Objective:To compare the epidemiological and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection in Kunming among the pre-and post-COVID-19 era, and to establish a prediction model for severe RSV infection in children during the post-COVID-19 period.Methods:This was a retrospective study. Clinical and laboratory data were collected from 959 children hospitalized with RSV infection in the Department of Pulmonary and Critical Care Medicine at Kunming Children′s Hospital during January to December 2019 and January to December 2023. Patients admitted in 2019 were defined as the pre-COVID-19 group, while those admitted in 2023 were classified as the post-COVID-19 group. Epidemiological and clinical characteristics were compared between the two groups. Subsequently, comparison of the clinical severity among the two groups was performed based on propensity score matching (PSM). Furthermore, the subjects in the post-COVID-19 group were divided into severe and non-severe groups based on clinical severity. Chi-square test and Mann-Whitney U test were used for pairwise comparison between groups, and multivariate Logistic regression was applied for the identification of independent risk factors and construction of the prediction model. The receiver operating characteristic (ROC) curve and calibration curve were employed to evaluate the predictive performance of this model. Results:Among the 959 children hospitalized with RSV infection, there were 555 males and 404 females, with an onset age of 15.4 (7.3, 28.5) months. Of which, there were 331 cases in the pre-COVID-19 group and 628 cases in the post-COVID-19 group. The peak period of RSV hospitalization in the post-COVID-19 group were from May to October 2023, and the monthly number of inpatients for each of these months were as follows: 72 cases (11.5%), 98 cases (15.6%), 128 cases (20.4%), 101 cases (16.1%), 65 cases (10.4%), and 61 cases (9.7%), respectively. After PSM for general data, 267 cases were matched in each group. The proportion of wheezing in the post-COVID-19 group was lower than that in the pre-COVID-19 group (109 cases (40.8%) vs. 161 cases (60.3%), χ2=20.26, P<0.001), while the incidences of fever, tachypnea, seizures, severe case, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and interleukin-6 levels were all higher than those in the pre-COVID-19 group (146 cases (54.7%) vs. 119 cases (44.6%), 117 cases (43.8%) vs. 89 cases (33.3%), 37 cases (13.9%) vs. 14 cases (5.2%), 69 cases (25.8%) vs. 45 cases (16.9%), 3.6 (1.9, 6.4) vs. 2.3 (1.8, 4.6), 9.9 (7.1, 15.2) vs. 7.8 (4.5, 13.9) mg/L, 20.5 (15.7, 30.4) vs. 17.2 (11.0, 26.9) ng/L, χ2=5.46, 6.36, 11.47, 6.42, Z=4.13, 3.06, 2.96, all P<0.05). There were 252 cases and 107 cases with co-infection in the post-and pre-COVID-19 groups, respectively. The proportion of triple and quadruple infection in the post-COVID-19 group was higher than that in the pre-COVID-19 group (59 cases (23.4%) vs. 13 cases (12.1%), 30 cases (11.9%) vs. 5 cases (4.7%), χ2=5.94, 4.46, both P<0.05). Among the 252 cases with co-infection in post-COVID-19 group, the most prevalent pathogens involving in co-infections, in order, were Mycoplasma pneumoniae 56 cases (22.2%), Influenza A virus 53 cases (21.0%), Rhinovirus 48 cases (19.0%), Parainfluenza virus 35 cases (13.9%), and Adenovirus 28 cases (11.1%).The result of multivariate Logistic regression showed that age ( OR=0.70, 95% CI 0.62-0.78, P<0.001), underlying diseases ( OR=10.03, 95% CI 4.10-24.55, P<0.001), premature birth ( OR=6.78, 95% CI 3.53-13.04, P<0.001), NLR ( OR=1.85, 95% CI 1.09-3.15, P=0.023), and co-infection ( OR=1.28, 95% CI 1.18-1.38, P<0.001) were independently associated with the development of severe RSV infection in the post-COVID-19 group. The ROC curve of the prediction model integrating the above five factors indicated an area under the curve of 0.85 (95% CI 0.80-0.89, P<0.001), with an optimal cutoff of 0.21, a sensitivity of 0.83 and a specificity of 0.80. The calibration curve showed that the predicted probability in this model did not differ significantly from the actual probability ( P=0.319). Conclusions:In the post-COVID-19 era in Kunming, the peak in pediatric hospitalizations for RSV infection was from May to October, with declined incidence of wheezing and increased incidence of fever, tachypnea, seizures, severe cases, and rates of triple and quadruple co-infections. Age, underlying diseases, premature birth, NLR, and co-infection were identified as independent risk factors for severe RSV infection in the post-COVID-19 period. In this study, a risk prediction model for severe pediatric RSV infection was established, which had a good predictive performance.

