Background:Etoposide-based protocols remain the first-line therapy for pediatric hemophagocytic lymphohistiocytosis (HLH), yet 20-30% of patients exhibit primary resistance. Early identification of non-responders is critical to enable timely salvage therapy. We aimed to develop and validate a predictive model for etoposide-based protocols resistance using readily available clinical and laboratory parameters. Methods:A retrospective cohort of 79 pediatric HLH patients (median age 3.5 years; 53% male) treated with etoposide-based protocols (HLH-94/2004) at Hunan Children's Hospital (2020-2024) was analyzed. Patients were stratified into refractory (n=20) and responsive (n=59) groups based on 8-week treatment outcomes. Chemosensitive patients were defined as those achieving complete response (CR) or entering maintenance by week 8; chemorefractory patients were defined as those who died during induction, required salvage therapy due to progression, or failed to achieve CR within 8 weeks. CR required normalization of all quantifiable disease markers (sCD25, ferritin, triglycerides, ALT, hemoglobin, neutrophils, platelets). Pre-chemotherapy and early post-chemotherapy (Day 3) variables were compared using t-tests, Mann-Whitney U-tests, and χ2 analyses. Multivariable logistic regression and ROC analyses identified predictors of resistance, with internal validation via 1000-bootstrapping. Results:Pre-chemotherapy IL-10 >131.2 μmol/L (OR=5.1; 95% CI 1.9-13.7; P=0.001) and pre-chemotherapy platelet count <55.5×109/L (OR=4.2; 95% CI 1.6-11.3; P=0.004) independently predicted refractoriness. A combined model incorporating these parameters achieved an AUC of 0.822 (sensitivity 81.3%, specificity 75.0%). Post-chemotherapy Day 3 platelet count (OR=1.02 per 109/L increase; P=0.01) and lymphocyte count (OR=2.5 per 109/L increase; P=0.03) further refined prediction (AUC 0.880). Calibration curves and decision curve analysis confirmed clinical utility. Conclusion:Pre-chemotherapy IL-10 and platelet count reliably identify pediatric HLH patients at high risk of etoposide-based protocols resistance. Integration of Day 3 post-chemotherapy parameters enables ultra-early and more precise risk stratification, facilitating prompt transition to salvage therapies.

Objective:To explore the effect of in-hospital follow-up on post-intensive care syndrome in families of PICU (Pediatric Intensive Care Unit) patients. Methods:A total of 88 families of children admitted to the PICU of Hunan Children's Hospital from January 1, 2023, to September 30, 2023, were selected as research subjects. The control group received routine nursing intervention, while the experimental group, based on the control group's care, established a PICU communication team. The team was divided into three subgroups: the department director and head nurse, Chief resident and Responsible Nurse Team Leader, Doctor in charge of the patient's bed and Person in charge of health education. On the day of Transfer to another department and 3 days after Transfer to another department, one group of personnel communicated face-to-face with the family members regarding the patient's condition and precautions. After the communication, the intervention effects on the parents of the children in both groups were assessed within 30 min using the Post-Intensive Care Syndrome Questionnaire (C-PICSQ), the Depression-Anxiety-Stress Scale (DASS-21), and the Critical Care Family Satisfaction Scale (CCFSS). Measurements and main results:Before the intervention, there were no statistically significant differences in the C-PICSQ scores, DASS-21 scores, and CCFSS scores between the family members of children in the two groups (p > 0.05). Three days after Transfer to another department, the C-PICSQ score of 16.25 ± 3.93 for the family members in the experimental group was lower than the C-PICSQ score of 33.25 ± 5.97 in the control group. The DASS-21 score of 17.91 ± 2.18 for the experimental group was lower than the DASS-21 score of 34.77 ± 5.30 for the control group, and the CCFSS score of 80.91 ± 9.64 for the experimental group was higher than the CCFSS score of 37.89 ± 14.49 for the control group, with all differences being statistically significant (p < 0.05). Conclusion:In-hospital follow-up can effectively alleviate post-intensive care unit (PICU) syndrome in family members, reduce negative emotions such as depression, anxiety, and stress among parents, improve family satisfaction.

