【Objective】 To dynamically monitor and analyze the changes of platelets and related indicators in infants with cow′s milk protein allergy (CMPA) during clinical treatment, in order to provide clues for further diagnosis and treatment of CMPA. 【Methods】 From August to November in 2022, 59 children aged from 1 month to 3 years old with CMPA in the pediatric outpatient clinic were selected as the CMPA group, and 29 healthy children who took physical examination were selected as the control group. The differences in platelet related indicators from a routine blood test were compared between the two groups, and their diagnostic value for CMPA was analyzed by receiver operating characteristic (ROC) curves. 【Results】 The mean platelet count (PLT) and plateletcrit (PCT) at baseline in the CMPA group were (374.68±113.21)×10⁹/L and 0.37±0.10, significantly higher than those in control group[(271.07±40.32)×10⁹/L, 0.26±0.05] (t=6.27, 6.43, P<0.001). In the CMPA group, after treatment, the mean PLT level was (316.39±94.68)×10⁹/L, and the mean PCT level was 0.31±0.10, indicating a statistically significant decrease in PLT and PCT levels after treatment compared to baseline (t=4.32,4.75,P<0.05). The diagnostic performance, indicated by the area under the curve (AUC), for PLT and PCT in diagnosing CMPA was 0.811 and 0.823, respectively. The cutoff values for PLT and PCT were determined to be 304.5×10⁹/L and 0.305, respectively. 【Conclusion】 The PLT and PCT levels in children with CMPA are found to be higher than those in healthy controls, suggesting their potential diagnostic value in the diagnosis of CMPA.

Helicobacter pylori (Hp) plays an important role in the development of a variety of digestive diseases in children, but in addition to Hp, there are many other gastric microbiota also critical for children′s health.At present, the characteristics of children′s gastric microbiota may be still relatively unclear.This artical summarizes the composition, succession process and function of children′s gastric microbiota, and reviews the relationship between gastric microbiota and Helicobacter pylori infection in children.

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

The immune mechanism of non-IgE-mediated food allergy is quite complex.Due to the lack of specific laboratory indicators and limited diagnosis and treatment methods, non-IgE-mediated food allergy is usually misdiagnosed.Therefore, it is urgent to clarify the pathogenesis of the disease and search for specific biomarkers and novel therapeutic targets.This review aims to summarize current research results on the immune mechanism of non-IgE-mediated food allergy from two aspects, including the specific immunity and innate immunity, and to explore the potential diagnostic markers.The results may provide novel ideas for effective therapeutic strategies of non-IgE-mediated food allergy.

Objective:To analyze skin manifestations of pediatric inflammatory bowel disease (IBD) .Methods:Children with IBD were collected from pediatric wards in Peking University Third Hospital from January 2010 to January 2022, and their skin manifestations were retrospectively analyzed.Results:A total of 50 children with IBD were included, including 27 with Crohn′s disease and 23 with ulcerative colitis. Twenty-five (50%) patients had skin manifestations, including specific skin manifestations in 11 (22%) and relevant skin manifestations in 11 (22%) . Specific skin manifestations included cutaneous perianal Crohn′s disease in 2 cases, and anal fistula and/or perianal abscess in 9 cases; relevant skin manifestations included erythema nodosum in 5 cases, aphthous stomatitis in 3 cases, psoriasis in 1 case, polyarteritis nodosa in 1 case, and Henoch-Sch?nlein purpura in 1 case. Compared with the ulcerative colitis group, the Crohn′s disease group was more prone to suffer from specific skin manifestations and relevant skin manifestations, and there were significant differences in the prevalence of specific and relevant skin manifestations between the two groups (both P < 0.05) . Of the 27 children with Crohn′s disease, 19 (70%) had one or more skin manifestations, 2 of whom successively presented with 4 different skin manifestations. One child with Crohn′s disease and 1 with ulcerative colitis had 3 different skin manifestations in different periods. The fecal calprotectin level was elevated in all children with skin manifestations, and in 12 (48%) children without skin manifestations. The skin lesions of 5 children were improved or subsided after dose adjustment (1 case) or switch (4 cases) of biological agents. Conclusions:Half of the children with IBD have skin manifestations, and children with Crohn′s disease are more prone to have specific and relevant skin manifestations. Different skin manifestations could be observed in the same child in different periods. Multidisciplinary teamwork is conducive to the overall control of this disease.

Helicobacter pylori infection in children can cause a variety of gastrointestinal and extra-digestive diseases, even the gastric cancer.Most Helicobacter pylori infections are acquired in childhood and can cause various manifestations such as nausea, vomiting, anorexia, idiopathic thrombocytopenic purpura, refractory iron deficiency anemia, and growth retardation.In recent years, many advances have been made in the study of children′s Helicobacter pylori infection.This review focuses on the risk factors of Helicobacter pylori infection in children, containing the perspectives of Helicobacter pylori strains, hosts and environment, and looks forward to further research directions.

