Consistency between nasopharyngeal aspirates and bronchoalveolar lavage fluid in pathogen detection in children with pneumonia: an analysis of 533 cases / 中国当代儿科杂志

OBJECTIVES@#To study the consistency between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in pathogen detection in children with pneumonia@*METHODS@#A retrospective analysis was performed on the data of pathogens detected in 533 children with pneumonia from February 2017 to March 2020. The paired McNemar's test was used to compare the difference in pathogen detection between NPA and BALF groups. The @*RESULTS@#NPA had a sensitivity of 28%, a specificity of 74%, a positive predictive value of 14%, and a negative predictive value of 91% in detecting bacteria, and a @*CONCLUSIONS@#There is poor consistency between NPA and BALF in the detection of bacteria and viruses, and clinicians should be cautious in diagnosing lower respiratory tract infection based on bacteria or viruses detected in NPA. There is moderate consistency between NPA and BALF in the detection of

Epidemiological characteristics of respiratory syncytial virus in hospitalized children with acute lower respiratory tract infection in Chongqing, China, from 2013 to 2018: an analysis of 2 066 cases / 中国当代儿科杂志

OBJECTIVE@#To study the detection rate, epidemic pattern, and clinical features of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory infection (ALRI).@*METHODS@#Nasopharyngeal aspirates were collected from children with ALRI, aged < 2 years, who were hospitalized in Children's Hospital of Chongqing Medical University from June 2013 to May 2018. Multiplex PCR was used to detect 16 common respiratory viruses. The epidemiological characteristics of RSV were analyzed.@*RESULTS@#A total of 2 066 hospitalized children with ALRI were enrolled. Among the children, 1 595 (77.20%) tested positive for virus and 826 (39.98%) tested positive for RSV [410(49.6%) positive for RSV-A, 414 (50.1%) positive for RSV-B, and 2 (0.2%) positive for both RSV-A and RSV-B]. RSV-B was the main subtype detected in 2013-2014 and 2016-2017, while RSV-A was the main subtype in 2014-2015 and 2017-2018, and these two subtypes were prevalent in 2015-2016. The highest detection rate of RSV was noted in winter. RSV + human rhinovirus was the most common combination of viruses and was detected in 123 children. These children were more likely to develop wheezing than those with single RSV detected (@*CONCLUSIONS@#In Chongqing in 2013-2018, RSV-A and RSV-B not only can predominate alternately, but also can co-circulate during a season. RSV is the major viral pathogen of hospitalized children with ALRI and can cause severe lower respiratory tract infection. There are no differences in clinical manifestations between children with RSV-A infection and those with RSV-B infection, but boys are more susceptible to RSV-A infection.

Diffuse alveolar hemorrhage in children / 中国当代儿科杂志

Diffuse alveolar hemorrhage (DAH) is a clinical syndrome with major clinical manifestations of hemoptysis, anemia, and diffuse infiltration in the lung. DAH has a high mortality rate in the acute stage and is a life-threatening emergency in clinical practice. Compared with adult DHA, childhood DHA tends to have a specific spectrum of underlying diseases. It has long been believed that idiopathic pulmonary hemosiderosis (IPH) is the main cause of childhood DAH; however, with the increase in reports of childhood DAH cases, the etiology spectrum of childhood DAH is expanding. The treatment and prognosis of DAH with different etiologies are different. This review article gives a general outline of childhood DAH, with focuses on DAH caused by IPH, systemic lupus erythematosus, anti-neutrophil cytoplasmic antibody-related vasculitis, COPA syndrome, or IgA vasculitis.

Effect of vitamin A as an adjuvant therapy for pneumonia in children: a Meta analysis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect and safety of vitamin A supplementation in children with pneumonia through a systematic review.</p><p><b>METHODS</b>Cochrane Library, EMbase, PubMed, China Biology Medicine disc, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) on vitamin A as an adjuvant therapy for pneumonia in children. Two reviewers independently screened the studies and evaluated their quality according to the inclusion and exclusion criteria. RevMan5.3 was used for the Meta analysis.</p><p><b>RESULTS</b>A total of 15 RCTs with 3 021 patients were included. The Meta analysis showed that vitamin A supplementation did not reduce the mortality of children with pneumonia (P>0.05), but it increased the overall clinical response rate (P<0.05) and shortened the duration of pyrexia and cough, clearance time of signs and abnormal chest X-ray results, and length of hospital stay (P<0.05). As an adjuvant therapy, vitamin A did not increase the incidence rates of adverse reactions such as nausea, vomiting, diarrhea, allergy, and bregma bulging.</p><p><b>CONCLUSIONS</b>Current evidence shows that in the treatment of pneumonia in children, vitamin A supplementation helps to relieve clinical symptoms and signs and shorten the length of hospital stay.The adjuvant therapy does not increase the incidence rates of adverse reactions.</p>

