Demographic data and clinical data were collected retrospectively from patients with pertussis at the Children's Hospital Affiliated to the Capital Institute of Pediatrics between March 2011 and February 2023. Among the 270 hospitalized patients, 151 cases were male and 119 were female. The youngest age of admission was 10 days and the eldest age of admission was 11 years. The 270 hospitalized patients were divided into two groups according to onset age: <3 months (n=143) and≥3 months (n=127). For those in the <3-month-old group, the incidence of severe pneumonia and severe pertussis were 21.0% and 38.5%, respectively, both were significantly higher than those in≥3-month-old group (7.9% and 11.0%, both P<0.05). For those in the <3-month-old group, paroxysmal spasmodic cough, post-tussive vomiting, paroxysmal cyanosis, apnea, and decreased heart rate after coughing were 86.7%, 25.2%, 38.5%, 7.0% and 16.8%, respectively, all were significantly higher than those in ≥3-month-old group (76.4%, 10.2%, 15.7%, 1.6% and 1.6%, all P<0.05). For those in the<3-month-old group, the incidence of hypoxemia, respiratory failure, were 36.4%, 16.8%, respectively, and both were significantly higher than those in≥3-month-old group (10.2%, 7.1%, P<0.05). It indicated that among the infants under 3 months, the incidence of vomiting after coughing, paroxysmal cyanosis, apnea, hypoxemia, respiratory failure, decreased heart rate after coughing and severe pneumonia were significantly higher than those above 3 months. Infants under 3 months were prone to severe pertussis.

Abstract Background Pertussis is a highly contagious respiratory illness that can cause severe complications, particularly in children. However, predicting which patients with pertussis are at risk of developing severe symptoms remains a challenge in clinical practice. In this study, we developed a two-step cascading machine learning pipeline to predict severe pertussis in patients with the disease. Study Design This work retrospectively involved both outpatients and inpatients with pertussis between March 2011 and December 2018 from Capital Institute of Pediatrics. We developed a two-step cascading prediction pipeline for severe pertussis in both outpatients and inpatients based on logistic regression models and nomograms. The pipeline selected potential severe pertussis patients with high sensitivity in the first step and predicted severe pertussis patients with high specificity in the second step using additional information. Further, the second step of pipeline was tested on a held-out test set of 17 inpatients with pertussis patients enrolled since December 2018. Results This work split the enrolled patients into training cohort and validation cohort in a 7:3 ratio. The first-step machine learning models included onset age (months) as a predictor and achieved a sensitivity of 0.923 (95% CI, 0.778-1.00) in the validation cohort. The second-step machine learning model consisted of five variables: white blood cell count, globulin usage, fever, paroxysmal cyanosis, and increased leukocyte levels. The validation cohort showed an accuracy of 0.797, AUC of 0.920 (95% CI, 0.832-1.000), sensitivity of 0.647 (95% CI, 0.413-0.827), and specificity of 0.846 (95% CI, 0.725-0.920). Nomograms were developed based on the machine learning models, and the calibration curves indicated a good fit. Conclusion This study developed a severe pertussis prediction pipeline using machine learning models, which demonstrated high sensitivity in the first step and high accuracy in the second step. The pipeline provides a useful screening and prediction workflow for severe pertussis patients, and the inclusion of nomograms enhances its practicality for clinical use. Overall, this pipeline has potential to improve the early identification and management of severe pertussis cases.

