Systemic lupus erythematosus is a chronic autoimmune disease. Childhood systemic lupus erythematosus has complex pathogenesis,more severe tissue damage,and higher involvement rates of kidneys and other systems. The treatment goals are to reduce damage and prevent recurrence. B cells play a key role in its pathogenesis,making B-cell-targeted therapy a focus. Various drugs like Rituximab,Belimumab,Obinutuzumab,Telitacicept,and chimeric antigen receptor T-cell therapy have been used. Although each shows efficacy,long-term safety needs research. In the future,precise individualized treatment based on biomarkers is expected.

IgA nephropathy（IgAN）is one of the most common primary glomerular diseases and a leading cause of chronic kidney disease and end stage kidney disease worldwide both in children and adults.B cells and their related factors，including B-cell activating factor（BAFF）and a proliferation-inducing ligand（APRIL），play critical roles in the pathogenesis of IgAN.In recent years，significant advancements have been achieved in drug development targeting B cell depletion and the BAFF/APRIL signaling pathways.The advancement of clinical trials of B-cell and cytokine-targeted drugs such as Rituximab，Felzartamab，Sibeprenlimab，Zigakibart，Atacicept，Telitacicept and Povetacicept has also brought new directions for the further optimization of the treatment regimens for children with IgA nephropathy.

Objective:To investigate the efficacy of antiviral therapy and influencing factors of hepatitis B surface antigen(HBsAg) negative conversion for hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB) in children.Methods:The clinical data of 38 children with CHB who received antiviral treatment in Children's Hospital Affiliated to Xi'an Jiaotong University from January 2019 to August 2024 were collected.All patients were treated with interferon alpha monotherapy or combined with nucleoside analogues for 48 weeks.The patients were divided into HBsAg negative group and HBsAg non-negative group according to the therapeutic results at 48 weeks.Multivariate Logistic regression were used to identify influencing factors of HBsAg negative conversion at 48 weeks.The receiver operator characteristic（ROC）curve was used to analyze the predictive value of each factor to HBsAg negative conversion.Results:The alanine aminotransferase normalization rate，hepatitis B virus DNA negative rate，HBeAg negative rate and HBsAg negative rate were 76.3%，94.7%，39.5% and 47.4%，respectively at 48 weeks.There were 18 cases in HBsAg negative group and 20 cases in HBsAg non-negative group.There were statistical significant differences in age and HBsAg decline level at 12 and 24 weeks of antiviral treatment between HBsAg negative group and HBsAg non-negative group（ P<0.05）.Multivariate Logistic regression analysis showed that age and HBsAg decline level at 12 and 24 weeks of antiviral treatment were independent predictors of HBsAg negative conversion at 48 weeks（ OR=0.664，95% CI 0.473-0.932， P=0.018； OR=8.719，95% CI 1.920-39.604， P=0.005； OR=6.182，95% CI 2.083-18.347， P=0.001）.The area under the curve of age and HBsAg decline level at 12 and 24 weeks were 0.737（95% CI 0.576-0.899， P=0.012），0.847（95% CI 0.725-0.969， P<0.001）and 0.939（95% CI 0.811-0.991， P<0.001），respectively.When the age was less than 4.625 years，the sensitivity，specificity，positive predictive value and negative predictive value of HBsAg negative conversion at 48 weeks were 83.3%，65.0%，68.2% and 81.3%，respectively.A decrease in HBsAg level of >1.07 lg IU/mL at 12 weeks of treatment had a sensitivity，specificity，positive predictive value，and negative predictive value of 72.2%，90.0%，86.7%，and 78.3%，respectively，for predicting HBsAg seroclearance at 48 weeks.A reduction in HBsAg of >1.92 lg IU/mL at 24 weeks of treatment showed a sensitivity，specificity，positive predictive value，and negative predictive value of 83.3%，90.0%，88.2%，and 85.7%，respectively，in predicting HBsAg seroclearance at 48 weeks. Conclusion:The children with CHB have a higher rate of HBsAg negative conversion after antiviral therapy at 48 weeks.Age and HBsAg decline level at 12 and 24 weeks of antiviral treatment can serve as early predictors for HBsAg negative conversion in children with CHB.

