Clinical features and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae pneumonia in children.

BACKGROUND: We analyzed the clinical characteristics of children with plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explored its risk factors. METHODS: We prospectively analyzed clinical data of children with MP pneumonia (MPP) treated with fiberoptic bronchoscopy (FB). Patients were classified into a PB and non-PB group. General information, clinical manifestations, laboratory tests, results of computed tomography scan, and FB findings were compared between groups. We conducted statistical analysis of risk factors for developing PB. RESULTS: Of 1169 children who had MPP and were treated with FB, 133 and 1036 were in the PB and non-PB groups, respectively. There were no significant differences in sex, age, and incident season between groups (P > 0.05). The number of children in the PB group decreased during the COVID-19 pandemic. Compared with children in the non-PB group, those in the PB group had longer duration of hospitalization, increased levels of neutrophil (N), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), alanine transaminase (ALT) and aspartate transaminase (AST); lower levels of lymphocyte (L) and platelet (PLT); and higher incidence of lack of appetite, decreased breath sounds, single lobar infiltrate, pleural effusion, pericardial effusion, mucosal erosion and/or necrosis, and bronchial embolization. L levels and pleural effusion were identified as risk factors in multivariate logistic regression. CONCLUSIONS: Children with PB caused by MPP had a strong and local inflammatory response. L levels and pleural effusion were independent risk factors of PB with MPP in children. Our findings will help clinicians identify potential PB in pediatric patients for early and effective intervention.

Opportunity for invasive mechanical ventilation in NRDS: a retrospective cohort study in China.

PURPOSE: Mechanical ventilation, as a critical breathing support, plays a critical role in the treatment of neonatal respiratory distress syndrome (NRDS). We aim to describe the clinical characteristics of NRDS and give suggestions about when to start mechanical ventilation. METHODS: We conducted a retrospective cohort study, enrolling 95 neonates between December 2016 and October 2021. Diagnosis of NRDS was according to the Berlin definition. Spearman's and ROC analysis was used to determine the variables correlated with hospital stay and optimal opportunity for mechanical ventilation. RESULTS: Ninety-five subjects with NRDS were included. Lower PaO2 and higher PaCO2 in arterial blood gas prompt longer discharge time after mechanical ventilation and total in-hospital stay (p < .05), in which significant correlations were identified in Spearman's analysis. ROC analysis illustrated that mechanical ventilation starting when PaO2 was 52.5 mmHg contributed to the shortest discharge time and in-hospital stay. PaCO2 of 45.4 mmHg was another optimal cut-off value for the initiation of mechanical ventilation with an AUC of 0.636 (sensitivity 91.5%, specificity 29.2%, p = .022). CONCLUSION: PaO2 and PaCO2 were significantly correlated with discharge time and in-hospital stays. When PaO2 was reduced to 52.5 mmHg or PaCO2 increased to 45.5 mmHg, mechanical ventilation was strongly recommended.

Association of maternal pre-pregnancy body mass index and gestational weight gain with Chinese infant growth.

AIM: To evaluate the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with offspring growth from birth to 12 months in China. METHODS: A retrospective cohort of 3764 mother-child dyads, with children born between June 2014 and June 2016, was identified in an electronic medical record database. Maternal pre-pregnancy body weight and height measurements throughout pregnancy were extracted, and body weights and lengths of their children had been measured at birth, 3, 6, 9 and 12 months. The association between maternal pre-pregnancy BMI and GWG and offspring growth was evaluated using repeated-measure general linear models and post hoc tests. RESULTS: Both pre-pregnancy BMI and GWG were significantly associated with the Z-scores for weight and for length during the first year of age. Moreover, their interactions were associated with a greater risk of overweight/obesity of offspring in early infancy after controlling for potential confounding factors. Defined by the Institute of Medicine guidelines, excessive GWG, especially during the first trimester, was associated with an increased risk of offspring overweight or obesity at 12 months old in all maternal pre-pregnancy BMI categories. CONCLUSION: Maintenance of appropriate body weight before and during pregnancy, especially during the first trimester, is crucial to prevent paediatric obesity.

[Maple syrup urine disease and gene mutations in twin neonates].

OBJECTIVE: To investigate the clinical features of one pair of twin neonates with maple syrup urine disease (MSUD) in the Chinese Han population and pathogenic mutations in related genes, and to provide guidance for the early diagnosis and treatment of MSUD. METHODS: The clinical and imaging data of the twin neonates were collected. The peripheral blood samples were collected from the twin neonates and their parents to detect the genes related to MSUD (BCKDHA, BCKDHB, DBT, and DLD). The loci with gene mutations were identified, and a bioinformatic analysis was performed. RESULTS: Two mutations were detected in the BCKDHB gene, missense mutation c.304G>A (p.Gly102Arg) and nonsense mutation c.331C>T (p.Arg111*), and both of them were heterozygotes. The mutation c.304G>A (p.Gly102Arg) had not been reported in the world. Their father carried the missense mutation c.304G>A (p.Gly102Arg), and their mother carried the nonsense mutation c.331C>T (p.Arg111*). CONCLUSIONS: The c.331C>T (p.Arg111*) heterozygous mutation in BCKDHB gene is the pathogenic mutation in these twin neonates and provides a genetic and molecular basis for the clinical features of children with MSUD.