2012年 · 第50卷第10期

bronchiolitis is a common respiratory disease in children, among which infectious bronchiolitis constitutes a public health problem for infants under 2 years old, especially under 1 year old. For a long time, the domestic pediatric community has habitually called infectious bronchiolitis "bronchiolitis". Is it an independent disease or a group of clinical syndromes? There are also differences in views. Some people think that it is a specific type of viral pneumonia, and the catalogue of Practical Pediatrics also includes it in the chapter "Viral Pneumonia". In fact, bronchiolitis is not only infectious. In recent years, bronchiolitis obliterans has attracted the attention of pediatric clinics, and diffuse panbronchiolitis, which was originally thought to be rare in Chinese people, has been reported frequently. Then there are eosinophilic bronchiolitis, follicular bronchiolitis, granulomatous bronchiolitis, idiopathic diffuse endocrine cell proliferative bronchiolitis, etc. There are many kinds of secondary bronchiolopathy, and we know very little about it, so it is urgent to comprehensively understand and update the knowledge.

Mycoplasma pneumoniae (MP) is one of the important pathogens of respiratory tract infections in children. 10% ~40% of community-acquired pneumonia (CAP) in children is caused by MP^[1]。 Children with MP lower respiratory tract infection (MP-LRTI) often have severe irritating cough in the acute phase, often accompanied by wheezing. After the acute phase, some children have repeated cough and/or wheezing attacks, and even develop into persistent asthma. Early prevention and treatment of childhood asthma includes primary prevention, secondary prevention and tertiary prevention (early intervention). The effective prevention and treatment of wheezing associated with MP infection in children is one of the secondary preventive measures of childhood asthma. At present, the mechanism of wheezing in the acute phase, postreactive airway disease (RAD) in the acute phase and asthma in children with MP-LRTI is not completely clear. This paper reviews the pathogenesis and treatment of wheezing associated with MP infection and the research progress of the correlation between MP infection and asthma, hoping to provide a reference for the rational and effective treatment of wheezing associated with MP infection in children. Based on the high incidence of MP infection in children, it is expected that the rational prevention and treatment of wheezing associated with MP infection in children will help to reduce the potential risk of asthma caused by long-term respiratory damage caused by MP infection.

Neonatal necrotizing enterocolitis (NEC), late onset sepsis (LOS), and feeding difficulties are important factors that affect neonates, especially premature and very premature infants (gestational age<28 weeks), the root cause of its occurrence is the immature development of intestinal function. A number of newly published meta-analyses and systematic reviews of randomized controlled trials (RCTs) on the use of probiotics in newborns have been published. The most encouraging result was that probiotic supplementation prevented the incidence of NEC and reduced prevalent neonatal mortality^[1]and it is useful in LOS, feeding intolerance, and even allergic diseases^[2]It also showed certain efficacy in prevention.

With the development of NICU and the improvement of premature infant treatment technology, the survival rate of very low and ultra-low birth weight infants has improved significantly. As a result, due to its anatomical and physiological characteristics, susceptibility to hypoxia and infection, the incidence of brain injury in premature infants is increasing year by year. In recent years, white matter damage (WMD) has become the most common form of brain injury in premature infants, and periventricular leukumalacia (PVL) is its most serious outcome. Numerous studies have shown that although PVL lacks specificity in clinical manifestations in neonatal period, its late neurological adverse outcomes, such as cognitive impairment, visual and auditory dysfunction, language impairment, behavioral psychological problems and cerebral palsy, have become one of the main causes of pediatric disability. The early imaging findings of white matter injury in premature infants, especially magnetic resonance imagine (MRI), and the relationship with late neurodevelopmental outcomes are reviewed.

A male child, 20 days after cesarean section, when his mother was bathing the baby, she accidentally found that her left calf was slightly thicker than the opposite side, and there was induration palpable, so she came to the outpatient clinic for treatment.