Objective:To summarize the clinical characteristics and follow-up data of premature infants with metabolic bone disease（MBDP）complicated with spontaneous fracture，and to provide a reference for clinical diagnosis and treatment.Methods:The clinical characteristics,physical growth,and development of eight premature infants with MBDP and spontaneous fracture admitted to the Neonatology Department of the Third Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2022 were retrospectively analyzed.Results:Among the eight cases，six were male and two were female，with gestational ages ranging from 24 +6 to 28 +5 weeks and birth weights ranging from 495 to 1 070 grams.They were complicated with multiple serious complications associatied with premature birth.All patients had a history of drug use,including glucocorticoids,diuretics，caffeine,or sedation，as well as prolonged mechanical ventilation,parenteral nutrition，and multiple blood transfusions.During hospitalization，the normal blood calcium was monitored in all eight premature infants，and the blood phosphorus levels were all below 1.8 mmol/L，serum alkaline phosphatase（ALP）levels exceeded 500 IU/L，with five cases exceeding 900 IU/L.The diagnostic time of MBDP ranged from 61 to 157 days after birth.All premature infants were complicated with fractures of different parts，and the diagnostic time of fractures ranged from 74 to 157 days after birth.They were actively treated with calcium，phosphorus and vitamin D，and were discharged from the hospital after the fracture recovery.The hospitalization time was 95 to 226 days.At discharge，six premature infants had retarded growth in body length and/or weight，and four premature infants still had retarded growth to varying degrees at the correct gestational age of 12 months. Conclusion:Early screening and prevention of MBDP should be carried out in extremely and very premature infants to prevent the occurrence of spontaneous fractures.Furthermore,follow-up management and monitoring after discharge should be strengthened to improve their prognosis.

Surfactants are the cornerstone of treatment for neonatal respiratory distress syndrome (NRDS).In recent years,with the continuous development and popularization of minimally invasive techniques and related concepts,less traumatic administration methods such as less invasive surfactant administration (LISA) have been proposed.Although LISA technology has become the mainstream solution for the prevention and treatment of NRDS in regions such as Europe,the pathophysiological mechanisms underlying its potential clinical advantages have not yet been fully elucidated.This article reviewed the differences in efficacy between LISA and the intubation-surfactant-extubation technique in the treatment of NRDS,the unique advantages of LISA,and its pathophysiological basis,providing a theoretical rationale for optimizing neonatal respiratory support strategies.

The birth weight of newborns in plateau areas was lower than that in plain areas，and showed a downward trend with the increase of altitude.The average birth weight of newborns would decrease by about 100 grams for every 1 000 meters increase in altitude.The mechanism is mainly related to maternal physiological changes caused by hypoxia at high altitude，such as reduced uterine arterial blood flow，changes in placental structure and decreased nutrient transport capacity.Studies have shown that gestational age，altitude，ethnicity，maternal age and the number of prenatal visits are the main factors affecting the birth weight of newborns.The genetic adaptation mechanism of native plateau nationalities（such as Tibetans）can partially alleviate the restriction of fetal growth caused by hypoxia，but its role in ultra-high altitude（>4 500 m）needs further study.Young or advanced maternal age（≥35 years old）and inadequate prenatal care would increase the risk of low birth weight.It is suggested to strengthen health education in plateau area，promote regular prenatal examination，and explore the genetic mechanism of plateau adaptation in order to improve pregnancy outcomes.

In recent years，the incidence of deep vein thrombosis（DVT）in critically ill children has shown an increasing trend.Risk factors such as central venous catheterization，mechanical ventilation，and sepsis have been well-documented.However，there remains a lack of unified risk stratification systems or widely validated risk assessment models specific to pediatric DVT.With advancements in anticoagulant agents and interventional approaches，emerging studies have explored the efficacy of novel anticoagulant regimens in pediatric DVT management，yet standardized protocols for treatment and prevention are still lacking.This article comprehensively reviewed the risk factors，therapeutic advances，and preventive strategies for DVT in critically ill children.

Neonatal hypoxic-ischemic encephalopathy (HIE) refers to hypoxic-ischemic brain damage caused by perinatal asphyxia.Its manifestations are diverse，which can cause a series of neurological dysfunction，and it is one of the main causes of neonatal death and disability in China.Therapeutic hypothermia has become a recognized treatment for HIE at present，which can significantly reduce the mortality and disability rate of moderate and severe HIE and improve the outcome of neurological development.This review summarized the implementation strategies of therapeutic hypothermia，including cooling mode，time window，target temperature，duration，rewarming speed，object selection，contraindications，and the progress of combination therapies，in order to optimize the therapeutic hypothermia scheme of HIE.