Levels of surfactant proteins A and D in bronchoalveolar lavage fluid of children with pneumonia and their relationships with clinical characteristics / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe the levels of pulmonary surfactant proteins A and D (SP-A, SP-D) in bronchoalveolar lavage fluid (BALF) of children with pneumonia, and to explore their relationships with clinical characteristics.</p><p><b>METHODS</b>Thirty-five children with pneumonia were enrolled in this study. Differential cell counts were obtained by Countstar counting board. The levels of SP-A and SP-D in BALF were detected using ELISA.</p><p><b>RESULTS</b>In children with pneumonia, SP-D levels were significantly higher than SP-A levels (P<0.001). SP-D levels were negatively correlated with the neutrophil percentage in BALF (r(s)=-0.5255, P<0.01). SP-D levels in BALF in children with increased blood C-reactive protein levels (>8 mg/L) were significantly lower than in those with a normal level of C-reactive protein (P<0.05). Compared with those in children without wheezing, SP-D levels in children with wheezing were significantly lower (P<0.01). There was no correlation between SP-A levels and clinical characteristics.</p><p><b>CONCLUSIONS</b>SP-D levels in BALF are significantly higher than SP-A levels, and have a certain correlation with clinical characteristics in children with pneumonia. As a protective factor, SP-D plays a more important role than SP-A in regulating the immune and inflammatory responses.</p>

Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the distribution of pathogens of children with community acquired pneumonia (CAP) from the Chongqing area.</p><p><b>METHODS</b>Nasopharyngeal specimens and blood specimens of 1 613 children with CAP were collected between January 2014 and December 2014 for bacterial culture and detection of 7 respiratory viruses and antibodies against Mycoplasma pneumoniae (MP).</p><p><b>RESULTS</b>The overall positive rate of bacteria was 50.22% (810 cases). Hemophilus parainfluenzae (40.8%), Streptococcus pneumonia (29.7%) and Moraxelle catarrhalis (7.3%) were the predominant ones. Among the viruses, the top detected virus was respiratory syncytial virus (RSV, 58.3%), followed by parainfluenza virus type3 (17.4%) and adenovirus (14.3%). A total of 481 cases (29.82%) were MP-positive. The co-infection rate was 32.18% (519 cases), and the mixed infections of bacteria and viruses were common (47.4%).</p><p><b>CONCLUSIONS</b>RSV and Hemophilus parainfluenzae are the major pathogens of CAP in children from the Chongqing area. MP is also an important pathogen. The co-infection of bacteria and viruses is prevalent.</p>

Efficacy of regular or intermittent inhalation of corticosteroids in treatment of asthma and its effects on growth and development in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe the efficacy of regular or intermittent inhalation of salmeterol/fluticasone propionate (SM/FP) in the treatment of bronchial asthma and its effects on growth and development in children.</p><p><b>METHODS</b>A total of 112 children diagnosed with bronchial asthma between September 2012 and October 2013 were assigned to standardized treatment (standard group, n=56) and non-standardized treatment (intermittent group, n=56). Comparisons of clinical symptom scores and main pulmonary function indicators between the two groups were carried out before treatment and at 6 and 12 months after treatment. The growth velocity and changes in body mass index (BMI) were observed in the two groups.</p><p><b>RESULTS</b>At 6 and 12 months after the treatment, the standard group had significantly reduced clinical symptom scores and significantly increased pulmonary function indicators (percentage of predicted peak expiratory flow, PEF%; percentage of forced expiratory volume in 1 second, FEV1%) (P<0.05); the intermittent group had significantly reduced clinical symptom scores and significantly increased FEV1% (P<0.05), but PEF% was significantly increased only at 6 months after treatment (P<0.05). At 12 months after treatment, the standard group had significantly lower clinical symptom scores and significantly higher PEF% and FEV1% when compared with the intermittent group (P<0.05). The growth velocity and BMI showed no significant differences between the two groups at 6 and 12 months after treatment (P>0.05).</p><p><b>CONCLUSIONS</b>Compared with intermittent inhalation, long-term regular inhalation of SM/FP performs better in controlling clinical symptoms and enhancing pulmonary function in children with asthma. Inhalation of SM/FP for one year reveals no apparent effect on the growth and development of these children.</p>