Objective:To compare the efficacy of a Ruxolitinib-based regimen versus the conventional HLH-94 protocol in children with newly diagnosed hemophagocytic lymphohistiocytosis (HLH). Methods:This single-center, retrospective historical control study enrolled 67 pediatric HLH patients who met the HLH-2004 diagnostic criteria. Patients treated with the HLH-94 regimen (dexamethasone plus etoposide) from 2022 to 2023 constituted the control group (Group C, n=40), while those treated with a response-guided, ruxolitinib-based regimen from 2024 comprised the treatment group (Group T, n=27). Primary endpoint was 12-month overall survival (OS). Secondary endpoints included early response, safety, and cumulative exposure to glucocorticoids and etoposide during the first 8 weeks of therapy. Results:Group T achieved a significantly higher complete response (CR) rate at week 2 compared to Group C (25.9% vs. 0%; P = 0.001). CR rates at weeks 4 and 8 were 55.5% vs. 35.0% (P = 0.096) and 78.0% vs. 70.0% (P = 0.481), respectively, with no significant difference in overall response rate. The 12-month OS (96.3% vs. 92.5%) and EFS (74.1% vs. 77.5%) rates did not differ significantly (P>0.05). Serial laboratory monitoring revealed that Group T exhibited faster hematological recovery and earlier neutrophil normalization (by week 2 vs. week 4) (P < 0.001). Key inflammatory markers (ferritin, IFN-γ, IL-10) declined rapidly in both groups. Crucially, the ruxolitinib-based strategy drastically reduced chemotherapy exposure: a significantly lower proportion of patients in Group T received glucocorticoids (66.7% vs. 100%, P<0.001) and etoposide (41.7% vs. 100%, P<0.001), and a significantly different distribution of glucocorticoids(Group T median: 60mg/kg (IQR: 0, 60); Group C median: 60mg/kg (IQR:60, 60); P = 0.012)and etoposide(Group T median: 0mg/m2 (IQR: 0, 885.5mg/m2); Group C median: 900mg/m2 (IQR:900, 1000); p=0.000) The incidence of secondary infections and treatment-related laboratory abnormalities (TBil, AST, ALT, or Scr) was comparable between groups. Conclusion:For pediatric HLH, a ruxolitinib-based regimen is a viable and effective therapy. It facilitates more rapid complete remission and markedly reduces chemotherapy exposure, particularly to etoposide, while preserving high short-term survival with an acceptable safety profile. This study provides a compelling rationale for future prospective randomized controlled trials to confirm the long-term benefits and safety of this approach.

BACKGROUND:Pediatric hemophagocytic lymphohistiocytosis (HLH) patients who develop disseminated intravascular coagulation (DIC) experience rapid disease progression and substantially elevated mortality. Currently, no validated early identification strategies exist for this life-threatening complication. We aimed to develop a prediction model for early DIC detection in pediatric HLH patients. METHODS:This retrospective cohort study included patients from the Hunan Children's Hospital HLH database (January 2018-August 2024). Data imbalance was addressed through combined oversampling and undersampling techniques, including Synthetic Minority Oversampling Technique. The cohort was divided into training and validation sets (7:3 ratio). A Least Absolute Shrinkage and Selection Operator (LASSO)-logistic regression model was developed and validated internally, with external validation using prospectively collected cases (January-August 2025). Model performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis. RESULTS:Of 265 included patients, 217 cases were analyzed after the Synthetic Minority Oversampling Technique application. DIC incidence was 42.1% (64/152) and 44.6% (29/65) in training and validation cohorts, respectively. LASSO regression (lambda.1se = 0.08) identified six potential predictors: C-reactive protein, globulin, cholesterol, high-density lipoprotein cholesterol, prothrombin time, and interferon-γ. Multivariable logistic regression confirmed three independent predictors: C-reactive protein prothrombin time, and interferon-γ (all P < 0.05). The model demonstrated robust discriminative performance with an area under the receiver operating characteristic curve (AUROC) of 0.865 (95% confidence interval [CI] 0.809-0.922) in the training cohort and a bootstrap-corrected C-index of 0.857 (95% CI 0.828-0.886). Internal validation yielded an AUROC of 0.797 (95% CI 0.686-0.908), whereas external validation achieved an AUROC of 0.950. Decision curve analysis showed positive net benefit across threshold probabilities of 0% - 99% in training and 0% - 88% in validation sets. CONCLUSIONS:The LASSO-logistic prediction model, incorporating three readily available biomarkers, demonstrated promising discriminative ability for predicting DIC risk in pediatric HLH. This tool may facilitate early risk stratification and timely therapeutic interventions to improve clinical outcomes.

