under different types of respiratory support in the rescue and prognostic prediction of severe pneumonia in children，providing reliable evidence for organ protection in treating this disease.Methods　150 children with severe pneumonia who were admitted to the ICU，Hebei Children's Hospital from December 2015 to April 2018 were enrolled.Clinical data were collected，including demographic factors（gender，age and so on），blood test parameters 〔procalcitonin（PCT），C-reactive protein（CRP），oxygen saturation（SaO2），arterial partial pressure of oxygen（PaO2），arterial partial pressure of carbon dioxide（PaCO2）〕，symptomatic treatment，and type of respiratory support 〔nasal cannula oxygen therapy（group A，n=50），continuous positive airway pressure（CPAP）（group B，n=50）and mechanical ventilation（group C，n=50）〕，and IAP measured at 24 and 72 hours after admission.Subgroup comparisons of ventilator parameters〔positive end expiratory pressure，peak inspiratory pressure（PIP），fraction of inspired oxygen（FiO2）〕 and incidence of MODS and ACS were performed between those with 72 hours post-admission increased IAP（n=32）and normal IAP（n=18）in group C 〔increased and normal IAP were defined as >10 mm Hg（1 mm Hg=0.133 kPa）and ≤10 mm Hg，respectively〕.Results　Group B had a younger average age than other groups（P<0.05）.Group C had higher average levels of admission CRP，PCT and PaCO2 and lower average levels of admission SaO2 and PaO2 than other groups（P<0.05）.There was no significant difference in average IAP levels among the three groups on admission（P>0.05）.There were significant differences in average IAP levels between the three groups at 24 and 72 hours of respiratory support（P<0.05）.In particular，group C had higher average IAP level at 24 or 72 hours of respiratory support than other groups（P<0.05）.There were significant differences in average IAP levels between groups B and C at different time points（P<0.05）.The average IAP levels in group C measured at admission，24 and 72 hours of respiratory support showed a successive increase trend（P<0.05）.In group C，those with 72 hours post-admission increased IAP had higher average PIP and FiO2 and higher incidence of MODS than those with normal IAP（P<0.05）.Conclusion　IAP may be influenced by the level of airway pressure caused by the three types of respiratory support.PIP and FiO2 under mechanical ventilation may have a significant impact on IAP，which suggests that these two parameters should be lowered as soon as possible in clinical treatment to reduce iatrogenic damage.Dynamic monitoring of IAP in children with pneumonia has a predictive value for the evolution of disease and the degree of organ damage in severely ill children.

   

  Effect of Community-based Monitoring on Blood Pressure Control in Preschool Children：a Pilot Study　

  CHEN Yitong1，MA Mingjing2，JI Lang1，WU Wen2，MENG Linghui1*    

  1.Center for Evidence-based Medicine，Office of Science & Technology，Capital Institute of Pediatrics，Beijing 100020，China