Values of a combination of multiple less invasive or non-invasive examinations in the diagnosis of pediatric sputum-negative pulmonary tuberculosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the values of a combination of multiple less invasive or non-invasive examinations including chest computed tomography (CT) scan, purified protein derivative (PPD) test, erythrocyte sedimentation rate (ESR) test, and C-reactive protein (CRP) test in the diagnosis of pediatric sputum-negative pulmonary tuberculosis (TB).</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 269 children with confirmed pulmonary TB. Clinical symptoms and test results were analyzed and compared between the sputum-negative group (161 patients) and the sputum-positive group (108 patients).</p><p><b>RESULTS</b>The sputum-negative group had atypical clinical symptoms, with fewer typical or relatively specific imaging features compared with the sputum-positive group. The positive rates of PPD, ESR, and CRP tests for the sputum-negative group were 39.1%, 44.1%, and 56.5%, respectively, versus 55.6%, 79.6%, and 59.3% for the sputum-positive group. There were significant differences in the positive rates of PPD and ESR tests between the two groups (P<0.05). More than 80% of the patients in each group were diagnosed with pulmonary TB according to three or four less invasive or non-invasive tests, without significant difference in the positive rate between the two groups (P>0.05). Forty-six patients in the sputum-negative group underwent bronchoscopy, and morphological changes with a diagnostic value and/or etiological and pathological evidence were observed in 40 (87.0%) of them.</p><p><b>CONCLUSIONS</b>The diagnosis rate of pediatric sputum-negative pulmonary TB can be increased by combining tests including chest CT scan, PPD test, ESR test, and CRP test. Bronchoscopy is a reliable method for the auxiliary diagnosis of pediatric sputum-negative pulmonary TB if the combining tests cannot provide compelling evidence.</p>

Serious systemic adverse events associated with allergen-specific immunotherapy in children with asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To retrospectively assess serious systemic adverse effects of standardized dust-mite vaccine in children with asthma.</p><p><b>METHODS</b>Medical records of 704 children (5-17 years in age) with asthma between January, 2005 and December, 2011 were reviewed. Serious systemic adverse events following treatment with a standardized dust-mite vaccine in these children were analyzed.</p><p><b>RESULTS</b>A total of 336 systemic adverse reactions were observed in 17.0% (120/704) of the patients analyzed of these adverse reactions, 18 (5.4%) were serious (level 3), 318 (94.6%) were not serious (below level 3), and no single case of anaphylactic shock (level 4) was recorded. Systemic adverse events occurred most frequently in the 5 to 11-year age group and in the summer season (from June to August). In the 18 severe cases, the peak expiratory flow (PEF) dropped by 20% immediately after the vaccine injection, and other major clinical symptoms included cough, wheezing and urticaria. All children with serious systemic adverse effects were given inhaled hormone and atomized short-acting beta agonists, oral antihistamines, intravenous dexamethasone and/or intramuscular adrenaline. After these treatments, the clinical symptoms were significantly relieved.</p><p><b>CONCLUSIONS</b>The rate of serious systemic adverse events following allergen-specific immunotherapy is relatively low in children with allergic asthma. Conventional medications are effective in managing these immunotherapy-associated adverse events.</p>

Clinical analysis of 12 cases of childhood atypical endobronchial tuberculosis / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of atypical endobronchial tuberculosis(EBTB) in children and explore the value of bronchoscopy examination in diagnosis and treatment of this disease.Methods The records of 12 children diagnosed as atypical EBTB in Children's Hospital of Chongqing Medical University from Jan.2008 to Dec.2011 were reviewed,and their medical history,clinical manifestation,imaging and laboratory findings were analyzed.They all had fiberoptic bronchoscopy and bronchoalveolar lavage.Four patients had bronchial lining pathologic biopsy.Bronchoscope findings of the 12 children were analyzed.Results The clinical manifestations of childhood atypical EBTB were various.The major were cough(11 cases,91.7％) and fever(7 cases,58.3％),other manifestations included wheeze (3 cases,25.0％),shortness of breath following exercise (2 cases,16.7％),and so on.Only 1 case had hemoptysis (8.3％).The major imaging findings were lymph node enlargement of hilar and(or) mediastinum (10 cases,83.3％).Five cases were with obstructive pulmonary emphysema and atelectasis (41.7％).It was more common than other type of pulmonary tuberculosis.It mainly expressed granulation tissue and neoplasm (7 cases,58.3％),caseoussubstance (4 cases,33.3％),extrinsic compression (4 cases,33.3％) and narrowed orifice of the lobe bronchus (2 cases,16.7％) under fiber bronchoscopy.The detection rate of mycobacterium tuberculosis was 50.0％ (6 cases) through bronchoalveolar lavage fluid.Four children were diagnosed by transbronchial biopsy and 2 children were diagnosed by gastrointestinal fluid smear after fiberoptic bronchoscopy.Conclusions The clinical manifestations of childhood atypical EBTB are various.Bronchoscopy examination,bronchoalveolar lavage and transbronchial biopsy play very important role in diagnosis and pathological classification of childhood atypical EBTB.

