ObjectiveTo investigate the effect of different dosage recombinant human erythropoietin(rhEPO),an angiogenesis-like factor,on pulmonary angiogenesis exposed to hyperoxia in newborn rats.MethodsSixty Sprague-Dawley newborn rats were randomly divided into four groups:air group (room air exposure,n =15 ),hyperoxia group ( exposed to 95％ oxygen,n =15 ),hyperoxia + large dosage rhEPO group (received rhEPO 5000 U/kg,intraperitoneally on 1 hour before and 3 days after exposed to hyperoxia,n =15) and hyperoxia + small dosage rhEPO group (received rhEPO 800U/kg,the same time points,n =15 ).The isodose of saline were given intraperitoneally on the same time points in the air group and the hyperoxia group.After 6 d of exposure,the survival rate was compared,CD31 and vascular endothelial growth factor (VEGF) were measured by immunohistochemistry to assess hyperoxia-induced changes in lung morphology.ResultsAfter 6d of exposure,hyperoxia + large dosage rhEPO group prolonged the survival rate in comparison with the hyperoxia group [ 86.7 ％ ( 13/15 ) vs 60.0 ％ ( 9/15 ) ].The expression of lung CD31 [ ( 38.69 ±1.69)％ vs (33.57±4.12)％,P＜0.05] and VEGF (124.4296±7.2823 vs 114.2059 ±-8.345 7,P＜0.05) in newborn rats treated with large dosage of rhEPO was significantly higher than those in hyperoxia group.While there was no significant difference of CD31 [ ( 36.34 ± 1.89 ) ％ ] and VEGF( 115.429 6 ± 6.719 9) in small dosage rhEPO group compared with the hyperoxia group (P＞0.05 ).ConclusionInstead of treatment with small dosage rhEPO (800 U/kg),large dosage rhEPO (5000 U/kg) may have important protective effects on pulmonary angiogenesis in hyperoxia-induced lung injury of newborn rats.

Objective To investigate the risk factors of bronchopulmonary dysplasia(BPD)in very low birth weight infant.Methods The clinical data of 49 very low birth weight infants in our NICU from Sep 2006 to Sep 2009 were reviewed,and divided into BPD group(n =15)and without BPD group(n =34).The risk factors of BPD were analysed.Results Compared with the infants without BPD,there were significant differences in gestational age[(29.30 ± 1.48)week vs(30.54 ± 1.60)week],hospital-acquired infection(9 cases vs 10 cases),intrauterine infection(9 cases vs 8 cases),the time for continuous positive airway pressure(CPAP)[(12.47 ± 5.83)d vs(4.24 ± 4.19)d],the time for hyperoxia[(1.47 ± 1.41)d vs (0.18 ±0.63)d],patent ductus arteriosus(5 cases vs 1 cases)(P＜0.05).Logistic regression revealed that intrauterine infection and the time for CPAP were independent risk factors of BPD(P ＜0.05).Conclusion Prophylaxis of intrauterine infection may decrease the mortality and severity of BPD.The prolonged time for CPAP may predict the risk of BPD.

Objective To retrospectively analyze the clinical characteristics of 5 cases with recurrence of congenital tracheoesophageal fistula (rTEF) and to further understand the diagnosis and treatment of this disease.Methods We totally diagnosed 5 cases of rTEF from September 2015 to July 2016 in the department of respiration of Shenzhen Children′s Hospital.The clinical materials,characteristics,risk factors of recurrence and diagnostic methods were analyzed.Results Two cases were diagnosed of rTEF at 8 years after the first repair,one case was at one year after the initial repair and two cases were at 1 to 2 months after their operations.Three cases manifested mainly in bucking after feeding,recurrent pneumonia and growth retardation.One case was admitted for vomiting and abdominal distension.One case was asymptomatic.Esophageal anastomotic leaks occurred in three cases and esophageal trictures occurred in four cases after their repairs.Three cases accompanied with gastroesophageal reflux and five cases with tracheomalacia.Four cases were performed esophagography,but only two cases were suspected of recurrence.All of five cases were performed bronchoscopy.One case was diagnosed of rTEF directly.Two cases were found suspected fistulas.And another two cases were only found surgical scars.But these four cases were confirmed by Methylene blue test observed by bronchoscopy.Conclusion Although the leading clinical manifestations of rTEF are respiratory symptoms and feeding difficulties,sometimes rTEF is asymptomatic.Because rTEF is usually complicated with the other diseases with similar symptoms,it is possible to miss the diagnosis.Esophageal anastomotic leaks and trictures are the risk factors of recurrence.Bronchoscopy is the first choice for the diagnosis of rTEF,and Methylene blue test is golden standard.Thoracotomy is recommended for the treatment of rTEF.

