Background：Polyethylene glycol with electrolyte solution (PEGELS) is safe and effective for bowel preparation in children. The PEG regimen includes oral administration for 14 days. However, longlasting oral administration may cause inconvenience to children's lives, prolong hospitalization, and affect school attendance. It is observed that the intestinal cleanliness is also good in a rapid oral PEGELS protocol of bowel preparation in some children.
Objective：To investigate the efficacy, safety and tolerability of rapid or slow bowel preparation protocol using PEGELS in children over 2 years old.
Design：Nonrandomized controlled trial.
Methods：The newly diagnosed children in Department of Gastroenterology at Children's Hospital of Fudan University receiving the electronic colonoscopy were enrolled from August 1st, 2020 to May 31st, 2021 according to the inclusion and exclusion criteria. The participants were given PEGELS for the bowel preparation. The participants were nonrandomizedly divided into rapidly oral group (PEGELSR) and slowly oral group (PEGELSS). In the PEGELSR group, 2/3 dose of PEGELS was taken orally from the evening on the day before colonoscopy, and the remaining 1/3 dose of PEGELS was orally administered in the morning of the next day. In the PEGELSS group, PEGELS is given orally on the day before colonoscopy, which is divided into 1012 portions and taken one portion every hour. Bowel cleansing was assessed by Boston bowel preparation scale (BBPS). Compliance with PEGELS, adverse events, and tolerability were observed
Main outcome measures：Bowel cleanliness.
Results：A total of 315 children were enrolled into the study with the average age of (9.8±3.2) years old, 153 cases in PEGELSS group and 162 cases in PEGELSR group, respectively. There were no significant difference in Bristol stool form score between the two groups before electronic colonoscopy. The main reason for colonoscopy was abdominal pain in both groups. The score of BBPS in PEGELSR group was significantly higher than that in PEGELSS group(8.0±1.3 vs 7.1±1.5, P<0.000 1). The rate of excellence in PEGELSR was higher than that in the PEGELSS group［96.3%(156/162) vs 87.6%(134/153), P＜0.000 1］. Both groups of children could complete the dosage of PEGELS well with the completion rate over 90%. The incidence of nausea, vomit, abdominal pain and abdominal distension in PEGELSR group was significantly higher than that in PEGELSS group. There were no adverse events in the two groups.
Conclusion：Bowel preparation protocol of PEGELSS and PEGELSR was safe. The bowel cleanliness of PEGELSR regimen is better than that of PEGELSS regimen, but the incidence of adverse reaction of rapid oral PEGELS is higher than that of slow oral administration.
Background：The Chinese Infectious Disease Surveillance of Pediatrics （ISPED） program collects and analyzes the monitoring data of antibiotics resistance from its member units annually to understand changes in pediatric infectious pathogens and resistance patterns in China.
Objective：To explore the status of bacterial infections and resistance in children in China for 2023, aiming to guide the rational use of antimicrobial agents in pediatrics.
Design：Crosssectional survey.
Methods：Clinical isolates were collected from children hospitals in China enrolled in the ISPED program from January 1st to December 31st, 2023. Antimicrobial susceptibility testing was carried out using a unified protocol using the KirbyBauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by Etest, with results evaluated according to the 2022 standards of the Clinical and Laboratory Standards Institute (CLSI).
Main outcome measures：The distribution characteristics of bacteria strains in children, changes in antimicrobial resistance of major isolated strains, and the detection of multidrugresistant organisms (MDROs) in the pediatric population.
