2013年 · 第51卷第10期

• Foreword

The Respiratory Group of Pediatrics Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Pediatrics formulated China's first "Guidelines for the Management of Community-Acquired Pneumonia in Children (Trial)" in October 2006^[1,2]It has attracted the attention and affirmation of the majority of pediatric respiratory professionals, and has played a role in guiding clinical practice. It has become one of the top articles in the ranking of citation frequency in Chinese Journal of Pediatrics in recent years. Since then, it has been nearly seven years, and many new problems, new difficulties, new understandings and new progress have emerged in the diagnosis, treatment and prevention of community acquired pneumonia (CAP). Chinese pediatricians have also continuously deepened their understanding of CAP in clinical practice. Internationally, in 2011, the American Academy of Pediatric Infectious Diseases and the American Academy of Infectious Diseases launched the first "Clinical Practice Guidelines for CAP Management in Infants and Children Over 3 Months" at the national level in the United States^[3]。 The British Thoracic Society also updated the CAP Management Guidelines for Children in the same year^[4]Japan has also updated the Management Guidelines for Children's Respiratory Infections Focused on Pneumonia.^[5]。 Starting from pediatric practice, combining with the characteristics of each country, evidence-based recommendation of diagnosis and treatment to guide clinical practice, in order to reduce the prevalence and mortality of pneumonia, which is the common characteristic and goal of different national guidelines. It is also necessary for our country to keep pace with the times and update the 2006 guidelines for the management of children's CAP.

Mycoplasma pneumoniae (Mycoplasma pneumoniae,MP) is an important pathogen of community-acquired respiratory infections in children. The traditional idea is that MP infection is self-limiting, and even if it is not treated, most children will gradually alleviate. However, in recent years, the reports of severe and refractory MP pneumonia have increased obviously, and the treatment difficulty has increased, even fatal MP pneumonia has been reported^[1,2,3,4]Thus posing a serious challenge to traditional ideas^[5]。 How to treat refractory MP pneumonia scientifically and rationally based on evidence-based medicine has become an important task for pediatric clinicians. This paper introduces the current status and progress of treatment drugs and methods for refractory MP pneumonia.

Infant sleep apnea is characterized by central or obstructive apnea during sleep, including adverse maturity apnea (AOP), apparent life-threatening event (ALTE), infant apnea (AOI), periodic breathing (PB), and obstructive sleep apnea syndrome (OSAS). At present, insufficient attention is paid to infantile obstructive sleep apnea (OSA) in clinical practice. This paper discusses the characteristics of infant OSA from the aspects of pathogenesis, clinical characteristics, diagnosis and treatment, so as to arouse the attention of pediatricians to this disease.

respiratory distress syndrome (RDS) mainly occurs in premature infants. Premature infants with RDS have a higher chance of requiring respiratory support. In order to reduce the series of complications caused by invasive ventilation, an increasing number of (especially gestational age>32 weeks^[1]) Initial treatment of RDS in premature infants directly using non-invasive ventilation^[2,3,4]。 With the continuous improvement of ventilator technology and the transnasal connection interface, the noninvasive ventilation mode is no longer just a single nasal continuous positive airway pressure (NCPAP) ventilation. Commonly used non-invasive ventilation modes also include: intermittent positive pressure nasal ventilation (NIPPV) and its synchronous mode (SNIPPV), neuromodulation assisted ventilation (NAVA), high frequency nasal ventilation (NHFV), heated and humidified high flow nasal tube (HHHFNC) ventilation, etc^{[5,6,7,8,9,10]}。 Among them, the concept of NIPPV also covers nasal intermittent command ventilation (NIMV), bihorizontal positive airway pressure (BiPAP) ventilation, etc^[4]。 This paper focuses on the application of BiPAP ventilation in RDS of premature infants.

Case 1, a child, 5 d. She was a full-term natural delivery girl who was referred to our hospital by another hospital due to repeated myoclonic tics 2 days after birth. The child was asleep on the way home from the hospital 3 days after birth. Due to the loud street noise, the mother noticed that the child had repeated limbs twitching, which lasted for about 2 minutes and then relieved by itself. Later, the child had repeated myoclonic attacks, manifested as rhythmic twitches of the limbs, and the twitches of both upper limbs were more common, each time lasting for 1 to 3 minutes, and attacks occurred 2 to 5 times a day. There is no cyanosis of the lips and no physical rigidity at the time of attack, all of which appear during sleep, and can be induced by noise, all of which alleviate by themselves. Generally good. In the pediatric diagnosis and treatment of the local county-level hospital, neonatal convulsions were considered, and brain CT was examined. Blood routine, blood sugar and electrolytes were all normal, but phenobarbital sodium and diazepam were ineffective after treatment, so they were transferred to our hospital. The mother was 32 years old, normal pregnancy and delivery, and there was no epilepsy in the familyMedical history and history of convulsions in infancy. Physical examination at admission: vital signs stable, head circumference: 34.5 cm, good response, loud crying, normal cardiopulmonary auscultation, flat and soft abdomen, no enlargement of liver and spleen, normal muscle tone of limbs, and normal extraction of primitive reflexes. After admission, anticonvulsant drugs were suspended, and blood routine, C-reactive protein (CRP), liver and kidney function, electrolyte, blood gas analysis and cerebrospinal fluid examination were all normal. The brain CT film was normal when reviewed. The electroencephalogram was normal twice between attacks, but video electroencephalogram monitoring could not be performed due to conditions. After admission, there were still myoclonic attacks, 2 to 3 times/d, all of which occurred in quiet sleep, manifested as bilateral upper limbs or symmetrical rhythmic twitches of limbs, lasting for 30 to 60 s. At the time of attack, there was no change in heart rate and percutaneous oxygen saturation monitoring. Limb restriction could not prevent the attack, and myoclonus stopped immediately when the child was awakened. Diagnosis: Neonatal benign sleep myoclonus (BNSM), withdrawal of anticonvulsants, hospitalization for observation for 3 d and discharge. Myoclonus disappeared after 8 weeks. The child was followed up until 24 months, and the nervous system developed normally.