Streptococcus pneumoniae is the leading pathogen of community-acquired pneumoniae, acute otitis media and bacterial meningitis in children.The invasive pneumococcal diseases(IPDs) are also the main cause of death in children under 5 years old.Therefore, it′s an important task to prevent and control pneumococcal diseases in children worldwide, especially in developing countries.The inoculation of 13-valent pneumococcal conjugate vaccine(PCV13) is a chief precaution against IPDs in children, but PCV13 hasn′t been included in the immunization schedule in China.In this study, the research on the epidemiological characteristics of pneumococcal infections and pneumococcal diseases in children in China was reviewed with the view of providing strategic information for the control and prevention of pneumococcal diseases in children.

The exhaled air of healthy people contains nitric oxide.Under the physiological condition, nasal nitric oxide(NNO) comes primarily from the sinuses, a little is produced in the nasal mucosa.Fractional exhaled nitric oxide is mainly from the trachea and bronchus.When airway diseases occur, it can influence the concentration of exhaled nitric oxide.Therefore, with the continuous improvement of technology in recent years, the measurement of NNO has been widely used in upper airway diseases of children.It is characteristics of quantitative, non-invasive, simple and safe.This article reviews the measurement methods of NNO and its clinical application in children upper airway diseases such as rhinitis, sinusitis, nasal polyps and adenoid hypertrophy.

Objective:To investigate the etiology, clinical characteristics and outcome of severe pneumonia-associated hemophagocytic lymphohistiocytosis, and to analyze the risk factors for mortality.Methods:Clinical data of patients with severe pneumonia-associated hemophagocytic lymphohistiocytosis admitted to Shenzhen Children′s Hospital from February 2009 to February 2019 were retrospectively analyzed.The data included clinical characteristics, etiology, clinical manifestations, laboratory data, treatment and outcomes of the patients.The clinical characteristics and laboratory data of the survival group and the death group were compared by independent sample t-test. Results:(1) Clinical characteristics: the patients were aged from 3 months to 8 years and 7 months, including 15 males and 15 females.Severe pneumonia-associated hemophagocytic lymphohistiocytosis accounted for 2.74% (30/1 096 cases) of severe pneumonia in the same period.(2) Etiology: Mycoplasma pneumoniae infection was found in 8 cases (8/30 cases, 26.67%), virus infection in 7 cases (7/30 cases, 23.33%, including 5 cases with adenovirus infection, 1 case with EB virus infection, and 1 case with cytomegalovirus infection), Mycoplasma pneumoniae complicated with adenovirus infection in 4 cases (4/30 cases, 13.33%), bacterial infection in 3 cases (3/30 cases, 10%), and fungal infection in 2 cases, Mycobacterium tuberculosis infection in 1 case.The pathogens were not identified in 5 patients.(3) Clinical manifestations: fever and hepatomegaly were present in all patients.Besides, 86.67% (26/30)patients had fever duration more than 10 days, 83.33% (25/30 cases) patients had cough, 76.66% (23/30 cases) patients had splenomegaly, and 33.33% (10/30 cases) patients had nervous system symptoms.Laboratory data showed varying degrees of reduction of binary and ternary systems in 80.00%(24/30 cases) of the patients.Liver function impairment was found in half of the patients, and serum ferritin and lactate dehydrogenase levels were elevated in all patients.(4) The mortality rate was 30.00% (9/30 cases). The differences in age, hypertriglyceridemia and high serum ferritin levels between the survival and death groups were significant (all P<0.05). Conclusions:Severe pneumonia-associated hemophagocytic lymphohistiocytosis is a disease with a high mortality rate.Patients with Mycoplasma pneumoniae and adenovirus pneumonia are more likely to suffer from secondary hemophagocytic lymphohistiocytosis.Younger age, hypertriglyceridemia and high serum ferritin levels are indicative of poor prognosis.

