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Gut microbiota regulates the immune response of distal organs through microbiota-metabolites, microbiota related molecular patterns and interactions between microorganisms and immune cells.The gut microbiota can be affected by direct infection of intestine or indirect immunity in coronavirus disease 2019 (COVID-19) epidemic caused by SARS-CoV-2.The gut microbiota can also affect the virus through the diversity of microbiota and the interaction of specific microorganisms and viruses or their metabolites.Beneficial bacteria such as Bifidobacterium adolescentis in the gut microbiota can promote the production of antibodies against COVID-19 vaccine, including inactivated vaccine and RNA vaccine.Microbiota disorder has a long-term impacts on some COVID-19 patients, and interventions of gut microbiota, such as fecal microbiota transplantation, having a certain effect on the treatment of COVID-19.
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Group A Streptococcus (GAS) is a very important pathogenic organism, especially for children.Chinese experts′consensus statement on diagnosis, treatment, and prevention of Group A Streptococcus infection related diseases in children was developed in November 2022 by pediatric experts in the fields of respiration, infection, immunology, testing, cardiovascular, kidney, critical care and prevention in China, aiming to further standardize the prevention and treatment of diseases associated with GAS infections and to promote and maintain the health of children.Its main contents are now explained, including disease burden, prevention, diagnosis, antimicrobial resistance and therapy.
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Good sleep is essential for children′s physical and mental health, growth, and development.Adequate and high-quality sleep positively impacts children′s quality of life, memory, learning, attention, mood, and behavior.Children of different ages have different sleep needs.Children have various sleep problems in different cultures.Therefore, it is significant to guide children to get healthy sleep by popularizing the sleep problems of Chinese children of all ages and in all dimensions.Based on China′s social and cultural background, this paper summarizes the contents related to children′s sleep physiology, good sleep habits, common sleep problems, sleep apnea disorders, hypnagogic sleep, narcolepsy, insomnia, and other issues that interfere with children′s sleep.Chinese sleep experts summarize and interpret the 100 sleep health problems of children that medical workers and parents are most concerned about.To promote children′s sleep health and popularize solutions to sleep problems.
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China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.
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Recently, there have been outbreaks of Group A Streptococcus (GAS) infection in foreign countries.The reasons are varied.With the relaxation of control for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection, it is very likely that concurrent or secondary GAS infection peaks will occur at the same time as the number of Corona Virus Disease 2019(COVID-19) cases increases dramatically.Children are generally susceptible to GAS and are more vulnerable.In response to possible outbreaks, early identification of GAS infections and rational use of antibiotics are particularly important.
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Acute necrotizing encephalopathy (ANE) is a subtype of acute encephalopathy presented with disturbance of consciousness and symmetric bilateral thalamic necrosis in neuroradiology.Patients with ANE had a high mortality or severe neurological sequela.ANE usually secondary to virus infectious disease, in which influenza is a common etiology.During the 3 years of the worldwide pandemic of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection, ANE has become a severe complication and cause of death in children, which has aroused much concern.Here is a review of the research progress of epidemiology, pathogenesis, diagnosis, treatments and prognosis of ANE, in order to improve the knowledge of clinicians on this disease.
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Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.
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Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) and hospitalizations in infants under 1 year of age, seriously jeopardizing infants′ health.Most hospitalizations (up to 80%) due to RSV-LRTI occur in otherwise healthy infants born at term.At present, no effective treatment and preventative measure against RSV is available domestically.Passive immunization with fully human long-acting monoclonal antibody Nirsevimab offers immediate protection for all infants experiencing their first RSV season with one shot, thus ushering in a new era of prevention of RSV infection among infants.
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Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.
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Objective:To explore the epidemiological characteristics of Streptococcus pyogenes, namely β-hemolytic Group A Streptococcus (GAS) in children in Shenzhen. Methods:Multilocus sequence typing (MLST) data on the epidemic clonal population of GAS infection in children in Shenzhen Children′s Hospital from January 2016 to December 2018 were retrospectively analyzed.In the present study, 32 GAS strains belonging to 7 different emm types were from 32 children′s with impetigo, cellulitis, scarlet fever, sepsis, pneumonia, obstructive sleep apnea hypopnea syndrome, bronchitis, allergy with rhinitis, buttock abscess, allergic purpura or pharyngeal tonsillitis, which were isolated from 23 throat swabs, 5 sputum samples, 3 pus and 1 blood.Using polymerase chain reaction technology, 7 pairs of allelic housekeeping genes ( gki, gtr, murI, mutS, recP, xpt and yqiL) of 32 GAS isolates were analyzed, and the target gene products were subjected to sequencing.Then the obtained gene sequences of each allele were submitted to the MLST database to obtain the allele profile.Finally, the allele profiles were introduced in the MLST database again to confirm the sequence typing (ST). Results:The GAS clone groups of emm 1.00 and its subtypes, emm 4.00, emm 12.00 and its subtypes, emm 22.00, emm 28.00, emm 75.00, and emm 89.00 belonged to the sequence typing ST28, ST39, ST36, ST46, ST52, ST49, and ST921, respectively. Conclusions:From 2016 to 2018, the MLST clone populations of GAS isolates causing infections in children in Shenzhen are classified as ST28, ST39, ST36, ST46, ST52, ST49 and ST921.