The child was an 11-year-old male. Recurrent headache for 18 d and high blood pressure for 10 d were admitted to hospital. Physical examination: weight 23.8 kg, blood pressure (cuff method): left upper limb 155/80 mm Hg (1 mm Hg =0.133 kPa), right upper limb 160/90 mm Hg, left lower limb 100/70 mm Hg, right lower limb 100/80 mm Hg. A systolic grade 2/6 murmur could be heard in the third intercostal area of the left margin of the sternum and the interscapular area of the back, and the femoral artery pulsation of both lower limbs was weak. Echocardiography: aortic coarctation, pressure gradient (PG) 63 mm Hg across the coarctation segment, aortic insufficiency (mild); Cardiac CT: Localized congenital coarctation of the aorta (CoA), the narrowest diameter of the coarctation segment is 4 mm.

bronchiolitis obliterans (BO) is a chronic airflow restriction syndrome caused by bronchiolitis injury. After acute lower respiratory tract infection or acute airway injury, the children had persistent or repeated cough, wheezing, dyspnea, typical changes such as mosaic sign in high-resolution lung CT, and pulmonary function showed irreversible obstructive ventilatory dysfunction. In the past ten years, pediatricians in China have gradually recognized this disease, and the number of children diagnosed with BO has increased significantly, but it is inevitable that there are over-diagnosis or under-recognition.

bronchiolitis obliterans (BO) is a chronic airflow restriction syndrome caused by bronchiolitis injury. At present, there is no definite incidence statistics. Post-infectious bronchiolitis obliterans (PBO) has been reported in South America and Asian countries (such as Brazil, Chile, Argentina, Uruguay, South Korea, etc.)^[1]In the literature, it is stated that approximately 1% of acute viral bronchiolitis may develop BO^[2]。 BO is pathologically presented as partial or complete occlusion of bronchioles, and clinically presented as persistent cough, wheezing and dyspnea after airway injury caused by severe pneumonia or other causes, which affects children's physical health and quality of life.

First reported in 1967 by Dr. Tomosaki Kawasaki in Japan, Kawasaki disease has become one of the most common causes of acquired cardiovascular disease in childhood. The diagnosis and treatment of Kawasaki disease in the acute phase has been relatively mature^[1,2,3]。 With regular treatment, the incidence of coronary artery disease can be significantly reduced^{[4,5,6,7,8,9]}Japan reported 13.0% since 1993^[7]Down to 3.2 percent in 2008^[9]。 However, the diagnosis, treatment and long-term management of coronary artery disease in Kawasaki disease are still an urgent problem to be solved. In order to standardize the clinical diagnosis and management process of Kawasaki disease coronary artery disease, since 2010, experts from the cardiovascular group, immunology group and the editorial board of Chinese Journal of Pediatrics have discussed many times, referring to foreign guidelines on the diagnosis, treatment and long-term management of Kawasaki disease coronary artery disease, combined with the latest research progress and domestic actual situation^{[10,11,12,13,14,15,16]}, to make this recommendation.

Asthma, the most common chronic respiratory diseases in childhood, is currently considered to be a persistent inflammatory disease of the airways that may be a local manifestation of systemic inflammation. Observational studies suggest that different hormones in the body may affect the inflammatory state of asthma and determine the course of asthma. It is also recognized that obesity plays a major role in the development of metabolic syndrome, and it is found that obesity is an important risk factor for chronic inflammatory diseases such as type 2 diabetes. Epidemiological data show that the rise in the prevalence of childhood asthma in recent decades is parallel to the rise in the prevalence of childhood obesity. According to the Global Asthma Prevention and Treatment Strategy report, there are about 300 million asthma patients worldwide^[1]Nearly half of them are children, while there are nearly 40 million overweight and obese children under the age of 5 worldwide^[2], suggesting that common environmental factors affect both diseases, and it is likely that asthma shares the same genetic determinants as metabolic disorders such as obesity^[3]。 The relationship between obesity and asthma has attracted increasing attention in pediatric clinical practice.

Bronchial asthma (asthma for short) is one of the most common chronic diseases affecting children's health. In recent years, its prevalence has increased significantly^[1]。 Despite the continuous introduction of guidelines for asthma prevention and treatment around the world, there are still many problems in the diagnosis and treatment of asthma that confuse clinicians and become the focus of clinical controversy. This paper describes several hot issues in the diagnosis and treatment of childhood asthma and their corresponding analysis for your reference.