2016年 · 第54卷第12期

In recent years, countries are aware of the shortage of professional clinicians. In order to further improve the medical level, primary doctors and primary children's health care doctors need to actively participate in dealing with children's clinical problems. Because primary physicians and primary child health doctors have extensive daily contact with children, it plays an important role in promoting children's health. As a result, many countries have published various guidelines for primary care physicians in recent years, which contribute to improving the quality of pediatric care. For example, in 2001, the American Academy of Pediatrics published health care guidelines for children with Down syndrome (DS), which were revised and published again in 2011^[1]； 2007 A team of American and Canadian Academy of Pediatrics experts co-authored guidelines for the management of adolescent depression in primary care^[2,3]； In order to guide primary child care physicians in early detection of developmental hip dysplasia in infants between 0 and 18 months of age, the American Academy of Pediatrics published a clinical practice guideline for early detection of developmental hip dysplasia in 2000^[4]Etc.

In 2009, the editorial board of Chinese Journal of Pediatrics and the Child Health Care Group of Pediatrics Branch of Chinese Medical Association published "Feeding Recommendations for Infants and Young Children"^[1]Provides specific clinical guidance recommendations for infant and young child feeding for child health doctors and pediatric clinical healthcare staff across the country. In recent years, with the continuous advancement of national hierarchical diagnosis and treatment, the role of grass-roots pediatric staff in children's health management has become more and more prominent. In order to adapt to the development, the editorial board of the Chinese Journal of Pediatrics and the Child Health Care Group of the Pediatrics Branch of the Chinese Medical Association published the "Feeding Recommendations for Infants and Young Children" in 2009^[1]On the basis of the latest research progress, the "Feeding Recommendations for Infants and Young Children Aged 0~3 (Primary Physician Edition)" was written for community child health practitioners and general practitioners. This recommendation is based on children<The age characteristics of different stages of 6 months, 6 to 8 months, 9 to 11 months and 12 to 36 months were described in four parts: nutrition (feeding) suggestions, eating behavior, treatment of common problems and nutrition evaluation. Finally, the main points of each stage were summarized in the form of tables. The main target population of this recommendation is healthy full-term infants, premature infants and/or low birth weight infants, and other infants with special needs for feeding recommendations, please refer to other relevant guidelines^[2,3]。

Recently,Horm Res PaediatrAndJ Clin Endocrinol MetabAt the same time, the "Global Consensus on the Prevention and Treatment of Nutritional Rickets" was published "(Global Consensus Recommendations on Prevention and Management of Nutritional Rickets, Hereinafter referred to as the Consensus)^[1,2]。 The consensus was completed by experts from around the world representing 11 international organizations in the fields of pediatric endocrinology, pediatrics, nutrition, epidemiology, public health and health economics. Consensus defines the concept of nutritional rickets, gives the diagnostic basis of nutritional rickets and the grading of vitamin D and calcium nutritional status, and formulates the clinical management and preventive measures of nutritional rickets. The consensus highlights children's own characteristics in the classification of vitamin D deficiency, diagnosis, treatment and prevention of nutritional rickets, etc., and is consistent with the "Evaluation, Prevention and Treatment of Vitamin D Deficiency-Endocrine Society Clinical Practice Guidelines" issued by the American Endocrine Society in 2011.^[3]There are many differences. The consensus applies to pediatric general practitioners, pediatric specialist physicians, as well as managers of child-related diseases and health policy makers. Combined with the current situation of rickets prevention and treatment in China, the consensus is interpreted.

With the rise of microecological research, the kinds of microecological preparations such as probiotics are gradually increasing, and their applications in intestinal flora-related diseases are more and more widely. Evidence-based evaluation of the clinical effects of probiotic products has been carried out at home and abroad, and application guidelines or consensus opinions have been formulated. Experts in the field of microecology at Yale University organized seminars in 2005, 2008 and 2011, and developed and updated consensus opinions on the application of probiotics for physicians to refer to when choosing drugs. This consensus opinion was updated at the 4th Yale/Harvard Symposium in 2015^[1](hereinafter referred to as the consensus). The new consensus provides a good reference for the selection of probiotic strains. Now make an interpretation of the background and key points of the consensus opinion.

In order to increase the transparency of clinical studies, mainly clinical trials, the International Medical Journal Editors' Board (ICMJE) in 2005 required that all published clinical trials should be registered with a public clinical trial registry. Clinical trial registration has changed from a recommended standard to the only way for clinical trials. As of September 2016, the China Clinical Trials Registry (www.chictr.org.cn) has completed 8,789 clinical study registrations, while www.clinicaltrials.gov in the United States has completed more than 210,000 registrations, of which non-U.S. studies account for 46%.

