中华儿科杂志最新文献

{"title":"[Construction and validation of a prognostic prediction model for children-onset initial steroid-resistant nephrotic syndrome].","authors":"X M Xu, Y H Gan, A S Wang, X J Yang, S J Yu, Q Y Yang, F H Zhang, M Wang, Q Li, H P Yang","doi":"10.3760/cma.j.cn112140-20251211-01095","DOIUrl":"10.3760/cma.j.cn112140-20251211-01095","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the risk factors for poor prognosis in children with steroid-resistant nephrotic syndrome (SRNS) and to construct and validate a prognostic model. <b>Methods:</b> A retrospective cohort study was conducted. Clinical data of 456 children with SRNS who were initially diagnosed and hospitalized at the Children's Hospital of Chongqing Medical University from January 2009 to December 2024 was collected, including general information, laboratory and pathological indicators, gene types, treatment, and prognosis. Follow-up was conducted for more than 12 months. The endpoint event was defined as a decrease in the estimated glomerular filtration rate (eGFR) of more than 30% compared to the baseline for three consecutive times (with an interval of at least one month between each measurement). The patients were divided into the event group and the non-event group based on whether the endpoint event occurred. Independent sample <i>t</i>-test, Mann-Whitney <i>U</i> test, test <i>χ</i><sup>2</sup>, or Fisher's exact probability test were used for comparison between groups. Multivariate Logistic regression was used to rank the importance of variables to screen for characteristic variables. The top 6 ranked characteristic variables were used to construct four machine learning models using Python: extreme gradient boosting, random forest, support vector machine, and logistic regression. The area under the receiver operating characteristic curve (AUC), accuracy, specificity, sensitivity, and F1 score were used to evaluate the discrimination and performance of the models. Calibration curves and clinical decision curves were drawn to assess the prediction accuracy and clinical net benefit of the models. The Shapley Additive Explanations (SHAP) method was applied to analyze the contribution of features. <b>Results:</b> Among the 456 children, 306 were male and 150 were female. The age of onset was 4.1 (2.3, 8.0) years, and the follow-up time was 2.2 (1.0, 4.0) years. There were 195 cases (42.7%) in the event group and 261 cases (57.3%) in the non-event group. The time of occurrence of the endpoint event in the event group was 1.0 (0.5, 2.5) years. Univariate analysis showed that there were statistically significant differences between the two groups in initial serum creatinine, initial eGFR, eGFR change rate after 3 months of treatment, gender, calcineurin inhibitor (CNI) treatment response, gene variation, white blood cell count, absolute monocyte count, blood urea nitrogen, and urine red blood cells (all <i>P</i><0.05). The top 6 characteristic variables, including the eGFR change rate after 3 months of treatment, genetic variation, baseline eGFR, CNI treatment responsiveness, gender and baseline serum creatinine (the AUC decrease percentages of 20.1%, 9.4%, 1.6%, 1.0%, 0.3% and 0.1% respectively after permutation test). Among the four machine learning models, the random forest model performed the best (test set AUC was 0.77 (95%<i","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"787-794"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress in adolescent management of Klinefelter syndrome].","authors":"X Y Gao, C X Gong","doi":"10.3760/cma.j.cn112140-20260206-00120","DOIUrl":"10.3760/cma.j.cn112140-20260206-00120","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"835-838"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A multicenter clinical study of diffuse alveolar hemorrhage in Chinese children].","authors":"","doi":"10.3760/cma.j.cn112140-20260118-00053","DOIUrl":"10.3760/cma.j.cn112140-20260118-00053","url":null,"abstract":"<p><p><b>Objective:</b> To understand the etiological diagnosis, triggers for disease recurrence and treatment status of diffuse alveolar hemorrhage (DAH) in Chinese children. <b>Methods:</b> A retrospective cohort study was conducted. Clinical data, including baseline information, laboratory findings, chest imaging findings and treatment regimens were collected from 567 children with DAH admitted to 21 hospitals in China from 2002 to 2021. Cases with immune-related etiologies or undetermined etiological diagnosis were included and divided into two groups based on glucocorticoids