OBJECTIVE:To summarize the clinical characteristics, diagnosis, treatment and prognosis of exogenous lipoid pneumonia (ELP) in children, and to improve the ability of pediatricians in early diagnosis and treatment of this disease among pediatricians. METHODS:A retrospective analysis was conducted on the clinical data of 2 children with ELP admitted to Hunan Children's Hospital from August 2023 to August 2024, including clinical manifestations, laboratory tests, imaging features, treatment process and prognosis, including clinical manifestations, laboratory examinations, imaging features, diagnosis and treatment process, and prognosis. Databases including CNKI, Wanfang and PubMed from inception to November 2024 were searched to review relevant literature and summarize the clinical characteristics and experience in the diagnosis and treatment of ELP in children. RESULTS:Both cases were acute ELP, respectively induced by accidental ingestion of lubricating oil and cough after oral administration of liquid paraffin, respectively. The main clinical manifestations were cough, fever and dyspnea. Laboratory examinations showed significant elevation of inflammatory indicators such as white blood cell count (WBC) count and C-reactive protein (CRP). Gastroscopy showed erosive gastritis in both cases. Chest CT showed bilateral pulmonary consolidation with multiple thick-walled cavities in one case, and extensive bilateral pulmonary exudation with consolidation in the other case. Both children received comprehensive treatment including oxygen therapy, systemic glucocorticoids, flexible bronchoscopic alveolar lavage and anti-infective therapy, and were discharged with improvement. Follow-up chest CT showed complete absorption of pulmonary lesions. A total of 493 cases of pediatric ELP at home and abroad were included in the literature review, mostly infants and preschool children, with more males than females. Mineral oil was the main type of aspirated oil. The common clinical manifestations were cough, fever and dyspnea. Chest CT was the preferred auxiliary examination, and glucocorticoid combined with flexible bronchoscopic alveolar lavage was a commonly used and effective treatment plan. Most children had a good prognosis. CONCLUSIONS:ELP in children is clinically rare, with non-specific clinical manifestations and auxiliary examinations, which is prone to missed diagnosis and misdiagnosis. Detailed inquiry about the history of oil aspiration is the key to diagnosis. With early comprehensive treatment such as glucocorticoids combined with flexible bronchoscopic alveolar lavage can lead to a good prognosis in most children. At present, there is no unified guideline for the diagnosis and treatment of ELP, and more large-sample prospective studies are needed to provide evidence-based basis.

OBJECTIVES:Complex chronic conditions (CCCs) are increasingly prevalent in the PICU. Identifying high-risk patterns of CCC and comorbidities is essential for patient risk stratification and targeted management. In this study, we aimed to describe the distribution and patterns of CCCs among children admitted to our tertiary PICU in China and to identify the types and combinations of conditions associated with a higher risk of adverse outcomes. DESIGN:Retrospective cohort study, January 2020 to February 2025. SETTING:Single center, at a tertiary referral PICU in Central-Southern China. PATIENTS:Children older than 28 days, up to 18 years old. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:CCCs were defined according to the Pediatric Complex Chronic Conditions Classification System Version 2. Of 9589 PICU admissions, 49% had one or more CCCs. Admissions with CCCs accounted for 69.8% of the adverse outcomes, 70.8% of in-hospital deaths, 58% of multiple organ dysfunction cases, and 57.6% of total patient days. Admissions with multiple CCC diagnoses were associated with higher odds of adverse outcomes compared with admissions with a single CCC diagnosis ( p < 0.0001). Transplantation and metabolic CCCs were associated with greater odds of adverse outcomes (odds ratios [OR], 6.06 and 5.27, respectively; p < 0.05). The most common co-occurring CCC categories were malignancy and hematologic/immunologic disorders. Among the most frequent combinations, the co-occurrence of metabolic and malignancy CCC was associated with greater odds of adverse outcomes (OR, 8.54 [95% CI, 4.48-16.29]). Admission with CCC was associated with pneumonia and sepsis ( p < 0.05). CONCLUSIONS:In our 2020-2025 experience, admission of patients with CCCs accounted for most of the adverse PICU outcomes. The odds of adverse outcomes varied across CCC types and combinations. Hence, incorporating CCCs into a stratified management approach across our healthcare system may support more effective planning and delivery of care.