Objective:To study the impacts of pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM) and gestational weight gain (GWG) on perinatal outcomes and mode of delivery.Methods:From November 2016 to December 2017, single-pregnancy women in early pregnancy (<13 weeks) regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery. They were assigned into four groups according to pre-pregnancy BMI: obese group (≥28.0 kg/m 2), overweight group(24.0-<28.0 kg/m 2), normal group (18.5-<24.0 kg/m 2) and underweight group(<18.5 kg/m 2). A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM. The optimal GWG was 11.0-16.0 kg for underweight group, 8.0-14.0 kg for normal group, 7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group. The effects of pre-pregnancy BMI, GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods. Results:A total of 802 pregnant women were included. The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%, respectively. The incidence of GDM was 14.1%. 57.2% of the participants experienced excessive GWG. The incidences of macrosomia, low birth weight and premature birth were 7.1%, 2.7% and 2.2%, respectively. The incidence of Cesarean delivery (C-section) was 37.7%. Pre-pregnancy obesity [adjusted odds ratio ( AOR)=4.355, 95% confidence interval ( CI) 1.900-9.980] and excessive GWG ( AOR=3.799, 95% CI 1.796-8.034) were independent risk factors for macrosomia. Excessive GWG was a protective factor for low birth weight ( AOR=0.279, 95% CI 0.084-0.928) and inadequate GWG was a risk factor for low birth weight ( AOR=10.954, 95% CI 3.594-33.382) and premature birth ( AOR=8.796, 95% CI 2.628-29.438). Compared with the normal group, overweight group had an increased risk of C-section ( AOR=1.817, 95% CI 1.119-2.949). Compared with pregnant women without pre-pregnancy overweight/obesity, GDM nor excessive GWG, any combination of two of the above-mentioned three factors increased the risks of macrosomia ( AOR=3.908, 95% CI 1.630-9.370) and C-section ( AOR=2.269, 95% CI 1.325-3.886). The risks of macrosomia and C-section were the highest when all three factors existed. Conclusions:Pre-pregnancy obesity and excessive GWG are independent risk factors for macrosomia and pre-pregnancy overweight is a risk factor of C-section. Exposure to any two of the three factors (pre-pregnancy overweight/obesity, GDM and excessive GWG) increases risks of macrosomia and C-section and the highest risk is observed when all three factors are present.

Background Fetal growth patterns are influenced by maternal thyroid function and vitamin A level during pregnancy. Vitamin A presents interactions with thyroid tissues and hormonal systems. We examined whether vitamin A status modified the associations of maternal thyroid hormones in early pregnancy and fetal growth outcomes among euthyroid pregnant women in a prospective cohort study (n = 637). Methods We performed multiple linear regression and multinomial logistic regression analysis to investigate the effects of thyroid hormones in early pregnancy on fetal growth according to different levels of serum vitamin A based on median value. Results A 1 pmol/L increase in maternal free triiodothyronine (FT3) levels was associated with an increased birth weight of 0.080 kg (p = 0.023) in women with lower maternal vitamin A levels in early pregnancy. Increased maternal free thyroxine (FT4) was associated with decreased odds for both small size for gestational age (SGA) [odds ratios (OR) = 0.66, 95% confidence interval (CI): 0.45–0.95] and large size for gestational age (LGA) (OR = 0.66, 95% CI: 0.45–0.98) in women with higher vitamin A level in early pregnancy after adjustment for maternal prepregnancy body mass index, gestational weight gain, maternal employed, parity, gestational week at sampling, and gestational diabetes mellitus. Conclusions In Chinese pregnant women without overt thyroid dysfunction, maternal FT4 in early pregnancy was positively associated with optimal fetal growth among women with higher serum vitamin A concentrations.

article: Clinical characteristics and management of congenital chylothorax refractory to conservative treatment: a retrospective study of 11 cases from a single center - Minerva Medica 2022 Oct 18 - Minerva Medica - Journals

Pertussis is a highly contagious respiratory disease.Although widespread vaccination has greatly reduced the incidence of pertussis, there was a " recurrence of pertussis" in the past 30 years, and pertussis outbreaks occurred in some areas.Infants who have not been vaccinated or have not completed the full course of immunization suffer from more severe pertussis infections.Because of the atypical symptoms of young infants, missed diagnosis and misdiagnosis often occur, and pertussis cannot be diagnosed and treated in time.As a result, they can easily develop into severe pertussis or even die.In this article, recently published research on severe pertussis are summarized, so as to provide guidance for the clinical diagnosis, treatment, prevention and basic scientific research of severe pertussis.