  2.Chaoyang District Tuanjiehu Community Health Center，Beijing 100026，China

  *Corresponding author：MENG Linghui，Associate professor；E-mail：linghui61@163.com

  Abstract: Background　The prevalence of hypertension in childhood increases year by year. Childhood hypertension will bring long-term health risks to the human body. As it is often asymptomatic，early diagnosis and treatment are the key to effective management of this disease. However，the blood pressure monitoring management model for preschool children is not clear. Objective　To develop a simple and feasible community-based blood pressure monitoring mode for preschool children. Methods　From January to July 2018，our research group entrusted Tuanjiehu Community Health Center to screen for hypertension in preschool children（n=382） in its service coverage area，and the children were given stratified management according to their blood pressure levels（blood pressure monitoring methods and hypertension diagnostic criteria adopted were from the 2010 Blood Pressure Reference Standards for Chinese Children and Adolescents）. Results　The screen identified 42（11.0%） children with hypertension，38（9.9%） with elevated blood pressure and 302（79.1%） with normal blood pressure. Then the blood pressure of the hypertensive children was remeasured twice，but four of them were lost to follow up during the measurement process. Three of them were still hypertensive after three-time measurement were transferred to the cardiovascular clinic of a higher level hospital for clinical diagnosis and treatment. The 47 children with elevated blood pressure（including the above-mentioned 38 children with elevated blood pressure and 9 children who were found with hypertension in the first measurement but were identified with elevated blood pressure in 2 subsequent measurements） were given life behavior interventions according to the results of a survey using the Life Behavior Questionnaire developed by our research group. And the 328（85.9%） children with normal blood pressure were given the routine management of the community health center. Both the rates of self-awareness of suffering from hypertension and receiving hypertension management were 90.5%（38/42）. The average systolic blood pressure of male children was higher than that of female children〔（98±9） mm Hg vs.（95±9） mm Hg〕（P=0.001）. The average diastolic blood pressure of male children was similar to that of female children〔（55±8） mm Hg vs.（55±7）mm Hg〕（P>0.05）. Conclusion　Using this community-based blood pressure monitoring mode，children can receive stratified management according to their blood pressure levels，and those with hypertension can be identified early and transferred to higher level hospitals timely，so this mode is of great significance in early detection and treatment of childhood hypertension.

   

  Clinical Characteristics and Outcome of High-dose Methotrexate on Refractory Langerhans Cell Histiocytosis in Children　

  XIE Yao，ZHAO Weihong*，HUA Ying，SUN Qing，WU Penghui    

  Department of Pediatrics，Peking University First Hospital，Beijing 100034，China

  *Corresponding author：ZHAO Weihong，Chief physician；E-mail：zhaowh3212@126.com

  Abstract: Background　Treatment of refractory Langerhans cell histiocytosis（LCH）is difficult.Methotrexate，a classic antitumor drug，is commonly used at a dose of 0.5 g/m2 in the treatment of LCH.Furthermore，high-dose methotrexate（HDMTX） can cross the blood-brain barrier，and its efficacy increases with increasing concentration.So HDMTX may improve the prognosis of refractory LCH，especially with hypophysis involvement.Objective　To analyze and summarize 5 pediatric cases of refractory LCH treated with HDMTX，offering guidance for clinical treatment of LCH with this therapeutic approach.Methods　Five pediatric cases of LCH from Peking University First Hospital between 2005—2019 with multi-organ injuries and risk organ involvement（RO+）or multiple relapses were selected.Their clinical data were retrospectively collected via reviewing medical records，including general information，symptoms and signs，treatment options，prognosis and follow-up situation.Results　（1）General information，symptoms and signs：the 5 cases included 4 boys and 1 girl，with an age of onset of less than 1.Fever was an initial symptom prevalent in all cases，3 cases had rash，1 case had decreased activity of the right lower limb muscles，1 case had orbital and right lower limb masses.All cases developed multi-organ injuries，and 4 of them had RO+，but it was unclear whether the other 1 also had RO+ at the time of consultation.3 cases had pituitary involvement with diabetes insipidus as clinical manifestation.（2）Treatment：all cases received induction therapy with international standard regimen.4 patients were treated with medium-dose MTX（0.5 g/m2）firstly.Due to early onset and risk organ injury，case 1 was treated with HDMTX（1 g/m2） consolidation therapy for a course of treatment.Case 2 was treated with HDMTX（2 g/m2）for 4 courses because of two episodes of relapses and hypophysis involvement.Case 3 recurred at 6-month of treatment，as the rash did not subside after chemotherapy with the original regimen and new defects appeared at the skull，so a regimen of 6-course HDMTX（2 g/m2）was chosen for treatment.Case 4 had good response at 6-week of initial treatment，but recurred after 1 year and 2 months of discontinuation.Bone destruction increased，the pituitary involved，and central diabetes insipidus symptoms appeared.Considering the good ability of HDMTX crossing the blood-brain barrier，HDMTX（1 g/m2）combined with vinblastine and prednisone were used for two courses.In case 5，considering hypophysis involvement，two courses of HDMTX（1 g/m2）were used.（3）Follow-up and outcome：in case 1，vinblastine was used for maintenance therapy after HDMTX treatment，but has been stopped for 13 years and case 1 survives the disease.In case 2，after 4 courses of HDMTX treatment，the masses disappeared，the skull lesions were stable，the pituitary lesions were controlled，and the diabetes insipidus symptoms disappeared，the curative effect was evaluated as intermediate after 6 weeks of treatment.But the third recurrence occurred after 3 months，then clatrabine was finally used for 5 courses and has been stopped for 5 years，case 2 survives.In case 3，the skin rash was controlled，and the bone lesions stable，the curative effect was evaluated as better after 6 weeks of treatment，and then received the maintenance treatment.At present，the drug has been stopped for 3 years，and disease-free survival was achieved.In case 4，the pituitary lesions were smaller，and the diabetes insipidus symptoms were significantly improved，the curative effect was evaluated as intermediate after 6 weeks of treatment，but the scapular bone destruction was slightly deteriorated and new lesions appeared at the frontal bone and clatrabine was used.Now the drug has been stopped for two years，and disease-free survival was achieved.In case 5，the symptoms of diabetes insipidus disappeared，the curative effect was evaluated as intermediate after 6 weeks of treatment.However，due to pulmonary infection during the treatment，HDMTX treatment was discontinued，and now the case is still receiving maintenance therapy and under the follow-up.（4）Side effects：bone marrow suppression was observed in 4 cases，elevation of glutamate aminotransferase was observed in 3 cases，gastrointestinal reactions such as nausea and vomiting were observed in 3 cases，and no serious adverse reactions of grade 3 or above were observed.Conclusion　HDMTX can be used effectively in the chemotherapy for children with refractory or recurrent LCH with RO+，especially in those with pituitary involvement under the condition of ensuring medication safety.

