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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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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 epidemiological characteristics and macrolide-resistance of hospitalized children with Mycoplasma pneumoniae (MP) infections in Beijing from 2016 to 2019, so as to provide basis for the prevention and treatment of pediatric Mycoplasma pneumoniae pneumonia (MPP).Methods:The clinical data were analyzed retrospectively from 8 691 children hospitalized with community acquired pneumonia in Beijing Children′s Hospital between January 2016 and September 2019.MP RNA was detected by simultaneous amplification and testing (SAT), and macrolide resistance of MP was examined by MP and macrolide-resistant isolate diagnostic kit (PCR with fluorescence probes). Chi- square test was used for categorical analysis. Results:Among 8 691 cases detected by SAT, the overall detection rate of MP was 28.10% (2 442/8 691 cases). The detection rates of MP from 2016 to 2019 were 26.23%, 31.36%, 27.84 % and 26.57%, respectively.The detection rate of MP in 2017 was significantly higher than that in other years ( χ2=16.11, P<0.05). The detection rate of MP in females was 29.65%(1 107/3 733 cases), which was evidently higher than that in males 26.93%(1 335/4 958 cases) ( χ2=7.85, P<0.05). The positive rates of MP in summer[32.21% (726/2 254 cases)] and autumn[39.76%(852/2 143 cases)] were significantly higher than those in spring[17.00% (327/1 924 cases)] and winter[22.66%(537/2 370 cases)] ( χ2=315.15, P<0.001). The percentages of MP were 35.06%(732/2 088 cases) in preschoolers and 37.71%(1 160/3 076 cases) in school-age children, which were significantly higher than 11.20%(232/2 072 cases) in infants and 22.01% (318/1 445 cases) in toddlers ( χ2=509.89, P<0.001). Macrolide resistance detection was conducted in 1 524 patients by fluorescent PCR.Among them, 1 386 patients were positive for drug resistance, and the positive rate was 90.94%.The prevalence of macrolide-resistant MP from 2016 to 2019 were 88.19%, 90.93%, 90.56% and 92.90%, respectively.Macrolide-resistant rates were not related with gender, age and season. Conclusions:MP can be detected in all seasons, but most prevalently in summer and autumn.Girls are more prone to MP infections than boys.The detection rate of MP increases with age, and the positive rate is higher in preschoolers and school-age children.During the 4-year study period, the drug resistant rate of MP remain high.
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Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.
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Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.
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Tuberculosis is still a big threat to children.However, due to the particularity of tuberculosis in children, there are many problems in diagnosis and treatment, such as the clinical manifestations and symptoms of children are not specific, clinicians do not pay enough attention to the disease, the specimen for pathogen detection is difficult to obtain, the sensitivity of existing diagnostic methods is not enough, lack of child-friendly anti-tuberculosis drugs, pharmacokinetic/pharmacodynamics researches of anti-tuberculosis drugs in children and anti-tuberculosis treatment regimens based on children studies.This paper summarizes the above-mentioned problems and their countermeasures and prospects.
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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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Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still worldwide.As a vulnerable group, severe and dead pediatric cases are also reported.Under this severe epidemic situation, children should be well protected.With the widespread vaccination of SARS-CoV-2 vaccine in adults, the infection rate have decreased.Therefore, SARS-CoV-2 vaccine inoculation for children groups step by step is of great significance to the protection of children and the prevention and control of corona virus disease 2019(COVID-19) as a whole.But the safety of children vaccinated with SARS-CoV-2 vaccine is a main concern of parents.Therefore, in order to ensure the safety of vaccination and the implementation of vaccination work, National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health and the Society of Pediatrics, Chinese Medical Association organized experts to interpret the main issue of parents about SARS-CoV-2 vaccine for children, in order to answer the doubts of parents.
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At present, severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still rampant worldwide.As of September 10, 2021, there were about 222 million confirmed cases of corona virus disease 2019(COVID-19)and more than 4.6 million deaths worldwide.With the development of COVID-19 vaccines and the gradual vaccination worldwide, the increasing number of cases in children and unvaccinated young people has drawn attention.According to World Health Organization surveillance data, the proportion of COVID-19 infection cases in children gradually increased, and the proportion of cases in the age groups of under 5 years and 5-14 years increased from 1.0% and 2.5% in January 2020 to 2.0% and 8.7% in July 2021, respectively.At present, billions of adults have been vaccinated with various COVID-19 vaccines worldwide, and their protective effects including reducing infection and transmission, reducing severe disease and hospitalization, and reducing death, as well as high safety have been confirmed.Canada, the United States, Europe and other countries have approved the emergency COVID-19 vaccination in children and adolescents aged 12 to 17 years, and China has also approved the phased vaccination of COVID-19 vaccination in children and adolescents aged 3 to 17 years. For smooth advancement and implementation of COVID-19 vaccination in children, academic institutions, including National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health, and The Society of Pediatrics, Chinese Medical Association organized relevant experts to reach this consensus on COVID-19 vaccination in children.
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Multi-drug resistant tuberculosis remains a serious infection disease endangering children health.Linezolid, as an effective and safe anti-tuberculous drug has achieved good results in the treatment of adults with multi-drug resistant tuberculosis.Recently, some advances have been made associated with Linezolid on treatment of multi-drug-resistant tuberculosis in children.Therefore, in this article, theses progresses were reviewed and the information associated with current status and problems to be solved of Linezolid on the treatment of pediatric multi-drug resistant tuberculosis was introduced to promote its rational application based on published guidelines and researches.