Objective:To investigate the clinical characteristics of 130 children with severe SARS-CoV-2 infection in Yunnan province after the relaxation of non-pharmaceutical interventions, and analyze the risk factors for mortality.Methods:This study is a retrospective case summary that analyzed the demographic data, underlying diseases, clinical diagnoses, disease outcomes, and laboratory results of 130 children with severe COVID-19 infections admitted to nine top-tier hospitals in Yunnan Province from December 2022 to March 2023. According to the prognosis, the patients were divided into survival group and death group. The clinical and laboratory data between the two groups were compared, and the risk factors of death were evaluated. The χ2 test and Mann-Whitney U test were employed to compare between groups, while Spearman correlation test and multiple Logistic regression were used to analyze the risk factors for death. The predictive value of independent risk factors was evaluated by receiver operating characteristic curve. Results:The 130 severe patients included 80 males and 50 females with an onset age of 28.0 (4.5, 79.5) months. There were 97 cases in the survival group and 33 cases in the death group with no significant differences in gender and age between the two groups ( P>0.05). Twenty-five cases (19.2%) out of the 130 patients had underlying diseases, and the number with underlying diseases was significantly higher in death group than in survival group (36.4% (12/33) vs. 13.4%(13/97), χ2=8.36, P=0.004). The vaccination rate in the survival group was significantly higher than that in the death group (86.1% (31/36) vs. 7/17, χ2=9.38, P=0.002). A total of 42 cases (32.3%) of the 130 patients were detected to be infected with other pathogens, but there was no significant difference in the incidence of co-infection between the death group and the survival group (39.3%(13/33) vs. 29.9% (29/97), χ2=1.02, P>0.05). Among the 130 cases, severe respiratory cases were the most common 66 cases (50.8%), followed by neurological severe illnesses 34 cases (26.2%) and circulatory severe 13 cases (10%). Compared to the survival group, patients in the death group had a significantly higher levels of neutrophil, ferritin, procalcitonin, alanine aminotransferase, lactate dehydrogenase, creatine kinase isoenzyme, B-type natriuretic peptide, interleukin-6 and 10 (6.7 (4.0, 14.0) vs. 3.0 (1.6, 7.0)×10 9/L, 479 (298, 594) vs. 268 (124, 424) μg/L, 4.8 (1.7, 10.6) vs. 2.0 (1.1, 3.1) μg/L, 66 (20, 258) vs. 23 (15, 49) U/L, 464 (311, 815) vs. 304 (252, 388) g/L, 71(52, 110) vs. 24(15, 48) U/L, 484 (160, 804) vs. 154 (26, 440) ng/L, 43 (23, 102) vs. 19 (13, 27) ng/L, 216 (114, 318) vs. 86 (45, 128) ng/L, Z=-4.21, -3.67, -3.76, -3.31, -3.75, -5.74, -3.55, -4.65, -5.86, all P<0.05). The correlated indexes were performed by multivariate Logistic regression and the results showed that vaccination was a protective factor from death in severe cases ( OR=0.01, 95% CI 0-0.97, P=0.049) while pediatric sequential organ failure assessment (PSOFA) ( OR=3.31, 95% CI 1.47-7.47, P=0.004), neutrophil-to-lymphocyte ratio (NLR) ( OR=1.56, 95% CI 1.05-2.32, P=0.029) and D dimer ( OR=1.49, 95% CI 1.00-1.02, P=0.033) were independent risk factors for death (all P<0.05). The area under the curve of the three independent risk factors for predicting death were 0.86 (95% CI 0.79-0.94), 0.89 (95% CI 0.84-0.95) and 0.87 (95% CI 0.80-0.94), all P<0.001, and the cut-off values were 4.50, 3.66 and 4.69 mg/L, respectively. Conclusions:Severe SARS-CoV-2 infection can occur in children of all ages, primarily affecting the respiratory system, but can also infect the nervous system, circulatory system or other systems. Children who died had more severe inflammation, tissue damage and coagulation disorders. The elevations of PSOFA, NLR and D dimer were independent risk factors for death in severe children.