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Objective:To investigate the etiological characteristics and changes of plastic bronchitis(PB)in children from 2010 to 2019 at Shenzhen Children′s Hospital, and provide reference basis for improving the understanding of PB etiology.Methods:The clinical data of children diagnosed with infectious-associated PB at Shenzhen Children′s Hospital from Jan 2010 to Dec 2019 were retrospectively analyzed, and the etiological characteristics and changes were summarized.Results:There were 94 cases of mycoplasma pneumoniae, 38 cases of influenza virus, 41 cases of adenovirus, 16 cases of mixed infection, 11 cases of bacteria, and 57 cases of unclear etiology in 266 infectious-associated PB children.The distribution of PB in each age group: 15 cases were infants, 63 cases were toddlers, 112 cases were preschoolers, and 76 cases were school-age children.Adenovirus was the main pathogen of PB in infants and toddlers(60.0%, 28.6%), and mycoplasma pneumoniae(34.8%, 60.5%) as well as influenza virus(13.4%, 22.4%) were the main pathogen in preschool and school-age children, with statistically significant difference( P<0.001). From 2010 to 2019, the annual positive rates of pathogens were 62.5%, 60.0%, 66.7%, 74.1%, 64.0%, 50.0%, 93.3%, 57.1%, 75.0%, and 84.7%, respectively.PB was caused by mycoplasma pneumoniae infection every year.From 2016 to 2019, PB caused by mycoplasma pneumoniae infection increased year by year, while PB caused by adenovirus infection increased every other year. Conclusion:Mycoplasma pneumoniae was the most common pathogen of PB, followed by adenoviruses and influenza viruses, while bacteria, fungi and other viruses were relatively rare.In the infant group, adenovirus infection was predominant, while in preschool and school-age children group, mycoplasma pneumoniae and influenza virus infection were predominant.
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Objective:To analyze the characteristics of sleep disordered breathing (SDB) in children with allergic rhinitis (AR), and improve the diagnosis and treatment at AR combined with obstructive sleep apnea (OSA).Methods:The clinical data of 120 patients with AR and OSA (AR and OSA group) admitted to the respiratory department at Shenzhen Children′s Hospital from May 2019 to December 2020 were retrospectively analyzed.A total of 120 children diagnosed with OSA and excluded AR during the same period were selected as control group.The SDB day and night symptoms, sleep structure characteristics and sleep breathing events were compared between two groups.Results:The average course of disease in children with AR and OSA was significantly longer than that in control group ( P=0.030). The main manifestations of children in AR and OSA group were mouth breathing (100.0%), snoring (99.2%), nasal obstruction (88.5%), and restless sleep (68.0%). There was no significant difference in sleep structure between two groups ( P>0.05), but the sleep efficiency of AR and OSA group was significantly lower than that of control group ( P=0.028). The respiratory events apnea hypopnea index, obstructive apnea index, obstructive apnea hypopnea index, hypopnea index and oxygen desaturation index of each sleep period in AR and OSA group were significantly higher than those in control group ( P<0.05). Among the children in AR and OSA group, moderate and severe OSA were the main manifestations, and the difference between two groups was statistically significant ( P<0.001). Conclusion:The combination of AR delayed the course of OSA in children.The main characteristics of sleep disordered breathing in children with AR are mouth opening, restless sleep, snoring and nasal obstruction.The sleep efficiency is decreased.Obstructive hypopnea and apnea are the most common respiratory events, and oxygen deficiency often occurs in rapid eye movement phase.Children with AR are more likely to have moderate or severe obstructive sleep apnea.
