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Vol 17, No 5
Vol 17, No 5 October 2021 ISSN 1708-8569
Review article
Original articles
Letters to the editor
Expert consensus on COVID-19 vaccination in children
  Yue-Jie Zheng, Xiao-Chuan Wang, Lu-Zhao Feng, Zheng-De Xie, Yi Jiang, Gen Lu, Xing-Wang Li, Rong-Meng Jiang, Ji-Kui Deng, Miao Liu, Bao-Ping Xu, Zhuang Wei, Gang Liu, Xiao-Xia Lu, Run-Ming Jin, Zhi-Sheng Liu, Yun-Xiao Shang, Sai-Nan Shu, Yan Bai, Min Lu, Guang-Hua Liu, Wan-Jun Luo, Yu-Xia Cui, Le-Ping Ye, Li-Kai Lin, Dong-Chi Zhao, A-Dong Shen, Jian-Bo Shao, Li-Juan Xiong, Li-Wei Gao, Tian-You Wang, China National Clinical Research Center for Respiratory Diseases, National Center for Children*s Health, Beijing, China, Group of Respirology, Chinese Pediatric Society, Chinese Medical Association, Chinese Medical Doctor Association Committee on Respirology Pediatrics, China Medicine
  [Abstract] [Full Text] [PDF]  
Global Pediatric Pulmonology Alliance (GPPA) proposal for COVID-19 vaccination in children
  Lance E. Rodewald, Kun-Ling Shen, Yong-Hong Yang, Gary Wing-Kin Wong, Leyla Namazova-Baranova, Lanny J. Rosenwasser, Adel S. Alharbi, Anne B. Chang, Jim Buttery, Basil Elnazir, Ruth A. Etzel, Anne Goh, Hilary Hoey , Rosemary Horne, Eitan Kerem, Antonella Muraro, Chris O*Callaghan, Kazunobu Ouchi, Varinder Singh, Jiu-Yao Wang, Spencer Li, Yu Guan, on behalf of the Global Pediatric Pulmonology Alliance (GPPA) Council, Yue-Jie Zheng, Zhengde Xie, Gen Lu, Yi Jiang, Xing-Wang Li, Rong-Meng Jiang, Xiao-Chuan Wang, Ji-Kui Deng, Xiao-Xia Lu, Bao-Ping Xu, Zhuang Wei, Lu-Zhao Feng, Zheng-Yan Zhao. on behalf of the Global Pediatric Pulmonology Alliance (GPPA) Expert Panel on Infectious Diseases and COVID-19
  [Abstract] [Full Text] [PDF]  
COVID-19 in children and the importance of COVID-19 vaccination
  Feng-Xia Xue, Kun-Ling Shen
  [Abstract] [Full Text] [PDF]  
Review article:
Environmental exposure during pregnancy and the risk of childhood allergic diseases
  Ming-Zhi Zhang, Shan-Shan Chu, Yan-Kai Xia, Dan-Dan Wang, Xu Wang
Background: Allergic diseases are one of the most common and important diseases that can exert hazardous effects on children's health. The prevalence of allergic diseases in childhood is gradually increasing all over the world in recent decades. Known causes of these diseases include anomalous immune responses and allergic inflammatory reactions, but the causes of allergic diseases in childhood are complex.
Data sources: PubMed, Cochrane Library, Embase and Web of Science were searched for articles focusing on environmental exposure during pregnancy and the risk of childhood allergic diseases, including asthma and atopic dermatitis, and the possible underlying mechanism.
Results: In terms of environmental factors, allergic diseases in childhood are closely related to environmental chemical exposure during pregnancy, including bisphenols, phthalates acid esters, perfluorochemicals, polybrominated diphenyl ethers, and polychlorinated biphenyls. However, allergic diseases in childhood are also closely associated with maternal dietary nutrition, maternal intake of drugs, such as acetylsalicylic acid (aspirin), paracetamol and antibiotics, and maternal lifestyle.
Conclusions: Several harmful environmental factors during pregnancy can result in the interruption of the function of helper T cells (Th1/Th2), cytokines and immunoglobulins and may activate allergic reactions, which can lead to allergic diseases during childhood.
  [Abstract] [Full Text] [PDF]  
Are patients recovering from Kawasaki disease at increased risk for accelerated atherosclerosis? A meta-analysis
  Yuan-Yuan Zeng, Feng Chen, Yong Zhang, Xing Ji
Background: Recent studies have suggested that Kawasaki disease (KD) may cause endothelial dysfunction, which can potentially induce atherosclerosis. However, there is still no consensus on the relationship between KD and atherosclerosis. This article aimed to determine whether patients with a history of KD may be at increased risk for accelerated atherosclerosis via a meta-analysis.
