Febrile seizures are the most common cause of convulsions in children.It is believed that the pathogenesis of febrile seizures involves a variety of factors, with most domestic and international studies focusing on genetic susceptibility; in contrast, the role of environmental factors, especially viral infections, is a relatively neglected field.Children are at high risk for various viral infections, many of which are prone to cause hyperthermia and induce febrile seizures when the individual convulsive temperature threshold is exceeded; in addition, inflammatory cytokines produced during viral infections may cross the blood-brain barrier affecting nerve cells.Focusing on the clinical characteristics and pathogenesis of febrile seizures caused by various viral infections in children, such as human herpesvirus-6, respiratory viruses(influenza virus, respiratory syncytial virus, adenovirus, severe acute respiratory syndrome coronavirus 2), gastroenteritis-associated viruses(rotavirus, norovirus), enteroviruses, this review may help clinicians understand the role of different viral infections in febrile seizures.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

Objective:To investigate the efficacy of antiviral therapy and its selection in hospitalized children with infectious mononucleosis (IM).Methods:The IM children admitted to Shenzhen Children’s Hospital from January 2017 to December 2021 were divided into acyclovir (ACV) treatment group and non-antiviral treatment group, and the clinical data were collected for retrospective analysis.Results:A total of 370 children were included, the median age was 3.6 years, each age group proportion: <3 years (25.9%), 3-<6 years (53.0%). 6-<10 years (17.6%) and ≥10 years (3.5%). Male∶Female=1.5∶1. While 42.4% (157/370) of the 370 children received ACV, 57.6% (213/370) did not receive antiviral therapy; 52 cases were treated in infectious disease department, and none of them received antiviral treatment, and 318 cases were treated in non-infectious disease department, of which 157 cases were in ACV group. There was significant difference between the two groups ( P <0.001); Thirty-eight cases of children in non-infectious disease department complicated with abnormal liver function, of which 23 cases (60.5%) were in the ACV group and 15 cases (39.5%) were in the non-antiviral treatment group. There was no significant difference between the two groups ( P=0.060). Compared with the non-antiviral treatment group, the ACV group has longer hospitalization days and higher hospitalization expenses ( P<0.01). There was no significant difference in duration of fever ( P>0.05). The number of atypical lymphocytes recovered faster in ACV group ( P=0.001). Conclusions:The hospitalized children with IM were mostly boys, and most of them were from 3 to 6 years old. ACV treatment could not shorten the duration of fever and hospitalization days of IM children, nor could it reduce the hospitalization expenses. Abnormal liver function did not affect the decision of antiviral treatment, and infectious disease specialists prefer not to use antiviral drugs. The authors advocate reducing the use of antiviral drugs for IM.

Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.

Salmonella are important food-borne infectious bacteria causing gastroenteritis, enteric fever, bloodstream infection and focal extraintestinal infection and other salmonellosis.It is a major global public health problem.Antibiotics play an important role in the prevention and treatment of salmonellosis.With the emergence of resistance to traditional first-line drugs for the treatment of salmonellosis, azithromycin has become one of the commonly used antibiotics.However, studies have reported azithromycin resistant Salmonella strains, and azithromycin resistance in Salmonella is becoming more common and increasing year by year.Enhanced activity of active efflux pump, destruction of lactone ring structure, methylation of ribosome, carrying ICE_erm42 gene may be related mechanisms of drug resistance.The discovery, monitoring and in-depth study of azithromycin resistance in Salmonella play an important role in the rational use of antibiotics and delaying the trend of resistance.This article reviews the research progress on the epidemiology and related mechanisms of azithromycin resistance in Salmonella.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Objective:To investigate the clinical characteristics of acute lower respiratory tract infection (ALRTI) in neonates caused by respiratory syncytial virus (RSV), and to analyze the factors associated with the severe infection.Methods:Clinical data of 399 ALRTI neonates with positive nucleic acids or antigen of RSV admitted to Shenzhen Children′s Hospital from January 2014 to December 2020 were retrospectively analyzed for their clinical cha-racteristics.They were divided into mild-to-moderate group and severe group according to the severity index (SI), and the clinical data of the 2 groups were compared.Relevant factors of severe ALRTI of RSV in neonates were analyzed by multivariate Logistic regression. Results:(1) A total of 399 ALRTI neonates with RSV infection were included, involving 239 males (59.9%) and 160 females (40.1%) with a male-to-female ratio of 1.49∶1.00.There were 349 cases (87.5%) and 50 cases (12.5%) in the mild-to-moderate group and severe group, respectively.The disease mainly occurred from March to October.(2) There were significant differences in the preterm delivery [15 cases (4.3%) vs.9 cases (18.0%)], low birth weight [11 cases (3.2%) vs.6 cases (12.0%)], previous hospitalization history [12 cases (3.4%) vs.5 cases (10.0%)], and breastfeeding [167 cases (47.9%) vs.16 cases (32.0%)] between the mild-to-moderate group and severe group ( χ2=14.524, 8.394, 4.616 and 4.426, respectively, all P<0.05). (3) There were significant differences in fever [78 cases (22.4%) vs.18 cases (36.0%)], shortness of breath [156 cases (44.7%) vs.36 cases (72.0%)], poor appetite [48 cases (13.8%) vs.15 cases (30.0%)], wheezing [20 cases (5.7%) vs.10 cases (20.0%)], cyanosis [30 cases (8.0%) vs.16 cases (32.0%)] and mental status (irritability/malaise) [20 cases (5.7%) vs.8 cases (16.0%)], and duration of cough[(8.1±2.6) days vs.(9.4±2.9) days ] between the mild-to-moderate group and severe group ( χ2=4.460, 13.057, 8.682, 12.806, 23.486 and 7.068, t=-3.054, all P<0.05). Moist rales in the lungs [29 cases (58.0%) vs.114 cases (32.7%)] and three concave signs [14 cases (28.0%) vs.20 cases (5.7%)] were commonly found in the severe group, while pulmonary phlegm sounds [168 cases (48.1%) vs.14 cases (28.0%)]was commonly found in the mild-to-moderate group, and the differences were statistically significant ( χ2=12.208, 27.823 and 7.149, respectively, all P<0.05). (4) Multifactorial analysis showed that premature delivery was an independent risk factor for the development of severe ALRTI caused by RSV in neonates ( OR=3.717, 95% CI: 1.257-10.987), and shortness of breath ( OR=2.216, 95% CI: 1.061-4.629), cyanosis ( OR=3.621, 95% CI: 1.638-8.004) and three concave signs ( OR=2.688, 95% CI: 1.077-6.711) may be early warning factors for the severe condition. Conclusions:Preterm infants with RSV infection are prone to develop into severe disease, and neonates with RSV infection with shortness of breath, cyanosis and three concave signs as symptoms of severe infection should be well concerned for a close monitoring.

2019 novel coronavirus(2019-nCoV) outbreak is one of the public health emergency of international concern.Since the 2019-nCoV outbreak, China has been adopting strict prevention and control measures, and has achieved remarkable results in the initial stage of prevention and control.However, some imported cases and sporadic regional cases have been found, and even short-term regional epidemics have occurred, indicating that the preventing and control against the epidemic remains grim.With the change of the incidence proportion and the number of cases in children under 18 years old, some new special symptoms and complications have appeared in children patients.In addition, with the occurrence of virus mutation, it has not only attracted attention from all parties, but also proposed a new topic for the prevention and treatment of 2019-nCoV infection in children of China.Based on the second edition, the present consensus further summarizes the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of treatment of 2019-nCoV infection in children.