Results：A total of 58,335 isolates were collected, of which 40% were grampositive organisms and 60% were gramnegative. The top five pathogens were as follows, Escherichia coli (14.5%), Streptococcus pneumonia (12.4%), Staphylococcus aureus (11.8%), Haemophilus influenza (10.2%), and Moraxella catarrhalis (6.4%). The most common pathogens in neonates and nonneonates were S. aureus (17%) and E. coli (14.4%), respectively. The primary specimen was the lower respiratory tract (47.1%), and the most common pathogens were S. pneumonia (24.3%) and H. influenza (19.4%). The rates of βlactamase production in Haemophilus influenzae and Moraxella catarrhalis were high, at 74.7% and 98.6%, respectively. Both S. pneumoniae and S. pyogenes showed highresistance to erythromycin and clindamycin. The proportion of penicillininsensitive S. pneumoniae (PNSP) from cerebrospinal fluid and noncerebrospinal fluid was 93.2% and 9%, respectively. Methicillinresistant S. aureus (MRSA) and Coagulasenegative staphylococci (MRCNS) accounted for 31.2% and 77.2%, respectively. The carbapenemresistant Enterobacteriaceae (CRE), carbapenemresistant P. aeruginosa (CRPA), carbapenemresistant A. baumannii (CRAB) were 3.7%, 8.1% and 30.8%, respectively. The detection rate of CRPA in the neonatal group was higher than that in the nonneonatal group (19.7% vs 7.4%, P<0.01), whereas the detection rate of CRAB was lower than that in the nonneonatal group (23.2% vs 32.1%, P<0.05). CRAB isolated from neonates presented higher resistance to multiple antimicrobials than nonneonates（P<0.05）. The detection rates of MRSA, CRE, CRPA and CRAB in the ICU department were much higher than those in other departments (P<0.001), especially CRAB, which was as high as 62.9%, much higher than that in the hematology department (23.5%, P<0.01) and other departments (28.1%, P<0.001). In addition, the proportion of CRE in hematology patients was 12.8%, higher than the 3.5% in other departments (P<0.001).
Conclusion：In 2023, the detection rates of CRE and MRSA in Chinese children showed a decrease compared to previous years, while the overall detection rates of CRAB and CRPA increased compared to the previous two years, with a notably higher detection rate of CRPA in the neonatal group and CRAB in the nonneonatal group. Proactive screening and continuous monitoring of MDROs in the ICU and hematology departments should be strengthened.
Background：Children with refractory and relapsed acute lymphoblastic leukemia (ALL) have poor prognosis. It is significant to identify new molecular markers with prognostic value to assist in prognosis assessment.
Objective：To explore the expression level of the IDE gene in children with ALL and its correlation with prognosis.
Design：Retrospective cohort study.
Methods：A total of 77 newly diagnosed ALL patients admitted to Beijing Children's Hospital, Capital Medical University, from January 1st, 2020, to October 31st, 2020, were included in the study as a testing cohort. The expression level of the IDE gene in bone marrow mononuclear cells at diagnosis was analyzed using ROC curve analysis to set the IDE cutoff value, comparing the prognosis of highexpression and lowexpression groups. The validation cohort consisted of ALL patients admitted to Henan Children's Hospital during the same period, and it was used to verify the correlation between the established IDE cutoff grouping criteria and prognosis. Prognostic factors, including clinical biological characteristics and early treatment responses, were also analyzed.
Main outcome measures：Eventfree survival (EFS).
Results：A total of 77 newly diagnosed ALL patients were included, with 37 in the testing cohort and 40 in the validation cohort. The expression level of the IDE gene at diagnosis was correlated with the prognosis of ALL. Patients with adverse events had significantly higher IDE expression levels at diagnosis than those without adverse events (P<0.001). ROC analysis showed that the IDE gene expression level could predict the prognosis of ALL patients, with an AUC of 0.961 (P<0.001). The cutoff value was set as 0.72 by the ROC curve. In the testing cohort, the highexpression group (IDE≥0.72, n=19) had a significantly worse prognosis than the lowexpression group (IDE<0.72, n=18), with 3year EFS rates of 55.7% and 100%, respectively (P=0.002). In the validation cohort, the highexpression group (n=26) and lowexpression group (n=14) had 3year EFS rates of 64.3% and 96.2% (P=0.009), which was statistically significant. Multivariate analysis indicated that high clinical risk and high IDE expression were independent prognostic factors for EFS in ALL patients, with risk ratios of 4.254 (95% CI: 1.08017.554, P=0.039) and 21.773 (95% CI: 2.632180.125, P=0.004), respectively. The predictive capacity of the recurrence risk index for prognosis, composed of these two independent prognostic factors, was higher than the current clinical risk stratification (AUCs of 0.892 and 0.741, P=0.009).