Methods: The PubMed, Embase, and SpringerLink databases were systematically searched. Studies on risk factors for atherosclerosis were included. A meta-analysis of case-control studies was performed using RevMan 5.3 software.
Results: Twenty studies were included with a total of 1684 subjects (990 patients after KD and 694 controls). The metaanalysis showed that the level of carotid intima-media thickness (cIMT) (95% CI: 0.01, 0.03; P = 0.005) and high-sensitivity C-reactive protein (hsCRP) (95% CI: 0.00, 0.10; P = 0.03) were significantly higher in patients after KD than controls, whereas flow-mediated dilatation (FMD) (95% CI: − 5.14, − 1.26; P = 0.001) in patients after KD was significantly lower. There were no significant differences in total cholesterol (TC) (95% CI: − 0.13, 5.92; P = 0.06), low-density lipoprotein cholesterol (LDL) (95% CI: − 0.65, 2.08; P = 0.31), or triglycerides (TG) (95% CI: − 1.94, 8.03; P = 0.23).
Conclusion: Endothelial dysfunction and inflammatory processes may exist in patients with a history of KD, which are risk factors for the development of atherosclerosis.
  [Abstract] [Full Text] [PDF]  
Original articles:
Low SARS-CoV-2 seroprevalence but high perception of risk
  Marietta Neumann, Annette Aigner, Eileen Rossow, David Schwarz, Maria Marschallek, Jörg Steinmann, Ralf St邦cker, Ingo Koenigs, Philippe Stock
Background: Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Healthcare workers in paediatrics are a unique subgroup: they come into frequent contact with children, who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, therefore, may transmit the disease to unprotected staff. In Germany, no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.
Methods: We tested the staff at a large children*s hospital in Germany for immunoglobulin (Ig) G antibodies against the nucleocapsid protein of SARS-CoV-2 in a period between the first and second epidemic wave in Germany. We used a questionnaire to assess each individual*s exposure risk and his/her own perception of having already been infected with SARS-CoV-2.
Results: We recruited 619 participants from all sectors, clinical and non-clinical, constituting 70% of the entire staff. The seroprevalence of SARS-CoV-2 antibodies was 0.325% (95% confidence interval 0.039-1.168). Self-perceived risk of a previous SARS-CoV-2 infection decreased with age (odds ratio, 0.81; 95% confidence interval, 0.70-0.93). Having experienced symptoms more than doubled the odds of a high self-perceived risk (odds ratio, 2.18; 95% confidence interval, 1.59-3.00). There was no significant difference in self-perceived risk between men and women.
Conclusions: Seroprevalence was low among healthcare workers at a large children*s hospital in Germany before the second epidemic wave, and it was far from a level that confers herd immunity. Self-perceived risk of infection is often overestimated.
  [Abstract] [Full Text] [PDF]  
Long COVID in children and adolescents
  Ali A. Asadi-Pooya, Hamid Nemati, Mina Shahisavandi, Ali Akbari, Amir Emami, Mehrzad Lotfi, Mahtab Rostamihosseinkhani, Zohreh Barzegar, Maryam Kabiri, Zahra Zeraatpisheh, Mohsen Farjoud-Kouhanjani, Anahita Jafari, Fateme Sasannia, Shayan Ashrafi, Masoume Nazeri, Sara Nasiri
Background: To identify the prevalence and also the full spectrum of symptoms/complaints of children and adolescents who are suffering from long COVID. Furthermore, we investigated the risk factors of long COVID in children and adolescents.
Methods: All consecutive children and adolescents who were referred to the hospitals anywhere in Fars province, Iran, from 19 February 2020 until 20 November 2020 were included. All patients had a confirmed diagnosis of COVID-19. In a phone call to patients/parents, at least 3 months after their discharge from the hospital, we obtained their current status and information if their parents agreed to participate.
Results: In total, 58 children and adolescents fulfilled the inclusion criteria. Twenty-six (44.8%) children/adolescents reported symptoms/complaints of long COVID. These symptoms included fatigue in 12 (21%), shortness of breath in 7 (12%), exercise intolerance in 7 (12%), weakness in 6 (10%), and walking intolerance in 5 (9%) individuals. Older age, muscle pain on admission, and intensive care unit admission were significantly associated with long COVID.
Conclusions: Long COVID is a frequent condition in children and adolescents. The scientific community should investigate and explore the pathophysiology of long COVID to ensure that these patients receive appropriate treatments for their condition.
  [Abstract] [Full Text] [PDF]  
Impact of guideline adherence and race on asthma control in children
  Shahid I. Sheikh, Nancy A. Ryan-Wenger, Judy Pitts, Rodney Britt Jr, Grace Paul, Lisa Ulrich
Background: Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines.