Objective:To analyze the characteristics of coronary artery lesions in infants under 6 months of age with Kawasaki disease(KD), and to explore their regression and risk factors.Methods:The clinical data of 61 infants with KD[34 boys, 24 girls, aged 2.2 (1.7, 3.1) months] admitted to the department of critical care medicine and neonatology, Children′s Hospital, Capital Institute of Pediatrics from October 2015 to February 2020 were retrospectively analyzed.Persistent coronary artery aneurysm(CAA)was defined as the persistent enlargement of coronary arteries(coronary Z-score≥2.5)on echocardiograms at 12 months after KD onset.Cox proportional hazards mode was conducted to evaluate the potential risk factors of persistent CAA.Results:The incidence of CAA in 61 infants with KD was 52.5% (32/61) and occurred on 5 (4, 8)d of the disease course.During a follow-up of 547 (399, 782)d, five(8.2%, 5/61)infants satisfied the definition of persistent CAA.The median recovery time of CAA was 20 (12, 82)d after KD onset.Cox proportional hazards mode revealed that the maximal coronary Z-score was an independent factor of CAA regression( HR=0.451, 95% CI 0.293-0.694, P<0.001). Receiver operating characteristic curve analysis showed that the best cutoff value of coronary Z-score for predicting persistent CAA was 6.15(sensitivity 80.0%, specificity 97.7%). Conclusion:CAA is common in infants younger than 6 months with KD.The maximal coronary Z-score is an independent factor of persistent CAA.

Objective:To study the clinical features, diagnosis, treatment and genetic characteristics of neonatal-onset protein C deficiency (PCD).Methods:The clinical data of a newborn patient with severe PCD admitted to our neonatal department was reviewed. Databases including CNKI, Wanfang Database, CMB, VIP database, PubMed, Embase and SCI database were searched using" infantile", " neonate ", "newborn", "protein C deficiency" and "purpura fulminans" as key words. Published cases of PCD were analyzed.Results:The patient was a full-term female infant who developed multiple symptoms within 2 days after birth. The symptoms included thrombocytopenia, intracranial hemorrhage, purpura fulminans (PF), disseminated intravascular coagulation (DIC), celiac hemorrhage, hypertension, portal and iliac vein thrombosis, purulent meningitis and retinal detachment. Protein C activity was less than 10%. Genetic tests showed compound heterozygous mutations c.314G>T (p.c105f) of paternal origin and c.1218G>A (p.m406i) of maternal origin in PROC gene. According to ACMG guidelines, the mutations were strongly suspected pathogenic variants and consistent with an autosomal recessive (AR) inheritance pattern. The patient was discharged after 6 weeks of treatment at parents' request of withdrawal. A total of 25 articles on 29 patients with relatively complete clinical data were retrieved, including 18 males and 11 females. 4 patients were preterm and 25 full-term. 28 patients showed symptoms within 7 days after birth. The common clinical features were cutaneous PF and splanchnic thrombi. 22 cases documented protein C activity and ranged from 0 to 25%. 16 patients had PROC gene abnormalities and compound heterozygous mutations were found in 10 patients. Among the 22 patients with prognostic data, 11 died (9 within 3 months after birth), the remaining survivors suffered from sequelae including severe intellectual motor development disorder, epilepsy and blindness.Conclusions:The main clinical manifestations of neonatal-onset PCD include PF, DIC, multi-organ hemorrhage and thrombus. The disease is acute and severe, with rapid progression, poor prognosis and high fatality rate. Protein C activity and PROC gene testing may help establish the diagnosis.