Children with high intracranial pressure can occur in a variety of neurological diseases，is an important cause of secondary brain injury，the disease has a high time sensitivity，and is easy to miss the best treatment time.Invasive monitoring of intracranial pressure has many complications and contraindications，which has promoted the clinical application of noninvasive monitoring of intracranial pressure.The optic nerve sheath has a special anatomical structure，and it is surrounded by cerebrospinal fluid，which is connected with the ventricular system of the brain.When intracranial pressure increases，the optic nerve sheath will be thickened.Ultrasound measurement of the optic nerve sheath diameter can provide non-invasive，real-time and repeated assessment of intracranial pressure.The diameter of optic nerve sheath in children was affected by race，age，sex，transverse diameter of eyeball，openness of fontanel，skull compliance，plasticity，disease course，interobserver variability and other factors.Although there are many influencing factors，compared with invasive monitoring，ultrasonic measurement of optic nerve sheath diameter may be a safe and non-invasive bedside tool to fill，which can evaluate intracranial pressure earlier and faster in real time，and have important role in children with neurocritical diseases.

Objective:To analyze the clinical characteristics of children hospitalized with acute lower respiratory tract infections (ALRTI) caused by respiratory syncytial virus (RSV) in Kunming area in 2023.Methods:The clinical data of children with RSV-ALRTI admitted to Kunming Children's Hospital from January to December 2023 were retrospectively analyzed.According to the severity of the disease and whether the children developed severe pneumonia,they were divided into common group and severe group.The general data,clinical manifestations,laboratory indexes,imaging results,treatment and outcomes of the children between the two groups were compared.Multinomial Logistic regression analysis was used to study the risk factors for severe RSV-ALRTI.Results:A total of 696 children with RSV-ALRTI were included,including 432 males (62.1%) and 264 females (37.9%),with a median age of 1.30 (0.40,3.38) years.The onset of RSV-ALRTI occured throughout the year,with a peak incidence in May to August (60.6%).One hundred and seventy-one of 696 samples were tested RSV gene sequence,and two genotypes of RSV A-ON1(60.8%) and RSV B-BA9(39.2%) were detected.Among the 696 children,480 (69.0%) were in the common group and 216 (31.0%) were in the severe group.The age of the children in the severe group was lower than that of the common group,and the proportions of age <1 year,preterm birth,congenital diseases (congenital anomalies of airway development,congenital heart disease),combined Mycoplasma pneumoniae infections,and combined bacterial infections were higher than those of the common group ( P<0.05).There was no statistically significant differences in fever and cough symptoms between the two groups ( P>0.05),but the proportions of children in the severe group with wheezing,shortness of breath,dyspnea,vomiting,and diarrhea were significantly higher than those in the common group ( P<0.05),and the proportions of moist rales and wheezing heard by lung auscultation were significantly higher than those in the common group ( P<0.05).The levels of leukocytes,neutrophils,neutrophil percentage,platelets,procalcitonin,lactate dehydrogenase,alanine aminotransferase,aspartate aminotransferase,creatine kinase isoenzyme,and ferritin in the severe group were higher than those in the common group,while the levels of hemoglobin,lymphocyte percentage,albumin,creatinine,IgG,IgM,IgA,interleukin 6,D-dimer,and fibrin were lower than those in the common group ( P<0.05).The proportions of pulmonary consolidation and pleural effusion in the severe group were higher than those in the common group,and the severe group was more likely to have bilateral pulmonary consolidation ( P<0.05).Both groups of children were given interferon aerosol inhalation for antiviral treatment,and actively symptomatic and supportive treatment.One case in the severe group died during hospitalization,and the remaining 695 cases were cured and discharged.The proportions of children in the severe group using antibiotics,dual antibiotics,intravenous hormones,intravenous immunoglobulin,complications,transfer to PICU,use of invasive mechanical ventilation,length of hospital stay,and treatment costs were significantly higher than those in the common group ( P<0.001).Multinomial Logistic regression analysis showed that low age ( OR=0.878,95% CI 0.800~0.963, P=0.006),congenital diseases (congenital anomalies of airway development,congenital heart disease) ( OR=2.892,95% CI 1.977~4.233, P<0.001),and co-infection with bacteria ( OR=1.846,95% CI 1.268~2.686, P=0.001) were risk factors for the development of severe pneumonia in RSV-infected children. Conclusions:In 2023,RSV-ALRTI in children in Kunming area had an incidence throughout the year,and the peak age group of incidence was predominantly <1 year old,and the main genotype of infection was RSV A-ON1.Children with RSV-ALRTI who are young,suffering from congenital diseases (congenital anomalies of airway development,congenital heart disease) and complicated with bacterial infection are more likely to develop into severe diseases,and should be paid close attention and active intervention to reduce the incidence of critical illness.