Methods: This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year.
Results: Of the 345 children, ages 2每17 years (mean = 6.2 ㊣ 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 ㊣ 3) compared to CA (1.4 ㊣ 2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3每6 months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002).
Conclusion: Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.
  [Abstract] [Full Text] [PDF]  
Molecular epidemiology of coxsackievirus A16 circulating in children in Beijing, China from 2010 to 2019
  Ya-Fang Hu, Li-Ping Jia, Fang-Yuan Yu, Li-Ying Liu, Qin-Wei Song, Hui-Jin Dong, Jie Deng, Yuan Qian, Lin-Qing Zhao, Li Deng, Hui Huang, Ru-Nan Zhu
Background: Coxsackievirus A16 (CVA16) is one of the major etiological agents of hand, foot and mouth disease (HFMD). This study aimed to investigate the molecular epidemiology and evolutionary characteristics of CVA16.
Methods: Throat swabs were collected from children with HFMD and suspected HFMD during 2010-2019. Enteroviruses (EVs) were detected and typed by real-time reverse transcription-polymerase chain reaction (RT-PCR) and RT-PCR. The genotype, evolutionary rate, the most recent common ancestor, population dynamics and selection pressure of CVA16 were analyzed based on viral protein gene (VP1) by bioinformatics software.
Results: A total of 4709 throat swabs were screened. EVs were detected in 3180 samples and 814 were CVA16 positive. More than 81% of CVA16-positive children were under 5 years old. The prevalence of CVA16 showed obvious periodic fluctuations with a high level during 2010每2012 followed by an apparent decline during 2013每2017. However, the activities of CVA16 increased gradually during 2018每2019. All the Beijing CVA16 strains belonged to sub-genotype B1, and B1b was the dominant strain. One B1c strain was detected in Beijing for the first time in 2016. The estimated mean evolutionary rate of VP1 gene was 4.49 ℅ 10每3 substitution/site/year. Methionine gradually fixed at site-23 of VP1 since 2012. Two sites were detected under episodic positive selection, one of which (site-223) located in neutralizing linear epitope PEP71.
Conclusions: The dominant strains of CVA16 belonged to clade B1b and evolved in a fast evolutionary rate during 2010每2019 in Beijing. To provide more favorable data for HFMD prevention and control, it is necessary to keep attention on molecular epidemiological and evolutionary characteristics of CVA16.
  [Abstract] [Full Text] [PDF]  
Serum vitamin E concentration is negatively associated with body mass index change in girls not boys during adolescence
  Xiao-Dong Zang, Qing-Hui Hu, Xiao-Xu Liu, Min Da, Zhao-Cong Yang, Ji-Rong Qi, Xu-Ming Mo
Background: Vitamin E is the most abundant lipid-soluble antioxidants present in plasma; however, the relationship between serum vitamin E and change in body mass index (BMI)-for-age Z scores in adolescents has not been well described.
Methods: This study is a cross-sectional study. Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey. The nutritional status was calculated by BMI Z scores and was classified into normal weight, overweight, and obese. Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity. Besides, the interaction effects between potential confounders and vitamin E on obesity were further evaluated.
Results: After adjusting potential confounders, serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys. Per standard deviation increment in vitamin E concentrations was associated with a 92% decreased risk of obesity in females. Besides, lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls. Moreover, the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.
Conclusions: Our study supports the negative association between serum vitamin E levels and overweight/obesity in adolescents. A higher serum vitamin E level may be associated with a reduced probability of obesity in girls, but not in boys.
  [Abstract] [Full Text] [PDF]  
Pediatric upper extremity firearm injuries: an analysis of demographic factors and recurring mechanisms of injury
  D. Spencer Nichols, Mitsy Audate, Caroline King, David Kerekes, Harvey Chim, Ellen Satteson
Background: Little is known regarding risk factors specific to pediatric upper extremity fi rearm injuries. The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.
Methods: A 20-year retrospective review was conducted. Patients 17 years of age and younger, with upper extremity injuries related to a firearm, were included. Analysis involved Fisher*s exact and Chi-square tests.
Results: One hundred and eighty patients were included. The mean age was 12.04 ㊣ 4.3 years. Most included patients were male (85%). Interestingly, females were more frequently victims of assault (P = 0.03), and males were more frequently injured due to accidental discharge (P < 0.001). The most affected race/ethnicity was White-not Hispanic or Latino (48%). The hand was the most frequent location injured (31%) and was more likely to be accidental than proximal injuries (P = 0.003). Air rifles were the most common fi rearm type used (56%). Pistols were implicated in 47 (26%) cases, rifles in 17 (9%), and shotguns in 10 (6%). Ninety-nine (55%) patients had procedures in the operating room. The most frequent procedure was foreign body removal (55%).