Objective:To evaluate the relationship between the timing of complementary feeding for infants and the occurrence of food allergy.Methods:The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang Data database were searched for randomized controlled trials (RCTs) about the effects of early introduction of complementary foods in infants on the occurrence of food allergy. Papers published from the establishment of the databases to December 31, 2019 were extracted. The quality of the selected literature was evaluated using the risk-of-bias (ROB) tools in the Cochrane Handbook, and the RevMan 5.3 software was used for meta-analysis. For the complementary food analyzed in a few reports in literature, a systematic review was conducted.Results:A total of 8 RCTs were extracted, and the systematic review and Meta-analysis were carried out according to food types. The results of Meta-analysis showed that compared with late introduction (after 6 months of age), early introduction (before 6 months of age) of eggs ( RR=0.60, 95% CI 0.46-0.79) could reduce the risk of egg allergy in infants. The subgroup analysis of the six studies about eggs demonstrated that in infants with a prior or family history of allergic diseases, the introduction of eggs before 6 months of age was associated with reduced risk of egg allergy ( RR=0.55, 95% CI 0.40-0.75), and the introduction of raw eggs ( RR=0.67, 95% CI 0.49-0.93) and small amount of eggs (equivalent to weekly protein 0-4 g) ( RR=0.55, 95% CI 0.36-0.85) before 6 months of age were also associated with reduced risk of egg allergy. In addition, egg supplementation during 4-6 months of age reduced the occurrence of egg allergy compared with supplementation before 4 months of age ( RR=0.58, 95% CI 0.43-0.78). The systematic review found no conclusive relationship between early peanut introduction and peanut allergy, nor the correlation between early cow′s milk protein introduction and cow′s milk protein allergy ( P>0.05). Conclusion:Early introduction (before 6 months of age) of eggs in infants′ complementary foods can prevent infant egg allergy, but the limitations of the study need to be considered.

Objective:To analyze the risk factors of functional constipation in children aged 2-7 years.Methods:A case-control study was performed on 2-7-year-old children with functional constipation who were treated in the Department of Pediatrics, Peking University Third Hospital from May 20, 2019 to September 20, 2019 and healthy control children with same age.The general situation, defecation situation and factors that might affect the occu-rrence of constipation were collected through the questionnaire, the influence factors included antibiotic use before half year old, breastfeeding, dietary preferences, exercise, allergy-related medical history, parental medical history, family income and primary caregivers, which were analyzed by using a binary Logistic regression model. Results:A total of 203 subjects were included, including 81 children in the constipation group and 122 children in healthy control group.Thick stools, dry stools, painful bowel movements and reduced bowel movement frequency were the most common symptoms of functional constipation.The main causes children at this age were food supplements and going to kindergarten.The univariate analysis indicated that the history of anti-biotics before half year old, picky eating habits, exercise volume and allergy-related diseases, constipation-related family history, father′s allergic disease background, and whether the main caregivers were parents were significantly different between two groups (all P<0.05). The binary Logistic regre-ssion analysis revealed that father′s history of allergic diseases ( OR=2.302, 95% CI: 1.109-4.780), the use of anti-biotics within 6 months after birth ( OR=2.300, 95% CI: 1.053-5.022), parents′ history of constipation ( OR=2.151, 95% CI: 1.106-4.128), and dietary preference of staple food ( OR=3.526, 95% CI: 1.402- 8.867) were the risk factors for functional constipation in 2-7-year-old children. Conclusions:Parents′ history of constipation, father′s history allergic diseases and a dietary preference for staple food may be the risk factors for functional constipation.