Influenza is an acute respiratory infectious disease caused by influenza virus, which can promote the adhesion and colonization of Streptococcus pneumoniae in respiratory epithelial cells, increasing the incidence of pneumococcal infections.Therefore, children should take early precautions against pneumococcal diseases during or before the influenza season.The progress in research on the epidemiology of influenza and the prevention of pneumococcal diseases in children was reviewed in this paper.

Objective: To summarize the clinical characteristics of the diffuse parenchymal lung diseases in a child caused by a novel compound heterozygous ABCA3 mutation and explore the association between the phenotype and ABCA3 mutation. Method: The clinical material of a patient diagnosed with diffuse parenchymal lung disease with ABCA3 mutation in December 2016 in Shenzhen Children's Hospital was analyzed. The information about ABCA3 gene mutation updated before April, 2017 was searched and collected from the gene databases (including 1000Genomes, HGMD, EXAC) and the literatures (including Wanfang Chinese database and Pubmed). Result: The girl was one year and nine months old. She presented with chronic cough, tachypnea, cyanosis and failure to thrive since she was one year and three months old. Her condition gradually deteriorated after she was empirically treated. Physical examination showed malnutrition, tachypnea and clubbed-fingers. Her high resolution computed tomography (HRCT) revealed diffused ground-glass opacities, thickened interlobular septum, and multiple subpleural small air-filled lung cysts. The second generation sequencing study identified a novel compound heterozygous mutation (c.1755delC+c.2890G>A) in her ABCA3 gene, which derived respectively from her parents and has not been reported in the database and the literatures mentioned above. Conclusion c.1755delC+c.2890G>A is a new kind of compound heterozygous mutation in ABCA3, which can cause children's diffuse parenchymal lung disease. Its phenotype is related to its genotype.

Objective:To investigate the clinical characteristics and serotyping characteristics of respiratory syncytial virus(RSV)infection in children prevalent during summer of 2020 in Shenzhen City, and provide basis for the diagnosis, monitoring and prevention of RSV infection in this area.Methods:The clinical data of 509 cases of RSV infection were analyzed in the Respiratory Department at Shenzhen Children′s Hospital from July 1, 2020 to August 31, 2020.The children diagnosed with pneumonia were divided into mild RSV pneumonia group and severe RSV pneumonia group according to the severity.The age, sex, clinical manifestations, basic diseases, mixed infection, clinical diagnosis of the patients were analyzed.Results:In 509 children with RSV infection, the male to female ratio was 1.84∶1, and the mean thermal range was (3.98±3.25) d. The detection rate of RSV was 51.4% (126/245) in children aged < 6 months, 45.6% (247/542) in children aged from 6 months to 2 years, 41.8% (123/294) in children aged from 2 to 5 years, and 8.5% (13/153) in children aged > 5 years.Common clinical manifestations were cough (96.2%), fever (72.5%), runny nose (61.9%), and nasal congestion (54.6%). Of the 509 cases, 123 (24.2%) had underlying diseases and 49 (9.6%) had mixed infections.A total of 371 cases had RSV pneumonia, including 280 mild cases (55.0%) and 91 severe cases (17.8%). Compared with the mild RSV pneumonia group, the severe RSV pneumonia group was significantly higher in male, age < 1 years, proportion of wheezing, underlying disease, mixed infection, and hospitalization time and fever time (all P<0.05). Multivariate analysis showed that age less than 1 year, mixed infection and underlying diseases were the high risk factors of severe RSV pneumonia( OR=10.1, 14.3 and 3.4, respectively, all P<0.05). Of the 198 serotyping cases, 18 were type A and 180 were type B. Conclusion:During the summer of 2020, the epidemic of RSV infection in children in Shenzhen is dominated by type B. In addition to children aged from 6 months to 2 years, children aged 2-5 years are also susceptible groups.Age<1 year, underlying diseases and mixed infection are independent risk factors of severe RSV pneumonia in children.