Objective:To investigate the value of bronchoalveolar lavage fluid (BALF) genechip analysis for the identification of pathogens in children with refractory pneumonia.Methods:A retrospective study of 500 children clinically diagnosed with refractory pneumonia in the Department of Respiratory and Critical Care Medicine, Kunming Children′s Hospital, Kunming Medical University between January 2020 to January 2022 was made.During hospitalization, bronchoscopic examination and bronchoalveolar lavage were performed.BALF was collected and analyzed using genechip technology to detect potential pathogens.At the same time, bacterial culture tests of sputum and BALF samples from the patients were performed. χ2 test was used to compare the positive rates of pathogens detected by different detection methods. Results:Of the 500 children patients, 482 cases (96.4%) were positive of BALF genechip analysis for pathogen identification.There were 71 cases (14.7%) infected with a single pathogen, and 411 cases (85.3%) with 2 or more pathogens.The top 3 bacteria were Streptococcus pneumoniae [117 cases (8.3%)], Haemophilus influenzae [63 cases (4.5%)], and Bordetella pertussis [32 cases (2.3%)]. The patients were mostly infected with respiratory syncytial virus [269 cases (19.1%)], followed by parainfluenza virus [217 cases (15.4%)], and adenovirus [132 cases (9.3%)]. Among the 500 patients, 116 cases (23.2%) were positive of BALF genechip analysis for bacteria identification, 47 cases (9.4%) had a positive BALF culture, 43 cases (8.6%) had a positive sputum culture.The bacterial detection rate of BALF genechip analysis was statistically significantly higher than that of BALF culture and sputum culture tests ( χ2=34.90, 39.85; all P<0.001). Conclusions:Most patients with refractory pneumonia have mixed infections.The genechip technology can rapidly and efficiently identify the pathogens, thus providing clinical guidance for anti-infection treatment.

Objective:To study the risk factors and clinical outcomes of early pulmonary hypertension in preterm infants with gestational age(GA)≤32 w.Methods:From October 2017 to May 2021,preterm infants with GA≤ 32 w admitted to NICU of our hospital were retrospectively studied. According to their echocardiography 2 w after birth, the infants were assigned into early-onset pulmonary hypertension (ePH) group and non-PH group. SPSS 21.0 statistical software was used to analyze the general status, complications and clinical outcomes of the two groups. Multiple logistic regression was used to analyze the risk factors of early-onset PH.Results:A total of 183 cases were enrolled, including 24 in the ePH group and 159 in the non-PH group. The incidences of birth asphyxia, hemodynamically significant patent ductus arteriosus (hsPDA), FiO 2≥30% within 6 h after birth, late-onset PH, severe bronchopulmonary dysplasia(BPD) and intracranial hemorrhage(ICH) in the ePH group were significantly higher than the non-PH group( P<0.05). hsPDA was the independent risk factor for early-onset PH ( OR=11.781, 95% CI 4.192-33.108). Conclusions:Preterm infants with GA≤32 w and early-onset PH are at increased risks of ICH, late-onset PH and severe BPD, hsPDA is the independent risk factor for early-onset PH.

Objective:To study the effects of different sizes of maternal placental chorionic hemangioma (PCH) on neonatal clinical outcome.Methods:February 2013 to December 2020, neonates whose mothers with PCH delivered in our hospital were retrospectively analyzed. According to the diameter of PCH, the neonates were assigned into giant PCH group (diameter≥4 cm) and ordinary PCH group (diameter<4 cm). Clinical characteristics and outcomes were compared between the two groups.Results:A total of 35 cases were enrolled in the study. 13 cases (37.1%) were male, 12 cases (34.3%) were Cesarean section delivered, 11 cases (31.4%) were premature infants, 12 cases (34.3%) had low birth weight and 12 cases (34.3%) were admitted to NICU, 7 cases (20.0%) had intrauterine distress, cardiac enlargement and abnormal hematological indexes, respectively, 6 cases (17.1%) needed respiratory support; 5 cases (14.2%) had increased amniotic fluid and fetal edema, respectively, 4 cases (11.4%) received blood transfusion, 3 cases (8.5%) had postnatal asphyxia, 2 cases (5.7%) had brain injury and 2 cases (5.7%) had congenital malformation. 15 cases were in the giant PCH group and 20 cases in the ordinary PCH group. Compared with the ordinary PCH group, the giant PCH group had significantly higher incidences of prematurity, low birth weight, increased amniotic fluid, intrauterine distress, NICU hospitalization, fetal edema, cardiac enlargement, respiratory support, abnormal hematological indexes, blood transfusion and mortality ( P<0.05). Conclusions:Maternal complications with giant PCH may significantly increase the risk of neonatal complications, thus perinatal monitoring should be strengthened.【 Key words】Placental chorionic hemangioma; Infant, newborn; Clinical outcome

Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians′ heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.