Diagnostic values of bronchoscopy and multi-slice spiral CT for congenital dysplasia of the respiratory system in infants: a comparative study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate and compare the diagnostic values of bronchoscopy and multi-slice spiral computed tomography (CT) for congenital dysplasia of the respiratory system in infants.</p><p><b>METHODS</b>Analysis was performed on the clinical data, bronchoscopic findings and multi-slice spiral CT findings of 319 infants (≤1 years old) who underwent bronchoscopy and/or multi-slice spiral CT and were diagnosed with congenital dysplasia of the respiratory system.</p><p><b>RESULTS</b>A total of 476 cases of congenital dysplasia of the respiratory system were found in the 319 infants, including primary dysplasia of the respiratory system (392 cases) and compressive dysplasia of the respiratory system (84 cases). Of the 392 cases of primary dysplasia of the respiratory system, 225 (57.4%) were diagnosed by bronchoscopy versus 167 (42.6%) by multi-slice spiral CT. There were significant differences in etiological diagnosis between bronchoscopy and multi-slice spiral CT in infants with congenital dysplasia of the respiratory system (P<0.05). All 76 cases of primary dysplasia of the respiratory system caused by tracheobronchomalacia were diagnosed by bronchoscopy and all 17 cases of primary dysplasia of the respiratory system caused by lung tissue dysplasia were diagnosed by multi-slice spiral CT. Of the 84 cases of compressive dysplasia of the respiratory system, 74 cases were diagnosed by multi-slice spiral CT and only 10 cases were diagnosed by bronchoscopy.</p><p><b>CONCLUSIONS</b>Compared with multi-slice spiral CT, bronchoscopy can detect primary dysplasia of the respiratory system more directly. Bronchoscopy is valuable in the confirmed diagnosis of tracheobronchomalacia. Multi-slice spiral CT has a higher diagnostic value for lung tissue dysplasia than bronchoscopy.</p>

Clinical characteristics of 12 persistently wheezing children with human bocavirus infection / 中华儿科杂志

<p><b>OBJECTIVE</b>The impact of human bocavirus (HBoV), a newly identified human parvovirus, on childhood persistent wheezing has not been identified. In this study, the clinical features of infantile persistent wheezing induced by HBoV was analyzed.</p><p><b>METHODS</b>Tracheal aspirates were collected by bronchofibroscope or nasopharyngeal (NP) aspirates from April, 2006 to January, 2007. HBoV DNA in the tracheal aspirates of 33 children with persistent wheezing and in NP aspirates of 6 children with persistent wheezing, who had at least or more than four weeks wheezing. RSV was identified by virus isolation in Hep-2 cells and antigen detetion by direct immunofluorescence assay (DIFA) which was also used for diagnosis of adenovirus, influenza A and B, parainfluenza 1, 2, 3 infection.</p><p><b>RESULTS</b>Of the 39 children with persistent wheezing, 12 cases (31%) were positive for HBoV DNA. Age of HBoV-positive patients ranged from 2 month to 1 year. The results of sequencing of PCR products proved that sequences of HBoV DNA from these 12 samples were exactly identical to the those of HBoV stored in GeneBank (accession numbers DQ000495 and DQ000496). Two cases with HBoV infection were found to be co-infected with RSV. Ten of the 12 HBoV-positive samples were collected during the period from winter to spring (1 in November, 4 in December, 2 in January and 3 in April), the other two HBoV-positive samples were collected during the period from summer to autumn (1 in May and the other in July). Seven of the 12 HBoV DNA-positive patients had fever, 5 of them had high fever. Significantly more patients with HBoV infection had fever as compared to patients with RSV infection. All the HBoV positive patients showed abnormal findings on chest X ray such as interstitial infiltrates, lung infiltration and hyperinflation. Abnormal findings on chest X ray were found in higher proportion of HBoV positive patients as compared with RSV positive patients. And other manifestations such as wheezing, cough and respiratory distress had no significant difference between HBoV and RSV infected patients.</p><p><b>CONCLUSIONS</b>This study further demonstrated that HBoV probably is a common pathogen of lower respiratory infection in children and might particularly be associated with persistent wheezing.</p>

