Objective:To compare the differences in clinical characteristics among the patients at clinical high risk for bipolar disorder(CHR-BD),the patients with bipolar disorder(BD),and the healthy controls(HC)at low risk,and to provide the basis for the diognasis and treatment of CHR-BD.Methods:For the first time,the BD risk criteria and prospective structured assessment tools were jointly used in outpatients aged 16-30 years,and 43 CHR-BD patients were included to ensure the accuracy of the assessment.Meanwhile,33 BD patients and 32 HC subjects were also enrolled.The clinical symptoms,neurocognitive function,and global functional levels of the subjects in the three groups were evaluated using observer-rated and self-rated tools.The CHR-BD and BD groups were combined,and Logistic regression analysis was used to identify the independent influencing factors related to diagnostic status;Pearson or Spearman correlation analysis was used to analyze the correlations between the global functional levels and the symptoms or neurocognitive characteristics of the patients in CHR-BD and BD groups.Results:There were statistically significant differences in the scores of symptom and global functional level scales among HC,CHR-BD,and BD groups(P<0.05).Compared with HC group,the scores of mood symptoms(anxiety,depression,and mania/hypomania),psychotic symptoms,total affective temperament questionnaire scores,and some dimensions(cyclothymic,depressive,irritable,and anxious temperaments)in CHR-BD and BD groups were significantly increased(P<0.001),while the global functional levels were significantly decreased(P<0.001).Compared with BD group,the lowest global functional level score in the past year in CHR-BD group was significantly increased(P=0.022),while the current global functional level score was significantly decreased(P=0.005).No significant differences were observed in neurocognitive function scores among the three groups(P>0.05).The lowest global functional level score in the past year was an independent influencing factor for BD diagnosis[odds ratio(OR)=0.952,95%confidence interval(CI):0.917-0.988,P=0.010].In both CHR-BD and BD patients,the current global functional levels were negatively correlated with depressive(r=-0.417,P=0.005;r=-0.617,P<0.001)and anxiety symptoms(r=-0.360,P=0.018;r=-0.506,P=0.003).In BD patients,the current global functional level was negatively correlated with lifetime manic/hypomanic symptoms(r=-0.360,P=0.039),psychotic symptoms(r=-0.502,P=0.003),and affective temperament scores(r=-0.479,P=0.005),while the lowest global functional level in the past year was negatively correlated with lifetime manic/hypomanic symptoms(r=-0.391,P=0.024).Conclusion:CHR-BD patients share similar mood symptom characteristics with BD patients,and their global functional levels are negatively correlated with depressive and anxiety symptoms.BD patients exhibit worse lowest global functional levels in the past year,and their global functional levels are negatively correlated with manic/hypomanic symptoms.

Clinical data of one patient diagnosed with kaposiform hemangioendothelioma (KHE) in the spinal canal and mediastinum at the Children′s Hospital, Zhejiang University School of Medicine in October 2022 were retrospectively analyzed.Additionally, a literature review on mediastinal KHE was performed to summarize prior clinical characteristics and treatments.The patient, a 25-day-old boy, presented with refractory thrombocytopenia.Multiple chest radiographs suggested significant widening of the mediastinum and atypical atelectasis in the left upper lung, and enhanced chest CT and magnetic resonance imaging suggested KHE.After cocktail therapy with Prednisolone, Vincristine and Sirolimus, platelets increased to normal, and coagulation function improved.After 3 months of follow-up, hematologic parameters were stable, the mass became smaller, and no side effects occurred.

According to the International League Against Epilepsy (ILAE) standards, the Newborn Working Group of the ILAE put forward 6 necessary questions about the management of neonatal anti-seizure medication and gave evidence-based recommendations in 2023. The basic framework is systematic review+expert consensus. The clinical recommendations of ILAE guidelines 2023 and the similarities and differences between ILAE guidelines 2023 and ILAE guidelines 2011 were analyzed and interpreted in this paper, in order to provide reference for colleagues involved in neonatal convulsion management in China.

