Le Wang

Objective: To describe the clinical features, underlying mechanisms, and treatment approaches for negative pressure pulmonary edema (NPPE) that develops after flexible bronchoscopy (FB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: We retrospectively reviewed the case of a pediatric patient with SMPP who had NPPE during FB. Results: During bronchoscopy, the patient began coughing violently. Soon after, when the bronchoscope was in place, the patient showed signs of diffuse airway spasm. The Forceful inspiration against a functionally blocked airway led to a sharp drop in intrathoracic pressure. It triggered acute NPPE, severe hypoxemia, and acute respiratory failure. There were also biochemical evidence of myocardial injury and transient cardiac dysfunction. After emergency intubation with a 4.5 mm endotracheal tube and the start of mechanical ventilation, oxygenation improved quickly. The pulmonary edema largely resolved within 72 h. The patient was discharged on day 16. Conclusion: Children with SMPP tend to have marked airway hyperresponsiveness. This makes them more likely to have airway obstruction during bronchoscopy. When a child suddenly develops hypoxemia, significant dyspnea, and pink frothy sputum, NPPE should be strongly suspected. Careful selection of surgical timing and anesthesia strategy, continuous respiratory monitoring, timely relief of airway obstruction, and early positive pressure ventilation are crucial. It is also important to prepare for a difficult airway.

Seronegative immune-mediated cerebellar ataxia in young children is poorly defined and may be mistaken for self-limited post-infectious ataxia when magnetic resonance imaging and antibody panels are negative. A previously healthy 2-year-old girl developed acute cerebellar ataxia with gait instability, frequent falls, limb tremor, and choking while drinking. Brain/cerebellar magnetic resonance imaging was normal. At relapse, an equivocal cervical cord T2 signal was not confirmed on dedicated cervical imaging or accompanied by myelopathic signs. Extensive serum and cerebrospinal fluid antibody testing was negative. Initial cerebrospinal fluid showed mild pleocytosis; oligoclonal bands were reported as negative, although a single cerebrospinal fluid band was noted. She improved after intravenous immunoglobulin and high-dose corticosteroids but relapsed after early steroid discontinuation. At relapse, cerebrospinal fluid pleocytosis increased to 251 × 10⁶/L, with type 2 cerebrospinal fluid-restricted oligoclonal bands and intrathecal immunoglobulin M synthesis. Epstein-Barr virus serology suggested recent infection, but blood and cerebrospinal fluid Epstein-Barr virus DNA were negative. Genetic and metabolic testing was unrevealing. Rituximab was introduced as consolidation therapy after repeat first-line immunotherapy, while oral prednisone was tapered from 1 mg/kg/day to discontinuation in January 2026. Four weekly infusions depleted peripheral B cells, and a fifth infusion was given after B-cell reconstitution. No infusion reactions or infectious complications occurred. The retrospectively estimated Scale for the Assessment and Rating of Ataxia gait/posture subscore improved from 12/18 at relapse to 0/18 during follow-up. This case highlights serial evolution of intrathecal immune activation in relapsing seronegative pediatric cerebellar ataxia and adds pharmacodynamic and clinical follow-up support for the feasibility of B-cell-monitoring-guided rituximab consolidation in selected relapsing cases. Causal efficacy cannot be inferred from a single case treated with intravenous immunoglobulin, corticosteroids, and a subsequent prednisone taper.

Human metapneumovirus (HMPV) is a common cause of acute lower respiratory tract infections (ALRIs), accounting for 6–40% of paediatric outpatient visits and hospitalisations. However, its clinical severity and epidemiological characteristics remain poorly understood. To investigate the epidemiology and clinical features of HMPV infection, hospitalised children with ALRIs from 2023 to 2024 were screened for HMPV and ten other common respiratory pathogens using multiplex polymerase chain reaction. Demographic data, clinical presentations, diagnose, and outcomes were compared between children with moderate and severe diseases. The annual detection rate of HMPV was 7.5%, with peak incidence observed in summer and autumn. Children under 5 Years of age accounted for 93.9% of HMPV-associated ALRIs. Among the 131 confirmed cases, 35.1% were classified as severe. Wheezing, dyspnoea and liver function abnormalities were more frequently associated with severe cases. In contrast, mild or normal radiographic findings were significantly more common among children with moderate diseases. Furthermore, children with severe disease exhibited a significantly higher percentage of neutrophils, elevated levels of creatine kinase MB isoenzyme (CK-MB), and lower serum creatinine levels. Most hospitalized children recovered or showed clinical improvement. However, two infants under one year of age in the severe group died; both had underlying conditions. HMPV infections were primarily observed in summer and autumn During 2023–2024. Our findings underscore the importance of early identification of severe and potentially fatal HMPV-associated ALRI in pediatric populations. Given the observed seasonal pattern and the risk of severe outcomes—particularly among children with underlying conditions—timely diagnosis and risk stratification are critical for guiding clinical management and informing targeted public health interventions.