The 5-day-old child was admitted to Beijing Children's Hospital in July 2015 mainly because of "black skin color of both lower limbs for 4 days and fever twice". Four days before admission (i.e., one day after birth), the child showed redness of the skin of both lower limbs without obvious inducement, gradually turning purple-black, slightly hard to touch, and the purple-black skin lesions gradually appeared bullous and ruptured. He went to the local hospital and was given vancomycin and cefoperazone sulbactam sodium intravenous drip combined with anti-infection. The child's symptoms did not improve significantly, and he showed fever and swelling of the right calf, purple-black skin color, progressively aggravated swelling, and the purple-black skin range expanded. He was admitted to the neonatal intensive care unit (NICU) of our hospital as "neonatal skin gangrene". The child was the first birth and the first birth, at 39^＋6Delivered by perimenstrual cesarean section with unknown placenta, umbilical cord and amniotic fluid, birth weight 2 800 g. History of intrauterine distress and postnatal asphyxia was denied. The child's grandfather died in 2010 due to "sudden myocardial infarction". Other members of the family are in good health and deny family history of genetic diseases and family history of diseases.

The 13-day-old male was admitted to the First Affiliated Hospital of Zhengzhou University in April 2015 due to "yellowing skin for 12 days and dyspnea for 8 days". The child was the first child, with a gestational age of 40 weeks and a birth weight of 2,900 g. His mother suffered from systemic lupus erythematosus (SLE) and underwent cesarean section due to high blood pressure. Amniotic fluid was contaminated degree III, and there was no asphyxia after birth. The yellowing skin was found 2 days after birth, which gradually worsened. Dyspnea, moaning and breathing occurred 5 days after birth. CT of the outer hospital head (8 days after birth): low-density shadows of both temporal lobes, right frontal, parietal and occipital lobes, chest CT showed infection of both lungs, right pleural effusion, and thickened pleura on both sides. After 10 days of treatment, the effect was poor, and he was transferred to our hospital. Her mother suffered from SLE for 3 years. Before pregnancy, she took oral prednisone tablets (10 mg, once/d) and hydroxychloroquine sulfate tablets (0.2 g, once/d). She stopped taking the drug during pregnancy. She found her blood pressure to be 160/120 mmHg (1 mmHg =0.133 kPa) 1 month before delivery. She took oral labetalol hydrochloride tablets (200 mg, twice/d), and her blood pressure was not well controlled.

attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents, and its core features are inattention, hyperactivity, and impulsivity. The etiology and pathogenesis of ADHD have not been clarified, but it is currently believed that it is caused by the combination of genetic and environmental factors. Allergy is one of the risk factors of the disease that has received attention. Allergic diseases are also the most common chronic diseases in early childhood^[1]In most children, different allergic diseases occur together or sequentially. Food allergies and eczema are usually the beginning of atopic disease progression. About 50% of children with eczema can develop into allergic rhinitis and/or asthma. In the process of symptom migration, allergic diseases are not limited to allergic diseases themselves, but may also be combined with behavioral and neuropsychological problems^[2]。 The relationship between allergic diseases and ADHD is a subject of debate, and previous studies have reached some conflicting conclusions. In recent decades, the prevalence of allergic diseases and ADHD has been gradually increasing at the same time. A large number of studies have further confirmed the existence of epidemiological and pathophysiological associations between allergic diseases and ADHD.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, characterized by social interaction, communication deficits, and repetitive stereotypical behaviors^[1]。 The incidence of ASD is high, the occupation of medical and health resources is large, and the burden of caregivers is heavy. In 2014, the U.S. Centers for Disease Control and Prevention reported that the prevalence of ASD in the United States reached 1/68, (2.8-30.4) /10 000 in Mainland China, and (7.3-30.4) /10 000 in Hong Kong and Taiwan, China, with an increasing trend^[2]。 In addition to the symptom spectrum indicated by the diagnostic criteria, ASD patients also exhibit a wide range of neurological comorbidities, including intellectual disability, epilepsy, anxiety, and mood disorders; There are also non-neurological comorbidities, such as hyperserotonemia, immune disorders, gastrointestinal abnormalities, etc^[3,4]。 All these have led us to recognize the need to explore the causes of ASD as soon as possible and develop interventions targeting core and co-symptoms. Notably, although all were diagnosed with "ASD", significant clinical heterogeneity was shown among different individuals^[5]This makes clinical and research work face greater challenges. In order to advance ASD research and ultimately serve clinical practice, it is very important to define ASD subtypes, such as ASD with gastrointestinal problems. The research progress of common gastrointestinal problems in ASD, the influence of gastrointestinal problems on ASD symptoms, and the genetic and environmental risk factors of ASD combined with gastrointestinal problems will be described.

The clinical manifestations of Kawasaki disease are diverse, but shock is less common^[1]。 Kawasaki disease shock syndrome (KDSS) refers to patients with Kawasaki disease who have a persistent decrease in blood pressure, systolic blood pressure below the normal mean blood pressure value of the corresponding age group by 20%, or have peripheral circulation perfusion disorders^[2]。 Studies show that the incidence of KDSS in Kawasaki disease patients in Taiwan, China is 1.45%^[3], far lower than the report of about 7% in western developed countries^[2]。 However, there are few research reports on KDSS in mainland China, and there is still a lack of large sample epidemiological investigation data. The research progress of KDSS is reviewed.