Objective:To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods:This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017. Those in the feeding intolerance group (FI group) were further divided into subgroups of gestational age (GA) < 31 weeks group and GA ≥ 31 weeks group, as well as birth weight (BW)<1 250 g group and BW≥1 250 g group. Medical records of all subjects were reviewed to retrieve relevant clinical information. Independent-samples t-test, Chi-square test, and logistic regression tests were used for statistical analysis. Results:There were 612 eligible subjects with 182 (29.7%) in the FI group and 430 (70.3%) in the feeding tolerance (FT) group. (1) In the FI group, there were 103 (56.6%) males and 79 (43.4%) females with an average GA of (30.6±2.3) weeks and BW of (1 298±417) g, and 134 (73.6%) were very low birth weight premature infants. Among the patients with FI, there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group, and 93 in the BW<1 250 g group and 89 in the BW≥1 250 g group. The FI infants accounted for 63.2% of very low birth weight premature infants in the same period. (2) The age at diagnosis was (2.7±0.9) d and (13.2±6.9) d at recovery. And the duration of FI was (10.5±6.7) d. The main symptoms were gastric retention (100.0%, 182/182), abdominal distention (54.4%, 98/182) and vomiting (17.0%, 31/182). (3) FI in preterm infants with GA <31 weeks or BW <1 250 g occurred and disappeared later [GA subgroups: (2.4±0.8) vs (2.9±0.9) d, t=3.977 and (10.4±5.2) vs (16.0±7.3) d, t=5.935; BW subgroups: (2.5±0.9) vs (2.8±0.9) d, t=2.540 and (10.0±4.5) vs (16.3±7.4) d, t=6.951; all P<0.05] and had a longer duration than those with GA≥31 weeks or BW≥1 250 g [GA subgroups: (8.0±5.0) vs (13.0±7.3) d, t=5.450; BW subgroups: (7.5±4.3) vs (13.5±7.3) d, t=6.690; both P<0.05]. Premature infants with smaller GA took longer time to regain their birth weight [(9.4±4.1) vs (12.0±5.1) d, t=3.672, P<0.05] and those with lower BW were less likely to have symptom of vomiting [23.6% (21/89) vs 10.8% (10/93), χ2=5.308, P<0.05]. (4) Multivariate logistic regression analysis showed that BW was a protective factor for FI in premature infants ( OR=0.998, 95% CI: 0.997-0.998, P<0.001) and the independent risk factors for FI were neonatal respiratory distress syndrome ( OR=2.129, 95% CI: 1.163-3.897, P=0.014), multifetation ( OR=1.812, 95% CI: 1.116-2.941, P=0.016), caffeine citrate exposure within 48 h after birth ( OR=2.663, 95% CI: 1.619-4.381, P<0.001), continuous positive airway pressure (CPAP) treatment within 48 h after birth ( OR=5.211, 95% CI: 2.861-9.489, P<0.001) and intrauterine infection ( OR=1.988, 95% CI: 1.060-3.728, P=0.032). Conclusions:The incidence of feeding intolerance in premature infants is high. Premature infants with GA <31 weeks or BW <1 250 g may develop FI and recover at an older age, and suffer longer. Low BW, neonatal respiratory distress syndrome, multifetation, caffeine citrate exposure, or CPAP treatment within 48 h after birth and intrauterine infection are risk factors for FI in premature infants.

Objective:To investigate the relationship between gene polymorphism of rs2228055 locus in the exon region of interleukin-10 receptor A (IL-10RA) and susceptibility to food allergy in children.Methods:This was a case-control study. The food allergy group had 150 children who were diagnosed with food allergy in the Pediatric Food Allergy Clinic of Peking University Third Hospital from August 1, 2017 to November 30, 2018. Another 150 healthy children attended Child Health and Development Center in the same hospital were selected as control group. The genotypes of rs2228055 locus in both groups were detected by PCR re-sequencing. And the genotypes and allele frequencies of rs2228055 locus were compared between these two groups, as well as between food allergy children with positive and negative allergen specific IgE, and between those with and without involvement of different organs. Using the computer virtual mutation to stimulate the changes of amino acid caused by change of rs2228055 locus allele, to analyze the effect of amino acid changes on the structure of IL-10RA. The chi-square test was used for comparison between groups.Results:(1) There were 92 males and 58 females in food allergy group, and 86 males and 64 females in control group, without any statistically significant difference (χ 2=0.497, P=0.481). The ages of the two groups were 4.2 (0.1-15.0) and 8.0 (0.1-14.0) years old, respectively, the difference was statistically significant ( Z=-6.109, P<0.01). (2) The genotype frequencies of rs2228055 locus in the food allergy group and the control group were as follows: AA accounted for 73 (48.7%) and 98 (65.3%), AG accounted for 62 (41.3%) and 42 (28.0%), and GG accounted for 15 (10.0%) and 10 (6.7%), respectively. The allele frequencies in the two groups were as follows: 208 (69.3%) and 238 (79.3%) for A, 92 (30.7%) and 62 (20.7%) for G, respectively. AG and GG genotype frequency and the allele G frequency in food allergy group were significantly higher than that in control group (χ 2=8.501 and 7.862, P=0.014 and 0.005, respectively). (3) There were no significant differences in genotype frequencies and allele frequencies of rs2228055 locus of allergen-specific IgE-positive and negative food allergy children (all P>0.05). (4) There were no significant differences in genotype frequencies and allele frequencies of rs2228055 locus in the manifestations of skin, digestive system and respiratory system in food allergy children (all P>0.05). (5) The computer virtual mutation showed that the mutation energy was -0.08 without any increase in the stability of IL-10RA when the amino acid encoded by rs2228055 locus was changed from isoleucine to valine. Conclusions:The frequencies of genotype AG, GG and allele G of rs2228055 locus in the IL-10RA exon region in food allergy children are higher than that in non-allergic children, and those with the G allele are more likely to develop food allergy.