Children are at high risk for burns, and severe burns can lead to the destruction of their skin's physiological structure, causing excruciating pain. Burned children are highly prone to adverse emotions such as anxiety and panic, which can impact the outcome of their treatment and rehabilitation. Therefore, managing pain and anxiety is crucial in the care of burned children. In 2022, " Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures" was published in the journal " Annals of Medicine and Surgery" by Ethiopia expert panel engaged in burn rehabilitation after conducting a systematic literature search and evaluation, aiming to guide clinical management of related diseases in a more scientifical and standardized manner. This paper aims to inform clinical healthcare professionals in China to understand the latest relevant evidence, and to provide ideas and basis for effective management of pain and accompanying anxiety in children with burns, and standardized operations of relevant practice.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Since the introduction of extracorporeal membrane oxygenation (ECMO) technology, more newborns and children with cardiopulmonary failure have survived.However, the complication rate of children who have survived ECMO is still not optimistic.Comprehensive, multidisciplinary, and structured follow-ups after discharge and throughout adolescence are extremely critical.At present, scholars at home and abroad have been paying more attention to the long-term quality of life of children after ECMO, and related studies are constantly increasing.This article systematically analyzes the current research status at home and abroad from the content and tools of follow-up after discharge, personnel and methods involved in follow-up, follow-up time, existing problems, and prospects, aiming to provide insights and references for developing a scientific and systematic follow-up plan suitable for China′s national conditions.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

Sepsis is a common critical illness in PICU, with high morbidity and mortality.As the pathogenesis is still not well defined, the clinical management of sepsis can be tricky.The gastrointestinal tract is currently considered as one of the most susceptible organs in the early stages of sepsis, and intestinal microecology plays important roles in the development, progression and prognosis of this disease.There is a closely relationship between intestinal flora dysbiosis/translocation and sepsis.They interact with each other, and ultimately leading to multi-organ dysfunction.In this review, we provided a brief summary of intestinal microecological changes and its pathogenesis in sepsis, as well as the progress of treatment.

Objective:To explore the clinical features and the mortality risk factors of hemophagocytic lymphohistiocytosis (HLH) in pediatric intensive care unit (PICU).Methods:Clinical data of 68 children diagnosed as HLH and treated in PICU, the Children′s Hospital, Zhejiang University School of Medicine between January 2014 and December 2020 were retrospectively analyzed.According to the lowest pediatric critical illness score (PCIS) within 24 h after admission to PICU, they were divided into non-critical group, critical group and extremely critical group.Moreover, they were further divided into survivors and non-survivors based on the prognosis.Clinical characteristics in each group were analyzed and compared. Logistic regression analysis was performed to obtain the estimates of odds ratio ( OR) and corresponding 95% confidence interval ( CI) of possible predictive factors for death. Results:The median age of recruited 68 children with HLH and treated in PICU was 26 months, involving 39 female and 29 male patients.The overall mortality rate was 45.59%(31/68 cases). Epstein-Barr virus (EBV) infection was the major cause of HLH.The mortality of non-critical group, critical group and extremely critical group were 21.05% (8/38 cases), 57.14% (8/14 cases) and 93.75% (15/16 cases), the difference was statistically significant ( P<0.05). The PCIS, the pediatric logistic organ dysfunction score 2 (PELOD-2), duration of fever, mechanical ventilation within 6 h, vasoactive use, gastrointestinal and pulmonary hemorrhage, disseminated intravascular coagulation (DIC), hepatobiliary dysfunction (HBD) and acute kidney injury (AKI), acidosis[pH and base excess (BE)], hemoglobin (Hb), prothrombin time (PT), and activated partial thromboplastin time (APTT), serum creatinine (Scr), interleukin-6 (IL-6) were significantly different between survivors and non-survivors (all P<0.05). The Logistic regression analysis showed that PCIS ( OR=0.800, 95% CI: 0.707-0.905, P<0.001), Hb ( OR=0.929, 95% CI: 0.871-0.991, P=0.027), APTT ( OR=0.954, 95% CI: 0.910-0.990, P=0.047), and AKI( OR=29.064, 95% CI: 3.072-274.957, P=0.003) were risk factors for the death of HLH. Conclusions:HLH has a very high mortality and requires critical care in PICU, low PCIS, anemia, prolonged APTT and AKI are independent risk factors for the death of HLH.

Purulent pericarditis is still a life-threatening disease for children.Utilizing antibiotics and performing completely drainage of pus are the major treatment options.Constrictive pericarditis is an important complication of purulent pericarditis.Intrapericardial fibrinolysis can effectively reduce fibrin deposition in pericardium, prevent pericardium adhesion and fibrosis, therefore it will prevent constrictive pericarditis.However, it is seldom used in the treatment of children with purulent pericarditis.This article reviews the domestic and international reports on intrapericardial fibrinolysis in children with purulent pericarditis, introduces the indications, mechanisms, treatment protocols, effectiveness studies and complications of intrapericardial fibrinolysis, thus providing a reference for the treatment protocol of children with purulent pericarditis.