Conclusion：High expression of the IDE gene is closely associated with poor prognosis in children with ALL.
Background:Few studies have focused on the adherence to and implementation barriers of clinical practice guideline recommendations.
Objective:To assess compliance with the Clinical Practice Guidelines for IntraHospital Transport of Pediatric Patients (2023) among medical staff in the emergency department and PICU and to identify the implementation barriers.
Design:Field study
Methods:The research was carried out in the emergency department, PICU, and general wards of Children's Hospital of Fudan University. Through participation in the practice of medical staff during intrahospital transport of critically ill children, field notes were used to describe the current situation of oneway transport from the emergency department or PICU to general wards, as well as to analyze the barriers to implementing recommendations in the guideline. Based on recommendations 15 of the guideline, the PICUtotargetdepartment process (Appendix 2G in the guideline), was divided into three phases (pretransport, during transport, and upon arrival at the receiving department) and 10 specific indicators. Descriptive observation, interviews, focus observation, and selective observation were employed to collect data. A template analysis method was used to extract baseline data from the field notes and analyze compliance with specific indicators and barriers.
Main outcome measures:Barriers to adhering to recommendations of 15 in the guideline.
Results:From January 1st to March 21st, 2024, 49 intrahospital transports of critically ill children involving 25 medical staff (7 emergency nurses, 7 PICU doctors, and 11 PICU nurses) were observed. Ten transports were from the emergency department to the PICU, and 18 and 21 were from the PICU to internal and surgical wards, respectively. The 25 participating medical staff had an average age of 31.3±5.0 years, and the children transported (49 cases) had an average age of 70.0±48.6 months. The average transport time was 16.1±6.0 minutes, with an average bedside handoff time of 6.8±3.5 minutes. Bedside handoffs were interrupted in 11 cases, and two adverse events were recorded during transport: forgetting to carry tube feeding and a child vomiting en route. The 10 indicators across the three phases of transport (pretransport, during transport, and upon arrival at the receiving department) showed partial compliance with the guideline recommendations. The transport decisionmaking, child placement, and inquiry indicators generally aligned with the guideline; the monitoring, telephone communication, and transport planning indicators partially complied, while transport personnel, equipment and medication preparation, evaluation and documentation, and handoff of the child's condition did not meet the guidelines The preparation for receiving the child was in line with the recommendations. Potential barriers to guideline implementation included low enthusiasm among medical staff for adopting new practices, lack of effective communication mechanisms between departments, gaps between recommended practice and clinical situations, poor adherence to specific guideline evidence, and insufficient innovation in the guideline recommendations.
Conclusion:Adherence to the guideline recommendations for intrahospital transport of critically ill children is poor. Barriers include insufficient awareness among medical staff regarding the safety of intrahospital transport and a gap between the guideline recommendations and actual clinical transport scenarios.
Background：It is still unknown on the etiology, pathogenicity and associated prognostic factors of kawasaki disease(KD). Currently, multiple exposures which are collaborating with genetic background would induce the immunological responses and trigger the onset of KD, even coronary artery injuries.
Objective：To explore the significance of genetic susceptibility related to KD, IVIG resistance and coronary artery lesions.
Design：Casecontrol study.
Methods：Complete KD was diagnosed according to American Heart Association(AHA) guidelines, and coronary artery lesion was defined with echocardiography Zscore>2 according to the JCS/JSCS 2020 guidelines. From April 2020 to January 2022, we continuously recruited complete KD patients at West China Second University Hospital of Sichuan University. The children who were underwent physical examination and blood test from child health department in our hospital were enrolled in the controls. The whole exome sequencing of peripheral blood samples, quality control of raw data, enrichment analysis and site annotation were performed to screen for single nucleotide polymorphisms (SNPs) and associated genes related to KD, IVIG resistance and coronary artery lesions, which helped to compare the response to treatment and clinical outcomes of KD.