To explore the clinical phenotypic characteristics and genetic analysis of children with SCN2A gene mutation-related epilepsy. A retrospective study of children with SCN2A gene mutation epilepsy admitted to the Department of Neurology of Hebei Provincial Children's Hospital from January 2020 to May 2023 was conducted to analyze their clinical characteristics, treatment response, and prognosis, and to explore the correlation between mutation type and efficacy. The age of onset of disease in the 12 children with SCN2A was distributed from 22 h after birth to 10 years and 11 months of age, the neonatal missense mutation was the most common, followed by nonsense mutation, the type of seizure was predominantly generalized tonic–clonic seizures(Generalized tonic–clonic seizures, GTCS), paraventricular white matter echo enhancement was the most common of the magnetic resonance image(Magnetic resonance image, MRI), and electroencephalogram(Electroencephalogram, EEG) were predominantly spiking and spiking-slow wave issuance in all phases of wakefulness and sleep, and there was a generalized developmental disorder in 11 cases; of the 12 cases of the children, the diagnosis of epilepsy was diagnosed in 3 cases, and levetiracetam(Levetiracetam, LEV) treatment was ineffective in all of them; epilepsy syndrome was diagnosed in 9 cases, of which 4 cases of Dravet syndrome(Dravet syndrome, DS) had the highest number of cases, and LEV and valproate(Valproate, VPA) were effective in 50% of the children, and multiple medications were ineffective in the remaining 2 cases; 2 children with west syndrome(West syndrome, WS) were ineffective in the administration of topiramate(Topiramate, TPM), clonazepam(Clonazepam, CZP), and pro-adrenocorticotropic hormone, All have global developmental delays; 2 cases of ohtahara syndrome(Ohtahara syndrome, OS), 1 case of phenobarbital(Phenobarbital, PB) treatment was effective, 1 case was ineffective in multiple drug treatment; 1 case of self-limited epilepsy with centrotemporal spikes(self-limited epilepsy with centrotemporal spikes, SeLECTS) with normal development of central temporal spikes, LEV could control seizures. Cases of refractory epilepsy in infancy and young children with autism and abnormal paraventricular white matter on magnetic resonance imaging should be vigilant of SCN2A gene mutations. The degree of epilepsy control cannot be predicted based on the type of gene mutation, and treatment with LEV, VPA, and PB can achieve therapeutic effects in controlling epilepsy.