目的 分析北京地区单中心住院儿童百日咳的临床特征.方法 对2015年1月 ～2018年12月在笔者医院住院经聚合酶链反应(PCR)方法检测确诊百日咳患儿的临床资料进行回顾性研究.结果 56例患儿中男性31例(55.4％),女性25例(44.6％).发病年龄为10天 ～10岁,中位数75天.未接种疫苗41例(73.2％),有明确接触史29例(51.8％).发病季节:春季14例,夏季19例,秋季11例,冬季12例.入院时咳嗽持续时间2～40天,平均14.36±8.70天.痉挛性咳嗽54例(96.4％),发绀30例(53.6％),喘息25例(44.6％),发热、呼吸困难各18例(32.1％),吸气末回钩10例(17.9％),呼吸暂停9例(16.1％).肺部中小水泡音及喘鸣音各20例(35.7％).并发百日咳肺炎46例(82.1％).血常规白细胞计数增高54例(96.4％),中位数为19.66×109/L,淋巴细胞比例平均值66.48％ ±9.79％.CRP升高6例(10.7％).重症患者23例(41.1％),重症组喘息的发生率高于与普通组(P<0.05),且CRP升高的发生率高于普通组(P<0.05).住院时间1～70天,中位数为6天.除死亡1例(1.8％)之外均好转出院.结论 儿童百日咳好发于未接种疫苗的婴儿,约半数有明确接触史,全年散发.百日咳肺炎常见,喘息、CRP升高可能提示为重症病例.

The purpose of this study is to understand children’s clinical characteristics with pertussis and analyze risk factors on critical pertussis patients. Demographic data from patients with pertussis at Children’s Hospital affiliated to the Capital Institute of Pediatrics between March 2011 and December 2018 were collected. We retrospectively gathered more information with the positive exposure, vaccination, antibiotic usage before diagnosis, clinical manifestation, laboratory tests, therapy, and complications for hospitalized children. We divided the patients into severe and non-severe groups, comparing related factors and clinical characteristics among each group. In particular, we summarize the clinical features of the severe patients before aggravation. A total of 967 pertussis cases were diagnosed, of which 227 were hospitalized. The onset age younger than 3 months old accounted for the highest proportion, and 126 patients received hospitalization. For those patients, the incidence of post-tussive vomiting, paroxysmal cyanosis, post-tussive heart rate decrease, hypoxemia, severe pneumonia, and mechanical ventilation was significantly higher than that in the ≥ 3-month-old group (p < 0.05). Among 227 hospitalized patients, 54 suffered from severe pertussis. Risk factors for severe patients included early age of onset, pathogen exposure, and unvaccinated status. Cough paroxysms, post-tussive vomiting, paroxysmal cyanosis, facial flushing/cyanosis/fever during cough, increased WBC, and chest X-ray revealing pneumonia/consolidation/atelectasis were important indications of severe pertussis. Unvaccinated status was an independent risk factor for severe pertussis. The most vulnerable population was infants < 3 months old to pertussis, and may be on the severe end of the disease. Pediatricians must detect and treat severe cases promptly and recommend timely vaccination for all eligible children.

目的 分析儿童百日咳临床特征及重症百日咳发生的危险因素,为临床诊治提供参考.方法 以首都儿科研究所中心实验室为检测中心,回顾性分析2019年1月至12月确诊的114例百日咳住院患儿病例资料.根据是否合并其他病原感染,分为单纯百日咳组73例,混合感染组41例;根据病情程度分为普通百日咳组100例,重症百日咳组14例.组间进行单因素比较,同时行二元Logistic回归分析重症百日咳的危险因素.结果 (1)百日咳好发于秋冬季共66例(62.2％).患儿以≤6月龄为主,共79例(69.3％).未免疫89例(78.1％),免疫25例(21.9％).(2)单因素分析比较得出,混合感染组较单纯百日咳组更易出现血氧下降、三凹征、发热、肺部湿啰音(P＜0.05);重症组中有早产史、咳嗽后青紫、三凹征、发热、肺部湿啰音、肺炎和混合感染患者占比高于普通组(P＜0.05);混合感染组、重症组较单纯百日咳组、普通组住院时间更长(P＜0.05);重症组白细胞峰值较普通组高(P＜0.05),Logistic回归分析显示白细胞峰值高是重症百日咳的危险因素(OR=1.096,P＜0.05).(3)114例确诊患儿均使用大环内酯类抗生素治疗,10例(8.8％)患儿在病程7d内用药,33例(28.9％)在病程8～14d用药,余均＞病程14d用药,其中5例重症患儿＞病程21d用药.(4)≤4月龄的重症百日咳患儿易并发肺炎、百日咳脑病、心肺衰竭等严重并发症,其中8例患儿行有创通气治疗.经积极治疗,1例患儿死亡,余均好转出院.结论 ≤6月龄、未免疫的小婴儿百日咳发病多见,常需住院治疗,小月龄的百日咳患儿并发症发生率更高.合并感染、延迟用药可能会加重百日咳病情,延长住院时间.监测血白细胞峰值有助于病情程度的判断.

