Objectives To study the value of cough peak expiratory lfow (CPEF) in predicting extubation outcome of children with acute respiratory failure. Methods A total of 62 children with acute respiratory failure were selected and received mechanical ventilation longer than 72 hours. They were conscious at the time of extubation and successfully got through 30 minutes of spontaneous breathing trial. Children were divided into success group and failure group according to the outcome of extubation. CPEF, pulmonary function parameters, blood gas analysis and pediatric critical illness scores were compared before extubation between two groups. Results Fifty-two cases were successfully extubated but 10 cases failed. CPEF of the success group was signiifcantly higher than that of the failure group (P<0.01). Based on the results of receiver operating characteristic curves, the area under the curve was 0.873. The optimal operating point of CPEF was 40.5L/min, and the sensitivity and speciifcity were 76.9%and 90.0%, respectively (P<0.01). Conclusions It is suggested that CPEF can be used as a predictor of extubation outcome.

Objective To explore the effects of montelukast for improving pulmonary functions and airway inflammation in children patients with bronchial asthma. Methods A total of 108 children patients with bronchial asthma who were admitted to our hospital were assigned to research group and control group based on their disease conditions. The re-search group was given regular treatment and montelukast, and the control group was given regular treatment alone. Ex-amination of pulmonary functions (FEV1, FEV1/FVC and ratio of FEV1 to predicting value), changes of airway inflamma-tion factors (IL-5, IL-10 and TNF-α), eosnophils count and clinical effects before and after the treatment between the two groups of children patients were assessed. Results The differences of indices such as FEV1, FEV1/FVC and ratio of FEV1 to predicting value in the research group after the treatment were all statistically significant compared with those in the control group(P<0.05). The differences of IL-5, IL-10 and TNF-α in the research group after the treat-ment were statistically significant compared with those in the control group (P<0.05). EOS% was (4.29±1.03)% in the research group after the treatment, and the difference was statistically significant compared with that of (5.98±1.25)%in the control group (P<0.05). 79.6%of patients in the research group received an effective treatment of bronchial asthma, and the difference was statistically significant compared with that of 29.6% in the control group (P<0.05). Con-clusion Montelukast is effective in improving pulmonary functions and airway inflammation in children patients with bronchial asthma, which is worthy of clinical promotion and application.

Objective To elucidate the clinical significance in facilitating timely diagnosis and treatment of RMPP in children by investigating the association between infection caused by macrolide-resistant Mycoplasma pneu-moniae(MRMP)and refractory Mycoplasma pneumoniae pneumonia(RMPP)in pediatric patients.Methods The clinical data of 714 hospitalized children with refractory Mycoplasma pneumoniae pneumonia(RMPP)were retro-spectively analyzed.Bronchoscopy and bronchoalveolar lavage fluid(BALF)were performed on each subject,and the BALFs were collected to detect mutation sites in the V region of 23S rRNA for Mycoplasma pneumoniae DNA.Based on the gene detection results,children with RMPP were categorized into a macrolide-resistant group and a control group(non-macrolide-resistant group).Results A total of 714 children diagnosed with refractory Mycoplasma pneumoniae pneumonia(RMPP)were enrolled in this study,including 509 cases in the macrolide-resistant group and 205 cases in the control group.Among them,there were 369 males(54.7%)and 345 females(45.3%).The macrolide-resistant group exhibited higher average age,fever duration,and hospitalization days compared to the control group.Furthermore,elevated levels of white blood cell count(WBC),neutrophil percentage(NE%),high-sensitivity C-reactive protein(hs-CRP),lactate dehydrogenase(LDH),and interleukin-6(IL-6)were observed in the macrolide-resistant group when compared to the control group(P<0.05 or P<0.000 1).Compared to the control group,children with macrolide-resistant Mycoplasma pneumoniae pneumonia(RMPP)exhibited higher incidences of lung consolidation,pleural effusion,necrotic pneumonic lesions,severe MPP(SMPP)/fulminant MPP(FMPP),flocculent and viscous tracheal secretions,severe mucosal lesions(erosion,ulceration or necrosis),bronchial inflammatory stenosis,endo-bronchial plastic phlegm plugs and extra-pulmonary complications(P<0.05 or P<0.0001).Conclusions MRMP infection can contribute to the development of RMPP,potentially exacerbating respi-ratory conditions in affected children.Timely bronchoscopy and collection of BALF samples for accurate evaluation of respiratory tract lesions and detection of MRMP infection have significant implications for guiding precise clinical diagnosis and treatment.

Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis(HH)in children with shock.Methods Clinical data(general situation,clinical situation and prognosis)of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected.Serum biochemical indexes on day 1(d1),day 2(d2),day 3(d3),day 5(d5),day 7(d7)of children with shock were collected,including serum alanine aminotransferase(ALT),glutamate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),albumin(ALB),total bilirubin(TBIL),urea nitrogen(BUN),C reactive protein(CRP),international standardized time(INR)and lactate.And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed.Results A total of 234 cases(150 cases of males)of different types of shock in children were enrolled,ages ranged from 1 month to 16 years old.According to whether developed HH,the children with shock were divided into HH group(32 cases)and non-HH group(202 cases).The total incidence of HH was 13.7%(32/234).Septic shock was the main disease of the occurrence of HH in children with shock,accounting for 65.63%(21/32).According to the prognosis,children with shock combined HH were divided into survival group(17 cases)and death group(15 cases).The case fatality rate of children with shock combined HH was 46.9%.The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges.The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2,they were close to the normal ranges at the onset time d7,while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage.Compared with the survival group,the peak values of ALT,AST,ALP,TBIL,CRP,BUN,and INR in the death group were obviously higher(P<0.05,both).The lowest value of ALB in the death group was lower than that in the survival group(P<0.05).The results of multivariate Logistic regression analysis showed that pediatric critical illness score(PCIS),lactate,multiple organ dysfunction syndrome(MODS),decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock(P<0.05 or 0.01),and left ventricular ejection fraction(LVEF)and mean arterial pressure(MAP)were the risk factors of the death of HH in children with shock(P<0.01).Conclusions Children with shock who have the risk factors as decreased PCIS,increased lactate level,MODS,decompensated shock and cardiogenic shock are apt to suffer from HH.Poor prognosis in the chil-dren with shock combined HH is associated with worse condition and lower LVEF.There is a high fatality rate of shock combined HH in children,so that liver function indicators should be closely monitored to early detect HH,and reasonable treatment should be given.

Objective:To investigate the key points of diagnosis and treatment of glycogen storage disease type Ⅱ(GSD Ⅱ).Methods:The clinical data of one child patient with GSD Ⅱ who received treatment in Hainan Children's Hospital on May 7, 2017 were retrospectively analyzed.Results:The child presented with atypical clinical manifestations, including pneumonia first, accompanied by muscle weakness and elevated muscle enzymes. Whole-genome sequencing showed that there were two heterozygous mutations in the acid alpha-glucosidase (GAA) gene, c.871C > T and c.1447G > A. The child was diagnosed with GSD Ⅱ.Conclusion:GSD Ⅱ has atypical clinical manifestations. It is easily misdiagnosed. Early whole-genome sequencing is helpful for the diagnosis of GSD Ⅱ.

Objective:To assess the efficacy of the newly constructed system for screening, managing and monitoring congenital heart disease (CHD) in neonates of Hainan Province, thus providing references for a further promotion.Methods:Clinical data of neonatal CHD in Hainan Province from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including screening, diagnosis and treatment, prognosis and follow-up.Relying on Hainan Women and Children′s Medical Center as the leading unit, a neonatal CHD screening, diagnosis, treatment, and monitoring system was established.A dual-indicator method was adopted, that was, screening staffs in Hainan Province performed CHD screening in living neonates by cardiac auscultation and pulse oximetry (POX) within 6-72 h after birth.Echocardiographic examinations for the screened living neonates were performed in the 31 authorized diagnosis institutions.Evaluations, interventions and treatment of living neonates with CHD were performed in 6 authorized tertiary hospitals.Data of screening, diagnosis, evaluation and treatment were filled in, uploaded and managed online through the neonatal CHD screening information management system.The research team of our hospital was responsible for the data management and monitoring.Results:From January 1 st, 2019 to December 31 st, 2021, there were 329 387 living neonates in Hainan Province, and 321 447 (97.59%) were screened for CHD, and the annual screening rate increased year by year.The positive rate of CHD screening was 2.50%(8 032/321 447). The rate of cardiac ultrasound examination within 1 week of CHD positive screening was 94.66%(7 603/8 032). The referral rate of severe CHD was 100.00%(154/154). The overall prevalence of CHD in neonates of Hainan Province was 3.419‰ (1 099/321 447). Atrial septal defect was the most common CHD lesion, with a proportion of 38.40%(422/1 099). The sensitivity of cardiac auscultation, POX and their combination for CHD detection were 69.15%, 33.49% and 91.90%, respectively, and the specificity were 98.36%, 99.43% and 97.81%, respectively.At the initial screening, the ratio of dual-positive of cardiac auscultation and POX in neonates with severe CHD (serious and critical CHD) was significantly higher than that of a single positive indicator ( χ2=36.502, 46.214, respectively; all P<0.001). All neonates with CHD were evaluated.Fifteen neonates with severe CHD died.From 2019 to 2021, the standardized mortality rate of children aged 0-1 years with CHD in Hainan province was 4.67/100 000 (15/321 447). Conclusions:Dual-indicator screening for CHD (cardiac auscultation plus POX) is reliable, non-invasive, and simple, which is conducive to be clinically promoted.Introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD are extremely significant since they may have contributed to the timely diagnosis and treatment of CHD, especially severe CHD, thus lowering the mortality.