Analysis of 53 cases with bronchoscopically confirmed pediatric tracheobronchomalacia / 中华儿科杂志

<p><b>OBJECTIVE</b>Tracheobronchomalacia is one of the common respiratory tract dysplasia in children. Its symptoms are nonspecific, and routine methods are unreliable in the assessment of tracheobronchomalacia in children. In addition, many physicians are confused about its clinical characteristics, so tracheobronchomalacia is often underdiagnosed. The purpose of this study was to explore the clinical features of tracheobronchomalacia in children and to investigate the diagnostic value of flexible bronchoscopy for children with tracheobronchomalacia.</p><p><b>METHOD</b>For diagnosis and treatment, 229 children out of 4725 patients hospitalized in the division of respiratory disorders were examined by Olympus BF3c-20 flexible bronchoscopy or by Olympus BF-P20 flexible bronchoscopy under general anesthesia with propofol, in Chongqing Children's Hosptial from April 2004 to April 2006. Fifty-three cases were confirmed to have tracheobronchomalacia by bronchoscopy, patients' data including airway lesion, age, sex, clinical characteristics, aided examinations, treatment, final outcomes, were collected and analyzed.</p><p><b>RESULTS</b>(1) Of the 53 children with tracheobronchomalacia, 31 were not suspected for this diagnosis prior to bronchoscopy, who were instead misdiagnosed as refractory pneumonia, difficult-to-control asthma, bronchial foreign body, bronchopulmonary dysplasia and pulmonary atelectasis of unknown origin or bronchiolitis. (2) In the 53 children with tracheobronchomalacia aged one month to eight years, 41 were infants, 6 were younger than two years, 4 were younger than 3 years and the rest 2 cases were older than 3 years. The risk of tracheobronchomalacia related inversely with ages. Ten cases were girls and 43 were boys. (3) Eleven cases had tracheomalacia, 24 bronchomalacia, 18 tracheobronchomalacia; 12 cases had malacia on left lung, 11 on right lung, 19 on both sides; 21 children were mild cases, 25 moderate cases, 7 severe cases. (4) In the 53 children with tracheobronchomalacia, 28 had recurrent or prolonged wheezing, 16 chronic cough, 5 recurrent respiratory infections, 2 atelectasis of unknown origin, and 2 dyspnea.</p><p><b>CONCLUSIONS</b>The infants and toddlers seem to be predisposed more to the bronchomalacia than the older children. Clinical features of children with airway malacia were variable and atypical, expiratory stridor and cough are the most commonly reported symptoms. Flexible bronchoscopy should be regarded as a "golden standard" method for diagnosing TBM.</p>

Effect of Budesonide Inhalation Suspension Treatment on Mild to Moderate Wheezing Diseases in Infants / 实用儿科临床杂志

Objective To explore the effect of atomization inhaled Budesonide on mild to moderate wheezing diseases in infants.Me-thods One hundred and twenty infants in the ward of center of respiratory were divided into 2 groups randomly during Jan. to Dec.2006.They suffered from bronchiolitis(56 cases)or wheezing bronchitis(11 cases) or asthzma of infants and young children(53 cases),aged 1 month to 3 years old.On the basis of the routine treatment, Budesonide inhalation suspension was administered on the therapeutic group, the dosage of Budesonide was 0.5 mg/time(1 month to 1 year old),1.0 mg/time(1 to 3 years old),2 times/d;Dexamethasone was given in the control group,the dosage of Dexamethasone was 5.0 mg/time(1 month to 1 year old),7.5 mg/time(1 to 3 years old),2 times/d. The persistence time of clinical symptoms,signs and staying in hospital were compared after the treatment, and the pulmonary function of two groups were also compared before and after treatment.Software of SPSS 12.0 was used to analyze data.Results There were significant differences in clinical symptoms (wheeze, cough), signs(wheezing rale) and time of staying in hospital between the treatment group and control group (t=3.98,5.44,4.61,2.96 Pa