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Objective:To summarize the clinical characteristics and investigate risk factors associated with the development of plastic bronchitis(PB)in pediatric patients who have severe pneumonia caused by adenovirus(HAdVs)infections.Methods:We retrospectively reviewed the clinical manifestations, laboratory results, radiological examinations, and treatment courses of 258 children who were diagnosed as HAdVs associated severe pneumonia between 1st January, 2015 and 31st October, 2019 at Shenzhen Children′s Hospital.According to the presence of PB, patients were divided into PB group( n=45)and non-PB group( n=213). Results:In PB group, the male to female ratio was 1.65∶1(including 28 boys and 17 girls)and the median age was 41.0(18.5, 65.5)months.Patients younger than 6 years of age accounted for 80.0%(36/45)and older patients accounted for 20.0%(9/45). The major clinical symptoms of patients in PB group were high fever(95.6%, 43/45), cough(100.0%, 45/45)and conjunctivitis(33.3%, 15/45). Physical examinations revealed that most patients had tachypnea(80.0%, 36/45)and crackles(80.0%, 36/45). Compared to patients in non-PB group, the duration of fever in PB group was significant longer( Z=-13.519, P<0.001). Compared to non-PB group, there was a significant decrease of the lymphocyte count[2.24(1.44, 3.84)×10 9/L vs.1.75(1.21, 3.03)×10 9/L] and a significantly increase of the procalcitonin level[0.46(0.19, 1.73)ng/mL vs.1.54(0.37, 2.96)ng/mL] in PB group( P<0.05). Chest radiological examinations revealed that patients in PB group had higher rates to develop pleural effusion(62.2% vs.42.3%) and atelectasis(57.8% vs.22.1%) of the lungs compared to non-PB group( P<0.05). The majority of patients improved after resolution of symptoms(97.8%, 44/45) in PB group.Only one patient(2.2%, 1/45) died due to discontinuation of treatment.Conjunctivitis( P<0.001, OR=108.514, 95% CI 17.476-673.791), tachypnea( P<0.001, OR=18.788, 95% CI 5.172-68.246), pleural effusion( P=0.007, OR=3.363, 95% CI 1.389-8.139) were independent risk factors associated with the development of PB in children with HAdVs associated severe pneumonia. Conclusion:Pre-school age children are at higher risk to develop HAdVs related severe pneumonia that complicated with PB.Fever and cough remain the main clinical symptoms.The presence of PB is associated with longer period of fever and higher risks to have pleural effusion and atelectasis.Conjunctivitis, tachypnea orpleural effusion are higher risk to develop PB in those with HAdVs associated severe pneumonia.
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Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.
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Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.
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Objective:To investigate the feasibility of nebulizing injectable Tobramycin for the treatment of Pseudomonas aeruginosa (Pa) in pediatric cystic fibrosis (CF) patients. Methods:The clinical data of 3 CF children with Pa infection who were treated by nebulizing injectable Tobramycin in Shenzhen Children′s Hospital from September 2017 to March 2021 were retrospectively analyzed.The efficacy and safety were explored.The nebulized injectable Tobramycin (160 mg/dose) was given twice daily after airway clearance.After one-month treatment course, oral Ciprofloxacin would be given [30 mg/(kg·d)] to patients for another 1 month if Pa was still positive in repeat sputum cultures.Results:There were 2 males and 1 female in 3 cases recruited.The youngest patient was 1-year-old when receiving Tobramycin treatment.After airway clearance and inhalation of injectable Tobramycin, all had improvements in respiratory symptoms and chest CT scan.Two cases took additional oral Ciprofloxacin as Pa was still positive after the 1-month treatment course of Tobramycin.Pa turned to negative in all 3 cases after treatment for 3 months to 1.5 years.Besides, after treatment all the 3 patients had normal liver and renal functions, and normal hearing in multiple follow ups.One patient had a normal brainstem auditory evoked potential in the reexamination.Conclusions:Nebulizing injectable Tobramycin would be a reasonable alternative to inhaled Tobramycin solution for treating pediatric CF patients with Pa in view of the present condition in mainland China.However, it is still worth further study and discussion.
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Cystic fibrosis (CF) is a multisystem disease caused by CFTR gene mutations, affecting the lungs, digestive system, and reproductive tract.Infectious lung disease is the major cause of exacerbation and mortality in most patients.There are specific pathogen spectrums in infectious lung disease and antibiotics application principles in CF patients.In this article, the application of antibiotics in clinical guidelines for care of children with CF in Royal Brompton Hospital (2020) was introduced.
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As a pathogen of public health significance, group A Streptococcus (GAS) infects 18.1 million people and leads to 500 000 deaths all over the world every year.GAS is often transmitted through respiratory droplets and contact with damaged skin.Children, the elderly and immunocompromised people are highly susceptible to GAS infection.Schools, kindergartens, hospitals, nursing homes and other densely populated areas are high-risk areas for GAS transmission.Prevention and control measures should highlight the improvement of living conditions and hand hygiene.Adherence to infection prevention and control measures should be emphasized in high-risk environments.In this paper, the risk factors, prevention and control strategies of GAS infection and transmission were summarized, so as to provide basis for the prevention and control of GAS.
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Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.
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Group A Streptococcus(GAS) is a very important pathogen, especially for children.GAS may cause more kinds of diseases than any other microorganism and involve many disciplines.Since penicillin was discovered and widely used in the 1940s, bacterial infectious diseases have been conquered, and the incidence rate has decreased.However, the occurrence of antibiotics resistance is becoming more and more serious, and some bacterial infectious diseases have a rising trend.In recent years, GAS infection and disease have also been reported in a small range.There are not many Chinese people who pay attention to GAS, especially those who study GAS.They do not have enough understanding of GAS, which leads to some misunderstandings.There are still many questions about GAS that no one can explain so far.Therefore, we call for attention to GAS and GAS diseases.