Objective:To discuss the clinical characteristics and genetic diagnosis of fetal familial hemophagocytic lymphohistiocytosis (FHL).Methods:Clinical data of a case of fetal FHL from Children's Hospital, Capital Institute of Pediatrics was analyzed, and related FHL cases at home and abroad were retrieved from PubMed, CNKI, and Wanfang databases using terms including "fetus", "neonate", and "familial hemophagocytic lymphohistiocytosis", from the establishment of the database to January 3, 2021, to summarize the characteristics of this disease.Results:This index case was found with fetal splenomegaly, free fluid in the abdominal cavity, and enlargement of the ventricle at 39 +3 weeks of gestation, and presented with fever, tachypnea, hepatosplenomegaly, skin ecchymosis and petechia, and lymphadenectasis after birth. Laboratory examination revealed pancytopenia, abnormal liver function, elevated ferritin and triglyceride, and decreased fibrinogen levels. CD107a excitation experiment showed decreased degranulation function of NK cell (ΔCD107a<5%). Hemophagocytosis was observed in the bone marrow smear. Genomic DNA sequence analysis demonstrated compound heterozygous mutations of c.118-308C>T and c.3002T>C in the UNC13D gene. All the above findings led to the diagnosis of FHL3. Despite chemotherapy with dexamethasone and cyclosporin, and symptomatic treatment after admission without hematopoietic stem cell transplantation, the baby died on day 52. A total of 15 papers related to fetal FHL, including 20 infants, were retrieved. Among these 21 cases (including the index case), the main clinical symptoms were fetal edema and hepatosplenomegaly, which may be accompanied by fetal distress and increased amniotic fluid volume, and postnatal fever, dyspnea, rash, and central nervous system involvement. Laboratory and imaging examination results were consistent with the diagnostic criteria for hemophagocytic hyperplasia. As far as we know, the reported fetal FHL gene mutations were PRF1 (FHL2) and UNC13D gene mutation (FHL3), in which reduced expression of perforin and granzyme can be detected, respectively. Dexamethasone, cyclosporin, etoposide, and other chemotherapy and symptomatic treatment are the primary treatments currently, and alternative therapies include intrauterine chemotherapy in the third trimester and postnatal hematopoietic stem cell transplantation. Among the 21 cases, including the index case, intrauterine death occurred in four cases, 13 children died at different times after birth, and only four children survived, among which the eldest one was 12 years old. Conclusions:FHL is a condition with atypical early signs, high mortality rate and treatment difficulties. Fetal FHL should be considered in differential diagnosis in fetuses with edema or hepatosplenomegaly besides hemolysis, infection, autoimmune diseases, and hereditary problems. Therefore, with immunotechnology and gene sequencing, early diagnosis and treatment can be prompted to improve the prognosis of this group of population.

Objective:To study the genetic characteristics of idiopathic cholestasis during the neonatal period.Method:From November 2015 to November 2018, neonatal infants with idiopathic cholestasis admitted to the neonatal department of our hospital and completed the whole exon sequencing (WES) were retrospectively analyzed. According to the WES results, the infants were assigned into two groups, the etiology-determined group and the etiology-undetermined group. The bilirubin levels of the two groups at one-year-old were compared.Result:A total of 62 Han infants were enrolled, including 43 males and 19 females. The age of onset was <7 d in 39 cases, 7~14 d in 9 cases and >14 d in 14 cases. 16 infants were in the etiology-determined group, including 4 cases of neonatal intrahepatic cholestasis of citrin deficiency (NICCD), 2 cases of Alagille syndrome, 1 case of progressive familial cholestasis type 1 and 2, galactosemia, citrullinemia typeⅠ, Beckwith-Wiedemann syndrome, arthrogryposis-renal-dysfunction-cholestasis syndrome, Menkes disease, congenital bile acid synthesis disorder, D-difunctional protein deficiency and Dubin-Johnson syndrome. 46 infants were in the etiology-undetermined group. At 1 year of follow-up, the proportion of infants with abnormal bilirubin in the etiology-determined group was higher than the etiology-undetermined group ( P=0.001). Conclusion:WES technology can identify the etiology and predict the prognosis in some of the infants with idiopathic neonatal hepatitis. While neonatal cholestasis may have many genetic causes, NICCD, Alagille syndrome and progressive familial cholestasis are relatively common.