Genomic disorders caused by pathogenic copy number variation (pCNV) have proven to underlie a significant proportion of birth defects. With technological advance, improvement of bioinformatics analysis procedure, and accumulation of clinical data, non-invasive prenatal screening of pCNV (NIPS-pCNV) by high-throughput sequencing of maternal plasma cell-free DNA has been put to use in clinical settings. Specialized standards for clinical application of NIPS-pCNV are required. Based on the discussion, 10 pCNV-associated diseases with well-defined conditions and 5 common chromosomal aneuploidy syndromes are recommended as the target of screening in this consensus. Meanwhile, a standardized procedure for NIPS-pCNV is also provided, which may facilitate propagation of this technique in clinical settings.
Aneuploidy ; Cell-Free Nucleic Acids/genetics* ; Consensus ; DNA Copy Number Variations ; Female ; High-Throughput Nucleotide Sequencing ; Humans ; Pregnancy ; Prenatal Diagnosis

Purpose: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. Methods: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. Results: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). Conclusion FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Purpose: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. Methods: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. Results: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). Conclusion FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Objective:To investigate the effects of nutritional intake in the first two weeks of life on bronchopulmonary dysplasia (BPD) in preterm infants with gestational age (GA) ≤ 32 weeks.Methods:A retrospective case-control study was conducted 154 preterm infants with birth weight ≤ 1500 g and GA ≤ 32 weeks were enrolled from neonatal intensive care unit (NICU) of Affiliated Hospital of Qingdao University between January 1, 2016 and December 31, 2017. These infants were divided into BPD group or non-BPD group. All clinical and nutritional data were collected and analyzed to investigate the effects of early-life (within 2 weeks after birth) nutritional intake on BPD.Results:Among a total of 154 eligible neonates, 68 were without BPD and 86 with BPD (55.8%). Mild, moderate and severe BPD accounted for 39.5% (34/86), 58.1%(50/86)and 2.4%(2/86)of all BPD cases respectively. GA and birth-weight of BPD group were significantly lower than that of non-BPD group [(28.35 ± 1.55)weeks vs. (30.12 ± 1.23)weeks; (1050.91 ± 190.6)g vs. (1205.88 ± 195.83)g, both P = 0.000]. The duration of mechanical ventilation in BPD group was longer than that in non-BPD group [(2.65 ± 1.08)days vs. (0.47 ± 0.12)days, P < 0.05]. The incidences of complications in BPD group, including neonatal asphyxia, sepsis and patent ductus arteriosus, were all higher than those in non-BPD group( P < 0.05). The fluids and caloric intake, enteral fluids and caloric intake were significantly lower in BPD group on Day 7 and 14 of life ( P < 0.05). The macronutrient intake in BPD group was also consistently lower, reaching statistical significance for carbohydrate intake on Day 7 and 14 of life, and for protein and lipid intake on Day 14 of life ( P < 0.05). Multivariate logistic regression analysis showed that mechanical ventilation ( OR = 2.257, 95% CI: 1.143~4.456, P = 0.019) and GA ( OR = 0.325, 95% CI: 0.215~0.49, P = 0.000) were high-risk factors for BPD. The decreased odds of developing BPD were associated with higher levels of enteral calories on Day 14 of life ( OR = 0.96, 95% CI: 0.94~0.98, P = 0.000), fluids on Day 7 of life ( OR = 0.927, 95% CI: 0.876~0.981, P = 0.009) and protein intake on Day 14 of life ( OR = 0.044, 95% CI: 0.011~0.177, P = 0.000). Conclusions:GA and mechanical ventilation were independent high-risk factors for BPD. Higher intake of protein and enteral calories were protective factors. Proactive early enteral nutrition support, adequate protein intake and decreasing the duration of mechanical ventilation may reduce the risk of BPD.