treatment duration: ≥3 months group and <3 months group. The study period from January 2002 to December 2021 was divided into two time intervals: 2002-2011 and 2012-2021. The two groups were compared in terms of etiological diagnosis rate, initial and overall immunosuppressant use rate, disease recurrence rate and mortality rate. All group comparisons were performed using the <i>χ</i>² test. <b>Results:</b> Among the 567 children with DAH, 333 were male and 234 were female. The age at onset was 4.0 (2.1, 6.5) years and the follow-up duration was 4.4 (2.4, 7.2) years. A definite etiological diagnosis was established in 107 cases (18.9%), while 460 cases (81.1%) remained without a definite etiological diagnosis. Among the 494 cases (including idiopathic pulmonary hemosiderosis and those with undetermined etiological diagnosis), 389 cases (78.7%) were initially treated with glucocorticoids alone and 45 cases (9.1%) with a combination of glucocorticoids and immunosuppressants. Throughout the treatment, immunosuppressants were used in 132 cases (26.7%). Among the 549 cases (including immune-related cases and those with undetermined etiological diagnosis), 303 cases (55.2%) experienced recurrent exacerbation of the disease. The common triggers included respiratory infection in 193 cases (35.2%), glucocorticoid dose reduction in 103 cases (18.8%) and non-adherence to medication in 66 cases (12.0%). Eight cases were lost to follow-up. The mortality rate was 8.7% (47/541), with causes of death including end-stage lung disease with severe infection in 32 cases (5.9%), severe pulmonary hemorrhage in 12 cases (2.2%) and unknown cause in 3 cases (0.5%). Among those receiving glucocorticoids therapy, 373 cases were in the ≥3 months group and 125 cases in the <3 months group. The mortality rate in the ≥3 months group was lower than that in the <3 months group (<i>P<</i>0.01). There were 92 cases in the 2002-2012 group and 457 cases in the 2012-2021 group. The utilization rates of immunosuppressants in both initial treatment and the entire treatment course for children with immune-related and those with undetermined etiological diagnosis were higher in the 2012-2021 group than in the 2002-2012 group (both <i>P</i><0.01). <b>Conclusions:</b> In China, pediatric DAH has complex etiologies and a definitive etiological diagnosis remains difficult to establish in some cases. Recurrent exacer","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"774-779"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Key issues and optimization strategies in the management of neonatal respiratory distress syndrome].","authors":"R M Bai, Z K Li, Y Shi, W H Zhou","doi":"10.3760/cma.j.cn112140-20260318-00219","DOIUrl":"10.3760/cma.j.cn112140-20260318-00219","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"710-713"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiovascular system involvement in childhood-onset systemic lupus erythematosus mechanisms and clinical practice].","authors":"M Q Wang, J H Deng","doi":"10.3760/cma.j.cn112140-20251107-01008","DOIUrl":"10.3760/cma.j.cn112140-20251107-01008","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"831-835"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on endoscopic diagnosis and treatment for inflammatory bowel disease in children (2026)].","authors":"","doi":"10.3760/cma.j.cn112140-20260401-00259","DOIUrl":"10.3760/cma.j.cn112140-20260401-00259","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"729-738"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical features and long-term prognosis of probable antibody-negative autoimmune encephalitis in children].","authors":"H H Wu, J X Chen, S Liu, S P Li, P Zheng, S Feng, Q Chen","doi":"10.3760/cma.j.cn112140-20260227-00161","DOIUrl":"10.3760/cma.j.cn112140-20260227-00161","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical features and long-term prognosis of children with probable antibody-negative autoimmune encephalitis. <b>Methods:</b> A retrospective cohort study included 35 children who diagnosed with probable antibody-negative autoimmune encephalitis. They were admitted to the Department of Neurology, Capital Center for Children's Health, Capital Medical University, from September 2016 to December 2024. Demographic data (age at onset, sex), clinical manifestations (seizures, psychiatric symptoms, and altered consciousness), ancillary investigations (cerebrospinal fluid analysis, brain MRI, and electroencephalography), treatment strategies (immunotherapy and antiseizure medications), and