Background: Neuroblastoma (NB), one of the most common malignant extracranial solid tumors in children, is highly invasive and lethal with limited treatment efficacy. This study aimed to establish a prognostic model of advanced-stage NB.Methods: Differentially expressed genes were screened and validated using two training datasets and one validation dataset from the Therapeutically Applicable Research to Generate Effective Treatments and Gene Expression Omnibus databases. Protein–protein interaction networks were developed using the MCode plug-in, and the top three key clusters were used to produce candidate genes. We performed gene set enrichment analysis (GSEA), gene ontology analysis (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, immune cell infiltration, and drug sensitivity analysis to further understand the functions of these candidate genes. Kaplan–Meier (K–M) and receiver operating characteristic (ROC) curves were used to check their prognosis value. Real-time quantitative polymerase chain reaction (qPCR), Western blot (WB), and immunohistochemistry (IHC) were employed to verify the mRNA and protein levels in clinical samples.Results: A total of 699 differentially expressed genes were identified, including 294 upregulated and 405 downregulated genes. CNR1, PRKACB, CDKN3, and PCLAF were found to significantly affect the overall survival and event-free survival of neuroblastoma patients and were positively correlated with the INSS advanced stages. The functional analysis of these four genes revealed their cancer-promoting effects and correlations with immune-inflammatory, cell cycle, and p53 signaling pathways. After stratifying patients using the established model containing the above four genes, significantly different patterns were observed in terms of infiltrating immune cell proportion, drug sensitivity, and the expression of immune checkpoints. Finally, both the mRNA and protein expression verification assays demonstrated that the CDKN3 and PCLAF were upregulated, while the PRKACB was downregulated in advanced-stage neuroblastoma tissue samples.Conclusion: The model containing CNR1, PRKACB, CDKN3, and PCLAF can serve as a new prognostic biomarker for predicting the prognosis of patients with neuroblastoma. Findings on immune cell infiltration and immune checkpoints provide novel insights for the immunotherapy of neuroblastoma.

Influenza virus is a contagious respiratory pathogen that can cause severe acute infections with long-term adverse outcomes. For paediatric patients at high risk of severe influenza, the readmission and the associated risk factors remain unclear. Children discharged with a diagnosis of severe or critical influenza from October 2021 to March 2022 were included. The disease severity was categorized according to the “2020 edition of the Chinese expert consensus on the diagnosis and treatment of influenza in children”. Demographic data, clinical characteristics, underlying medical conditions, microbiology, treatment outcomes, and 90-day readmissions were retrieved and retrospectively analyzed. Those who tested positive for COVID-19 were excluded. Risk factors independently associated with readmission were identified using multiple logistic regression models. During the study period, 225 children with severe influenza were hospitalized and 14.7% (33/225) of them were readmitted within 90 days. The median length of readmission was 62 (IQR, 31–76) days, and the most common cause of readmission was pneumonia. M. pneumoniae and influenza virus are the most common infections for readmission The children who were readmitted were more likely to have critical influenza and neurological comorbidities compared to patients without readmission. The readmitted children had a significantly higher proportion of natural killer cells and a shorter febrile duration and length of stay on their first admission, compared with those who were not readmitted. Rhinosinusitis (OR = 30.085, p = .008) and high level of natural killer cells (OR = 1.107, p = .012) were independent risk factors and febrile duration (OR, 0.748, p = .018) was a protective factor for 90-day readmission. Our findings suggest that, to reduce the potential readmission of children with severe influenza, a sustained focus on the risk factors including rhinosinusitis and over-activated host immune response during the index hospitalization is needed.

Objectives: The increasing prevalence of severe Mycoplasma pneumoniae pneumonia (SMPP) poses a significant threat to the health of children. This study aimed to characterise and assess the outcomes in children with SMPP. Methods: We retrospectively analysed children hospitalised for M. pneumoniae pneumonia (MPP) between January and December 2022. Retrospectively, demographic, clinical, underlying diseases, laboratory and radiological findings, and treatment outcomes were collected and analysed. Disease severity was defined as severe or general according to the Guideline for diagnosis and treatment of community-acquired pneumonia in children (2019 version). Results: Over a 12-month observation period, 417 children with MPP were enrolled, 50.6% (211/417) of whom had SMPP, with the peak incidence observed in winter. Of the 211 children with SMPP, 210 were treated and discharged with improvement, while one child with congenital heart disease died of cardioembolic stroke. A significantly higher proportion of patients with SMPP had underlying diseases, extrapulmonary complications (myocardial and digestive system involvement), and bacterial co-infection. A total of 25 (12%) children with SMPP received mechanical ventilation. The median duration of mechanical ventilation was 3 days. All children were treated with macrolide antibiotic. A significantly higher proportion of patients with SMPP received antibiotic other than macrolides, methylprednisolone sodium succinate, intravenous immunoglobulin and anticoagulation, compared with patients with general MPP (GMPP). Children with SMPP had significantly higher levels of white blood cells, neutrophil percentage, C-reactive protein, procalcitonin, interferon-γ, interleukin (IL)-2, IL-5, IL-6, IL-8, IL-10 and significantly lower percentages of lymphocytes, monocytes, and natural killer cells, compared with GMPP group. Conclusion: Our findings suggest that severely ill children have more pronounced inflammatory reaction and extrapulmonary complications. For effective management of children with SMPP, hormonal, prophylactic, anticoagulant therapy, as well as the use of antibiotics other than macrolides for bacterial co-infections, could be incorporated into treatment regimens.