Objective:To explore the clinical characteristics and treatment strategies of refractory congenital chylothorax (CC) in neonates.Methods:Eleven neonates with refractory CC who were hospitalized in Children′s Hospital, Capital Institute of Pediatrics from June 2015 to December 2019 were selected as research subjects. The clinical manifestations, ancillary tests, treatment strategies, regression and follow-up were retrospectively analyzed. The procedures followed in this study were in accordance with the World Medical Association Declaration of Helsinki revised in 2013, and informed consent for clinical study was signed with the guardians of neonates.Results:①Among the 11 cases of refractory CC, 8 were term infants and 3 were preterm infants, with gestational age ranging from 31 to 40 weeks; 6 were boys and 5 were girls; 4 received prenatal diagnosis and 3 were combined with fetal edema. ② Seven cases developed within 10 min after birth, 11 cases showed tachypnea, weakening of respiratory sound in affected lung, chest X-ray, chest CT or chest ultrasonography all suggested pleural effusion, including 7 cases of bilateral pleural effusion and 4 cases of unilateral pleural effusion (left side), and the pleural effusion test showed celiac fluid. ③ After failure of 2-4 weeks of conservative treatment (dietary modification, respiratory support, thoracic close drainage, octreotide, anti-infective therapy, etc.), 10 cases were treated with chemical pleural fixation (intra-thoracic injection of erythromycin), of which 7 cases were treated with octreotide during the same time, and the number of erythromycin intrathoracic injections was 3-7 for those who did not combine with octreotide. During intrapleural injection of erythromycin, 4 children showed tachycardia and irritability, and 1 patient showed significantly increased blood glucose (18.8 mmol/L). Two cases underwent thoracoscopic exploration and repair of chylous fistula. ④After treatment, 11 cases of refractory CC were absorbed and improved, and the total length of hospital stay was 40-73 days. Among them, 1 case died after automatic discharge, and 1 case was lost to follow-up because of suspected parents of tracheoesophageal fistula. No recurrence occurred after discharge.Conclusions:Refractory CC is common in full-term children. For children who have failed in early dietary regulation, intravenous nutrition, thoracic close drainage and octreotide intravenous infusion for 2-4 weeks, chemical pleural fixation (intrathoracic injection of erythromycin) can be combined. For patients with ineffective treatment for more than 4 weeks, thoracoscopic exploration can be used to repair lymphatic fistula after identifying the leak in order to improve the cure rate of refractory CC.

目的 分析影响百日咳患儿住院时间的相关因素.方法 收集2018年8月至2019年12月在首都医科大学附属北京地坛医院儿科住院的167例百日咳患儿的临床资料,对可能影响住院时间的相关因素进行单因素和多元线性回归分析.结果 单因素分析结果显示,胎龄<39周、出生体质量<3000 g、双胎或多胎、百日咳疫苗部分接种或未接种、入院时痰百日咳鲍特菌阳性、住院期间应用过持续气道正压通气或机械通气以及合并其他呼吸道病原感染、重症肺炎、电解质紊乱、百日咳脑病均为百日咳患儿住院时间延长的影响因素(均P<0.05).多元线性回归分析结果表明,双胎或多胎、合并其他呼吸道病原感染、应用持续气道正压通气或机械通气、重症肺炎、百日咳疫苗未接种或部分接种、电解质紊乱、巨细胞病毒感染均为百日咳患儿住院时间延长的危险因素(偏回归系数分别为4.103、4.076、12.367、3.670、1.909、7.668、2.755)(均P<0.05).结论 双胎或多胎、百日咳疫苗未接种或部分接种、应用持续气道正压通气或机械通气以及合并其他呼吸道病原感染、重症肺炎、电解质紊乱、巨细胞病毒感染均可使百日咳患儿住院时间延长.