Conclusions: Risk factors such as male sex, White-not Hispanic or Latino race/ethnicity, and adolescent age were attributed to increased risk for injury. Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault. Air rifles were the most common fi rearm type overall, although female sex was associated with increased risk for injury by powder weapon.
  [Abstract] [Full Text] [PDF]  
Nasogastric or nasojejunal feeding in pediatric acute pancreatitis: a randomized controlled trial
  Hong Zhao, Yan Han, Ke-Rong Peng, You-You Luo, Jin-Dan Yu, You-Hong Fang, Jie Chen, Jin-Gan Lou
Background: The aim of this study was to compare nasogastric (NG) feeding with nasojejunal (NJ) feeding when treating pediatric patients with acute pancreatitis (AP).
Methods: We performed a single-center, prospective, randomized, active-controlled trial involving 77 pediatric patients with AP from April 2014 to December 2017. The patients were randomized into two groups: the NG tube feeding group (34 patients) and the NJ tube feeding group (33 patients). The primary outcome measures included the enteral nutrition intolerance, the length of tube feeding time, the recurrent pain of pancreatitis and complications.
Results: A total of 62 patients with AP (31 patients for each group) came into the final analysis. No differences were found in baseline characteristics, pediatric AP score and computed tomography severity score between the two groups. Three (9.7%) patients in the NG group and one (3.2%) patient in the NJ group developed intolerance (relative risk = 3.00, 95% confidence interval 0.33-27.29, P = 0.612). The tube feeding time and length of hospital stay of the NG group were significantly shorter than those of the NJ group (P = 0.016 and 0.027, respectively). No patient died in the trial. No significant differences were found in recurrent pain, complications, nutrition delivery efficacy, and side effects between the two groups.
Conclusions: NG tube feeding appears to be effective and safe for acute pediatric pancreatitis compared with NJ tube feeding. In addition, high qualified, large sample sized, randomized controlled trials in pediatric population are needed.
  [Abstract] [Full Text] [PDF]  
Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children
  Tian-Zhuo Yu, Ying Zhang, Wen-Zhi Zhang, Gao-Yi Yang
Background: To describe sonographic characteristics of cervical tuberculous lymphadenitis (CTBL) in children, clinical information, and sonograms of 348 lymph nodes (LNs) from 57 children with CTBL were retrospectively analyzed in this study.
Methods: We retrospectively reviewed the clinical data and sonograms of 348 LNs from 31 boys and 26 girls with CTBL, who were confirmed by pathology or laboratory examination, at the Hangzhou Red Cross Hospital between June 2014 and December 2020. The age of the children ranged from 1 to 14 years (average 7.1 ㊣ 2.9 years).
Results: Night sweats, fatigue and loss of appetite were the most common clinical symptoms observed in children with CTBL. Unilateral LN involvements were common. Occasionally, CTBL was found in healthy children with no symptoms. On sonography, the hilus was absent or unclear in all LNs. The short-to-long axis (S/L) ratio was ≡ 0.5, and the edges were unclear in most LNs. Other accompanying findings included necrosis (47.4%), an echogenic thin layer (36.8%), surrounding soft-tissue edema (38.5%), multiple intra-nodal strong echo (28.2%), sinus (22.7%) and abscess formation (6.9%). The Doppler ultrasound showed that the majority of vascularity patterns of CTBL were capsular or peripheral (33.3%).
Conclusions: Ultrasound is a recommended examination method for children from different age groups with cervical lymphadenitis. The ultrasonic signs of hilus absence, S/L ratio ≡ 0.5, unclear edge, necrosis, echogenic thin layer, strong echoes and capsular or peripheral vascularity may aid in the diagnosis of cervical tuberculous lymphadenitis.
  [Abstract] [Full Text] [PDF]  
Best practice of nutritional support for pediatric acute pancreatitis
  Wei Cai
  [Abstract] [Full Text] [PDF]  
Rising serum potassium and creatinine concentrations after prescribing renin每angiotensin每aldosterone system blockade: how much should we worry?
  Farahnak Assadi
  [Abstract] [Full Text] [PDF]  
Letters to the editor:
Febrile infants: written guidelines to reduce non-essential hospitalizations
  Ji Yoon Oh, Soo-Young Lee
  [Abstract] [Full Text] [PDF]  
Acute generalized exanthematous pustulosis as a manifestation of Kawasaki disease
  Wen-Jie Wu, Wen-Qun Zhang, Dao-Zhu Si, Yong-Chun Su, Qin Xie
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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