long-term outcomes with a follow-up of ≥12 months were collected and analyzed. <b>Results:</b> Among the 35 children, 21 children (60%) were male and 14 children (40%) were female, with the age at onset of (8±4) years. The predominant neurological manifestations were seizures in 27 children (77%) and psychiatric symptoms in 21 children (60%). Status epilepticus occurred in 18 children (51%) during the acute phase. In terms of ancillary findings, 25 children (71%) showed inflammatory changes in cerebrospinal fluid. Brain MRI abnormalities were observed in 24 children (69%). Among this 24 children there were 13 cases (54%) in the basal ganglia involvement group, 6 cases (25%) in the limbic lobe involvement group, and 5 children (21%) in the other brain regions involvement group. The duration to appearance of abnormal MRI signals was 7 (3, 15), 22 (12, 28) and 7 (5, 76) d respectively. Abnormal background activity on electroencephalography was detected in 29 children (83%). All children received first-line immunotherapy, and 13 children (37%) required second-line immunotherapy. The follow-up duration was 41 (22, 60) months. At the last follow-up, 32 children (91%) had a favorable outcome. A total of 5 children (14%) experienced relapse, occurring 10 (5, 16) months after initial onset; all showed clinical improvement after re-initiation of immunotherapy. <b>Conclusions:</b> Probable antibody-negative autoimmune encephalitis in children predominantly affects school-age individuals and is characterized by seizures as the main clinical presentation. Immunotherapy is effective in most cases, with generally favorable long-term outcomes and a low relapse rate. Re-treatment with immunotherapy remains beneficial in relapsing patients.</p>","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"809-814"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Survey analysis on the development and current status of pediatric digestive endoscopy over past 40 years].","authors":"Q C Xu, J J Xu, Z Q Jin, X L Xie, L L Geng, Q W Shan, Shakan Akenayi, Y K Huang, B X Wang, J Y You, X M Zhang, S N Shu, X H Xu, X Zhan, L Zhu, S H Wan, L Zhang, C Y Li, B Wu, M Sun, H Y Hu, M Wang, X Q Li, Y Zhao, J Wu, H F Liu, J H Zhang, L L Wang, L Zhang, Y H Zhang, Lamu Zhuoga, W Zheng, G P Jin, Z Y Liu, S T Gong, M Z Jiang","doi":"10.3760/cma.j.cn112140-20260514-00387","DOIUrl":"10.3760/cma.j.cn112140-20260514-00387","url":null,"abstract":"<p><p><b>Objective:</b> To understand the development and current status of pediatric digestive endoscopy over the past 40 years, so as to provide strategic recommendations for the discipline's future development. <b>Methods:</b> A cross-sectional survey was conducted between February and March 2025 across 504 hospitals practicing pediatric endoscopy in 31 provinces, autonomous regions or municipalities. The structured questionnaire encompassed institutional and endoscopy center profiles, workforce demographics, technical capabilities, and continuing education requirements. <b>Results:</b> All 504 distributed questionnaires were returned valid. Pediatric endoscopy was first established in 1985 in Zhejiang Province and Beijing, with the Xizang Autonomous Region commencing services in 2023. The 5 leading provinces by center volume were Shandong (65 hospitals), Zhejiang (47 hospitals), Jiangsu (36 hospitals), Sichuan (34 hospitals) and Guangdong (29 hospitals). Geographic distribution revealed significant disparities: East China dominated with 187 centers (37.1%), North China accounted for 51 (10.1%), Southwest China accounted for 84 (16.7%), South China accounted for 65 (12.9%), Central China accounted for 41 (8.1%), Northwest China accounted for 60 (11.9%), while Northeast China accounted for merely 16 (3.2%). The workforce comprised 2 089 physicians and 1 920 nurses (physician-to-nurse ratio 1∶0.92), with general hospitals demonstrating superior staffing ratios (1∶1.06) compared to pediatric specialized and maternal-child hospitals (1∶0.51). Training predominantly relied on external fellowships (49.4%, 249/504) or combined institutional-external programs (40.9%, 206/504), supervised mainly by pediatric endoscopists (75.2%, 342/455). Diagnostic and therapeutic capabilities achieved comprehensive gastrointestinal coverage, with the five most prevalent procedures being gastroscopy (100.0%,504/504), foreign body retrieval (89.7%,452/504), colonoscopy (74.6%,376/504), polypectomy (62.5%,315/504), and hemostasis (54.0%,272/504). Conversely, advanced interventions, including endoscopic retrograde