Background: In this retrospective study, we aimed to evaluate the factors associated with the severity of respiratory syncytial virus (RSV) bronchiolitis in children aged under 2 years who were admitted to the Children’s Hospital of Hebei between June 2018 and January 2019. Methods: Sputum samples positive for RSV via multiplex PCR were subtyped using real-time PCR. Data collected included risk factors for disease severity, demographics, microbiology, and outcomes. Results: Of the 82 children with RSV bronchiolitis, 79 were treated and discharged with improvement, while 3 died. All three patients had underlying medical conditions, including complex congenital heart disease and severe combined immunodeficiency. Further, disease severity was associated with preexisting underlying disease, fever duration, and bacterial co-infection, but not with the RSV subtype. Conclusions: Our findings suggest that an appropriate therapeutic regimen should include the detection of bacterial co-infections and the identification of underlying diseases for the effective management of severe RSV bronchiolitis.

Background: Community-acquired pneumonia (CAP) is usually diagnosed in children, and the type of respiratory specimen is critical. Differences in pathogens detection between induced sputum (IS) and bronchoalveolar lavage fluid (BALF) have not been evaluated. Methods: In 2018, paired sputum and BALF samples from CAP hospitalised children with indications for bronchoalveolar lavage (BAL) were subjected to multiplex PCR for the detection of 11 common respiratory pathogens. Results: A total of 142 children with paired sputum and BALF were tested. The overall positivity rate was 85.9% (122/142) for sputum and 80.3% (114/142) for BALF. The two specimens presented almost perfect agreement between the detection on M. pneumoniae, influenza A, influenza B, bocavirus and RSV. In contrast, adenovirus had the lowest kappa value of 0.156, and a false negative rate (FNR) of 66.7%. Rhinovirus had the highest false positive rate (FPR) as 18.5%. The consistent rate was significantly higher in school-age children than those under 1 year old (p = .005). Bacterial co-infection in BALF specimens were observed in 14.8% (21/142). Of the 11 discordant pairs of specimens, 9 cases were sputum(+)/BALF(-) with adenovirus predominating. Conclusion: Our findings suggest that the consistency of results between sputum and BALF is pathogen specific. Careful consideration needs to be given to whether sputum can be used as a substitute for BALF when children are young or co-infections with bacteria are suspected.

Background: Febrile seizures (FS) are a common cause of paediatric emergencies, but research on their aetiology and epidemiology are limited. The aim of this study was to investigate the prevalence of central nervous system (CNS) pathogenic infections in patients with FS-associated hospitalization. Methods: A prospective observational study was conducted in children under 16 years of age with FS-associated hospitalization. Demographic, clinical and laboratory data were recorded. Multiplex-PCR was performed on cerebrospinal fluid (CSF) samples for nine viruses, nine bacteria and one fungus. Results: A total of 119 children were enrolled between June 2021 and June 2022. Of these, 83.2% had a final diagnosis of FS (69.7%) or FS plus (13.4%). In addition, epilepsy and encephalitis/meningitis were also found in 16.8% (20/119). Seven pathogens were identified from 9 CSF samples (7.6%), including viruses (EV, EBV, HHV-6) and bacteria (H. influenzae, S. pneumoniae, M. tuberculosis, S. putrefaciens). There were no significant clinical or laboratory differences between children who tested positive or negative for pathogens in the CSF, except for the presentation of herpes pharyngitis. Children with encephalitis/meningitis had longer hospital stays compared with those diagnosed with FS at discharge; abnormal EEG findings were significantly more common in patients with epilepsy. Conclusion: FS-associated hospitalized children may have viral or bacterial intracranial infections. Pathogen testing of CSF is an important basis for timely antibiotic or antiviral therapy when clinical and laboratory findings make FS indistinguishable from other CNS disorders.