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Bacillus Calmette-Guerin (BCG) is the only effective and widely used tuberculosis(TB) vaccine.In recent years, researchers have been working on developing novel TB vaccines, but the results are still far from satisfactory.This makes people start to re-examine the BCG vaccine, which has been used for nearly a hundred years.This review will summarize the origin and evolution, immune response, immune protection and revaccination of BCG, and describe the latest progress in immune prophylaxis of BCG.
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Respiratory infectious diseases are a serious threat to children health.The early identification of the pathogen will lay the foundation for the diagnosis and treatment of the diseases.Metagenomics is a technique which directly sequences clinical samples without culture and reveals the information about all microbial sequences.It plays a very important part in the detection of pathogenic microorganisms, microbiology and interaction between microorganisms and host genes for the study of pathogenic organisms in children′s respiratory infectious diseases.In this article, the sequencing processes of metagenomics, its application in children′s respiratory infectious diseases and research progress at home and abroad were reviewed.
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Tuberculosis (TB) is an infectious fatal disease that seriously endangers human health worldwide.Isoniazid (INH) is an important first-line drug for TB, but it can cause serious adverse drug reactions, such as liver injury and even liver failure.At present, it is believed that metabolites of INH, imbalance of oxidative stress responses and immune response disorders are major causes of INH induced liver injury.In addition, involved genes and gene polymorphisms are susceptible to liver injury caused by INH.In this paper, the association of INH induced liver injury with the polymorphisms of genes related to INH metabolizing enzymes, as well as oxidative stress and immune responses are summarized to improve the understanding of INH induced liver injury and provide novel directions for its prevention and treatment.
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Tuberculous meningitis (TBM) is a serious type of extrapulmonary tuberculosis with a high disability rate and mortality, commonly diagnosed in children under 5 years old.It is known that early diagnosis and reasonable treatment can significantly improve the prognosis of TBM in children.Therefore, the strategies on diagnosis and treatment of TBM in children based on published guidelines and researchs were reviewed in this study, in order to provide guidance for its clinical diagnosis and treatment.
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Tuberculosis(TB) is a big threat to children′s health.In recent years, many guidelines and consensus on TB treatment have been developed and updated at home and abroad.According to the latest evidence-based practice, a lot of new viewpoints on TB drug treatment have been put forward.However, there are few guidelines and consensus focusing on drug treatment of TB in children at present.Based on the existing evidence, the author will summarize the feasible treatment regimens for sensitive tuberculosis and drug-resistant tuberculosis in Chinese children.
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Tuberculosis is still a serious disease threatening children′s health.The detection and early diagnosis of tuberculosis in children still face many problems, such as the low detection rate and high misdiagnosis rate from traditional methods, the difficulty of collection and low bacterial load of sputum specimens from children, and difficult diagnosis of extrapulmonary tuberculosis.Therefore, there is an urgent need to find new diagnostic markers for rapid, sensitive and efficient diagnosis of tuberculosis, and biomarkers point out the direction for us.In this review, progress in the application of new biological biomarkers of pediatric tuberculosis was summarized from the transcriptomic, proteomic, metabolomic and microRNA aspects.
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Tuberculosis(TB) is a serious threat to children′s health.The World Health Organization reported that there were almost 10 million new TB cases(including 1.12 million pediatric patients) and 1 240 000 deaths(173 000 were children) globally in 2018." Find.Treat.All.#End TB" points out that an effective vaccination is the most effective method for the control of infectious diseases.It is difficult to diagnose TB in children in the early stage due to atypical clinical symptoms of TB, leading to treatment delay.Therefore, vaccination is essential for the prevention of pediatric TB.However, the problems of limited immune duration, unclear protective effect and increasing the risk of BCG disease existing in Bacillus Calmette-Guerin(BCG), the only TB vaccine widely used in the world, necessitate the development of new vaccines.The progress in and challenges of research on TB vaccines were reviewed in this article, which helps provide reference for the development of new vaccines and seeking solutions of above problems.
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For safety reasons, Fluoroquinolones should be used with caution in children.The current consensus is that quinolones should not be banned in children.In clinical practice, under the condition of fully evaluating the risk and benefit, it can be used as appropriate for severe infection and multi-drug resistant pathogen infection.Therefore, this paper summarizes the application of Fluoroquinolones in the treatment of severe and drug-resistant respiratory infectious diseases, safety analysis and damages of joints and cartilages, pharmacokinetic studies and drug resistance in children.The paper aims to provide a reference for the treatment of severe and drug-resistant infectious diseases in children.
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Tuberculosis (TB) is a serious threat to children′s health.The world health organization (WHO) reported that there were almost 1 million TB patients and 230 000 deaths among children globally in 2017.In order to control the prevalence of childhood TB, WHO put forward a blueprint of " towards zero death for childhood TB" . However, due to the difficulty in obtaining specimens, the lack of typical symptoms and the insufficient of existing diagnostic methods for children, it is hard to achieve the goal of zero death.The summary of the TB diagnosis status will promote to solve the current problems in children.