   

  Systematic Review of Factors Influencing Oral Health-related Quality of Life in School-age Children　

  CHEN Xia，LIU Fangli*，LI Rui，WANG Ying    

  School of Nursing and Health/Institute of Nursing and Health，Henan University，Kaifeng 475000，China

  *Corresponding author：LIU Fangli，Associate professor，Master supervisor；E-mail：liufangli1229@126.com

  Abstract: Background　Various oral problems prevalence remains higher in school-age children，furthermore，they begin developing their self-perception about the appearance of oral and maxillofacial in this crucial period. Oral health problems affect oral health-related quality of life（OHRQoL），what is more，poor OHRQoL has a negative impact on children's intellectual，athletic and social skills development. Therefore，it is important to identify the influencing factors of OHRQoL in children to develop scientific preventive measures. Objective　To identify the influencing factors of OHRQoL of school-age children，to offer theoretical guidance for improving OHRQoL in this group. Methods　From December 18 2019 to January 15 2020，5 databases of PubMed，the Cochrane Library，Web of Science，CNKI，and Wanfang Data were searched comprehensively for studies about OHRQoL in school-age children published from January 2010 to January 2020 using "oral health" "school-age children" and "oral health-related quality of life" as search terms. References of the included studies were also screened. Quality assessment was conducted by two researchers independently according to JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results　1 251 studies were retrieved，and 24 cross-sectional studies of them were finally included. JBI risk of bias assessment revealed that the overall risk of bias was low. Analysis results showed that，clinical oral symptoms such as dental caries，malocclusion，traumatic dental injuries and periodontal disease were associated with decreased OHRQoL，while the use of fillers and fissure sealants and well-treated dental caries were associated with increased OHRQoL. In terms of socioeconomic factors，crowded living environment was associated with decreased OHRQoL，while high parental education level，high household income，and studying in a private school were associated with increased OHRQoL. Female gender，dental fear and bad oral habits and other factors related to personal belief and badly behavior habit were associated with decreased OHRQoL. Conclusion　OHRQoL of school-age children is influenced by clinical oral symptoms，socioeconomic conditions and school types，belief and behavior habit. Oral health together with OHRQoL is not just a public health problem，but also a socioeconomic issue，which needs concerns and supports from all sectors of society.

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