cholangiopancreatography, endoscopic retrograde appendicitis therapy and peroral endoscopic myotomy remained limited in adoption. Between 1996 and 2025, 18 practice guidelines, consensus statements and standard operating protocols were published. <b>Conclusions:</b> Pediatric gastrointestinal endoscopy has developed rapidly, with progress in discipline development, technical standards, talent cultivation, and consensus guideline formulation. However, challenges remain in achieving regional balance, optimizing the doctor-nurse ratio, and advancing high-level endoscopic therapeutic technologies. Future efforts should focus on refining minimally invasive technologies, integrating intelligent technologies, and achieving integrated management across the entire service chain.</p>","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"756-762"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of the neurodevelopmental impairments and its influencing factors in twins with birth weight discordance before 7 years of age].","authors":"T Zhou, Y C Wu, H Jiang, L X Wang, X L Qu, D D Fang, H F Dong, X L Wei, M S Lu, W H Zhou, P Wang","doi":"10.3760/cma.j.cn112140-20260208-00124","DOIUrl":"10.3760/cma.j.cn112140-20260208-00124","url":null,"abstract":"<p><p><b>Objective:</b> To explore the incidence and influencing factors of neurodevelopmental impairment before 7 years of age in twins with birth weight discordance. <b>Methods:</b> A multicenter retrospective cohort study was conducted. A total of 61 pairs of twins with birth weight discordance (birth weight difference >15%) who underwent regular child health care at Guangzhou Women and Children's Medical Center, Shenzhen Maternity and Child Healthcare Hospital of Women and Children's Medical Center of Southern Medical University, and the Third Affiliated Hospital of Zhengzhou University from January 2019 to June 2025 were enrolled. All children completed the Griffiths development scales-Chinese (GDS-C) assessment before 7 years of age. Data on neonatal characteristics, neurodevelopmental outcomes and maternal gestational conditions were collected. Paired <i>t</i>-tests were used to compare neurodevelopmental scores between the larger and smaller twins within each pair. According to the birth weight discordance, they were further divided into a smaller discordance group (>15%-<25%) and a larger discordance group (≥25%). Clinical characteristics and neurodevelopmental scores were compared between the groups using independent sample <i>t</i>-test, chi-square tests, or Fisher's exact test. Logistic regression analysis was performed to identify influencing factors of neurodevelopmental impairment. <b>Results:</b> A total of 54 pairs of twins (108 children) with birth weight discordance were enrolled, including 62 males and 46 females. The gestational age at birth was (33.7±2.7) weeks, birth weight was (1 766±544) g, and the age at GDS-C assessment was 27 (14, 46) months. The overall developmental quotient (DQ) was 93±14, with 29 children (26.9%) scoring <85 and 4 children (3.7%) scoring <70. Neurodevelopmental impairment occurred in 8 children (14.8%) of the larger twins and 21 children (38.9%) of the smaller twins. The larger twins showed higher DQ in the personal-social, hearing and language, and visual-performance, as well as in the overall DQ, compared with the smaller twins (all <i>P</i><0.05). No statistical difference was observed in domain-specific DQ and total DQ, between the smaller discordance group and the larger discordance group (all <i>P</i>>0.05). Both higher birth weight Z scores and larger gestational age were independent protective factors for neurodevelopmental impairment (<i>OR</i> (95%<i>CI</i>) (0.54 (0.31-0.95) and 0.77 (0.65-0.94) respectively, both <i>P</i><0.05). <b>Conclusion:</b> In twins with birth weight Z scores discordance, higher birth weight and larger gestational age are both independent protective factors for neurodevelopmental impairment, while the magnitude of birth weight discordance itself is not associated with neurodevelopmental outcomes.</p>","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"802-808"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Guidelines of diagnosis and management for food allergy-related gastrointestinal disorders (2026)].","authors":"","doi":"10.3760/cma.j.cn112140-20260310-00199","DOIUrl":"10.3760/cma.j.cn112140-20260310-00199","url":null,"abstract":"","PeriodicalId":60813,"journal":{"name":"中华儿科杂志","volume":"64 7","pages":"714-728"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}