本文报告1例新生儿歌舞伎面谱综合征(Kabuki syndrome，KS)，临床主要表现为肺部感染、喂养困难、反应差，经二代基因测序发现新发的KMT2D基因突变，位点为c.11944C>T，p.R3982*，随访至4月龄时渐出现KS患儿弓形眉、鼻尖扁平的特殊面容。

OBJECTIVE To investigate the incidence rate of infectious diseases during hospitalization in late preterm infants in Beijing, China, as well as the risk factors for infectious diseases and the effect of breastfeeding on the development of infectious diseases. METHODS Related data were collected from the late preterm infants who were hospitalized in the neonatal wards of 25 hospitals in Beijing, China, from October 23, 2015 to October 30, 2017. According to the feeding pattern, they were divided into a breastfeeding group and a formula feeding group. The two groups were compared in terms of general status and incidence rate of infectious diseases. A multivariate logistic regression analysis was used to investigate the risk factors for infectious diseases. RESULTS A total of 1 576 late preterm infants were enrolled, with 153 infants in the breastfeeding group and 1 423 in the formula feeding group. Of all infants, 484 (30.71%) experienced infectious diseases. The breastfeeding group had a significantly lower incidence rate of infectious diseases than the formula feeding group (22.88% vs 31.55%, P=0.033). The multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against infectious diseases (OR=0.534, P=0.004), while male sex, premature rupture of membranes, gestational diabetes mellitus, and asphyxia were risk factors for infectious diseases (OR=1.328, 5.386, 1.535, and 2.353 respectively, P < 0.05). CONCLUSIONS Breastfeeding can significantly reduce the incidence of infectious diseases and is a protective factor against infectious diseases in late preterm infants. Breastfeeding should therefore be actively promoted for late preterm infants during hospitalization.

目的 探讨新生儿百日咳的临床特征.方法 回顾性分析2015年1月至2018年12月首都儿科研究所附属儿童医院收治的经聚合酶链反应(PCR)方法确诊的14例百日咳患儿的临床资料,包括一般信息、病程、住院时间、主要临床症状、肺部体征、并发症、实验室及影像学检查等情况.结果 14例患儿中,男性10例(71.4％),女性4例(28.6％);发病年龄为10～28 d,平均(16.29±5.84)d.12例(85.7％)有咳嗽患者接触史,其中9例(75％)为母亲.入院时咳嗽持续时间为2～30 d,平均(11.93±8.00)d,临床症状有痉挛性咳嗽14例(100％),发绀9例(64.3％),流清涕5例(35.7％),鸡鸣样回勾4例(28.6％),呼吸暂停4例(28.6％),呼吸困难3例(21.4％),发热3例(21.4％),喘息2例(14.3％).肺部中小水泡音8例(57.1％),痰鸣音7例(50.0％),喘鸣音2例(14.3％).并发肺炎者13例(92.9％),重症患者5例(35.7％).14例患儿血常规白细胞均增高,中位数为20.42×109/L,淋巴细胞比率平均为(64.80±7.43)％.C反应蛋白(CRP)正常13例(92.9％),升高1例(7.1％).行降钙素原(PCT)检查10例,均正常.X线胸片显示双肺点片影或斑片影7例(50％),肺不张1例(7.1％),透亮度增高1例(7.1％).经隔离及综合治疗好转出院13例(92.9％),死亡1例(7.1％).住院时间为1～14 d,平均(6.50±4.15)d.结论 新生儿百日咳多有接触史,男性更易发生,并发肺炎者常见;痉挛性咳嗽和以淋巴细胞为主的白细胞增高是本病的特异性表现;反复呼吸暂停和白细胞显著增高是重症病例的特征.