Main outcome measures：Sites of SNPs and genes which had been associated with KD, IVIG resistance and coronary artery lesions.
Results：In total, 171 complete KD patients were enrolled, including 32 cases (27%) of coronary artery lesions and 55 cases (31%) of IVIG resistance, and 139 cases were enrolled in control group. There were no statistical differences in the age between two groups. A total of 609,732 SNPS were screened through upstream analysis. The two groups were separated by the principal component analysis categorized by Han and other ethic minorities, and there was no substructure in the principal component categorized by gender classification. With P<0.000 1 as the threshold, fifteen candidate genes were associated with KD susceptibility, including MYT1L、CYP26B1、NECTIN3、TENM3、GFI1B、KNDC1、LOC100133315、RNF121、SYNE3、MAPKBP1、SLFN14、MYOM1、ABCA7、PIP5K1C、PTGER1(30 SNPs). While six candidate genes had been identified to be associated with coronary artery lesion, including DGKH、CCDC130、KLF7、METTL6、COLQ、PRKN(19 SNPs). Moreover, there were also six candidate genes had been recognized as risk factors with IVIG resistance, including MICALCL、NT5DC3、KRT75、LOC105370980、TXK、BRD2(8 SNPs).
Conclusion：In this study,MYT1L（chr2, rs4381806）、NECTIN3（chr3, rs2399373）、MAPKBP1（chr15, rs2303517）have some significance in exploring the pathogenesis of KD. The SNP sites and genes asscociated with IVIG resistance and coronary artery lesions required further investigation.
Objective：To explore the distribution characteristics of blood uric acid levels and the detection rate of HUA among children attending the hospital.
Design： Crosssectional survey.
Methods：Children who underwent blood uric acid testing at Children's Hospital Affiliated to Zhengzhou University from July 2022 to July 2023 were included. Eligible subjects were aged >28 days at the time of uric acid testing and had a clear disease diagnosis in their medical records. HUA was defined as peripheral blood uric acid levels of ≥420 μmol·L-1 for males and ≥360 μmol·L-1 for females; levels ≥540 μmol·L-1 were classified as severe HUA.
Main outcome measures：Serum uric acid level and the detection rate of HUA.
Results：Among 38,317 children with blood uric acid test results, 22,534 were male and 15,783 were female. The overall median blood uric acid level was 259.3 (211.1, 316.1) μmol·L-1, with a statistically significant difference between boys and girls ［262.7 (213.0, 322.3) μmol·L-1 vs. 255.0 (208.3, 308.5) μmol·L-1, Z=10.365, P<0.001］. Blood uric acid levels in boys gradually increased with age, while girls' levels increased until age 14, then gradually declined and increased again after age 17; in all age groups except around ages 8 and 10, boys had higher blood uric acid levels than girls. A total of 3,719 cases of HUA were detected (9.7%), with detection rates of 7.7% (1,730 cases) in boys and 12.6% (1,989 cases) in girls, showing a statistically significant difference (χ2=256.882, P<0.001). The detection rate of HUA in boys increased with age, peaking at 45.8% around age 17; for girls, the detection rate increased until about age 13 (25.7%) and then gradually declined. Before age 13, the HUA detection rate was lower in boys than in girls, but higher after age 14. There were 284 cases of severe HUA (0.7%), with detection rates of 1.0%(222/22,534) in boys and 0.4% (62/15,783) in girls, showing a statistically significant difference (χ2=44.269, P<0.001). The proportion of severe HUA among children with HUA was higher in boys than girls in all age groups except around ages 7 and 17. The highest detection rates of HUA and severe HUA were observed in children with endocrine system diseases (15.3% and 1.8%, respectively), with the highest detection rate in the obesity category (46.3%, 320/691).
Conclusion：Pediatric HUA is clinically common, with significant age and gender differences in blood uric acid levels. It is urgent to establish reference values for blood uric acid in children of different ages and genders in China and to develop diagnostic criteria for pediatric HUA to enhance the clinical management of affected children.