Background Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome; current clinical and laboratory markers for early treatment response and relapse detection are imperfect.We evaluated clinical outcomes associated with an individualized ruxolitinib (RUX)-based induction approach in newly diagnosed pediatric HLH and examined serial C-X-C motif chemokine ligand 9(CXCL9) and Interferon-gamma(IFN-γ) measurements as candidate dynamic monitoring biomarkers. Methods This study retrospectively enrolled 11 pediatric HLH patients. All patients received RUX-based individualized treatment. Clinical manifestations, conventional laboratory parameters and a cytokine profile were sequentially monitored before treatment and at weeks 1,2,4, and 8 post-treatment. Treatment efficacy was assessed at weeks 1,2, and 4,and categorized as complete response (CR) or partial response (PR). Results By week 2 all patients had at least a PR (2 CR); by week 4 seven patients were in CR and all patients were in CR at week 8. Median IFN-γ,CXCL9, IL-10 and IL-18 levels fell substantially within the first week; median CXCL9 decreased 76% by day 3, and IFN-γ fell rapidly (median decline > 95% by day 3).In four illustrative episodes, rises in CXCL9 and IFN-γ preceded increases in conventional markers (e.g., ferritin). In these cases clinicians adjusted therapy in real time. These observations are hypothesis-generating and suggest potential utility for early detection of reactivation. Conclusion The RUX-based individualized induction regimen demonstrated favorable efficacy in pediatric HLH. Our results demonstrate the clinical value of CXCL9 and IFN-γ as early and sensitive dynamic monitoring biomarkers during RUX-based therapy for HLH.

BACKGROUND:Haploinsufficiency of A20 (HA20) is an immune dysregulation disorder caused by loss-of-function TNFAIP3 mutations. This international multicenter study aimed to delineate its clinical spectrum, genetic basis, and natural history. METHODS:A cross-sectional retrospective analysis was conducted in HA20 patients with pathogenic or likely pathogenic TNFAIP3 variants. Clinical, laboratory, and treatment data were assessed. Clustering analysis was applied to evaluate clinical features and disease phenotypes. Patients were stratified by age (<16 years vs ≥16 years), country of origin (China vs United States), and sex. RESULTS:A total of 185 patients from 41 clinics across 7 countries were included (median age at onset, 3.3 years). Common clinical features were mucocutaneous involvement (80.5%), recurrent fever (63.3%), gastrointestinal symptoms (58.6%), cytopenia (56.6%), arthritis/arthralgia (46.7%), and recurrent infections (35.5%). Compared with adults and patients from the US cohort, intestinal ulcers were significantly more frequent in children and patients from the Chinese cohort (P = .002 and P < .0001, respectively), whereas uveitis was less common in these groups (P = .001 and P < .0001, respectively). Hierarchical clustering of clinical disease phenotypes based on Pearson distance identified two major clusters, an autoinflammation-predominant phenotype and an autoimmune-predominant phenotype. The autoinflammation-predominant phenotype was more common in children and patients from the Chinese cohort (P = .033 and .003, respectively). A total of 89 pathogenic TNFAIP3 mutations were identified, including 46 novel variants. Large deletions were associated with neurologic disease and developmental delay (P = .0054 and .0245, respectively); however, there were no clear associations between disruptions of specific functional A20 domains and age at onset or phenotype. Therapeutically, TNF and IL-1 inhibitors were effective in most patients, with thalidomide and JAK inhibitors provided in refractory cases; 51.5% had obtained minimal disease activity at most recent follow-up. CONCLUSIONS:HA20 is a common dominantly inherited immune dysregulation disorder with phenotypic heterogeneity and potential age-dependent evolution. This large international cohort highlights diagnostic and therapeutic strategies to advance evaluation and management of HA20.

ObjectiveThis study aimed to assess the effects of comorbid paroxysmal sympathetic hyperactivity (PSH) on disease severity, resource utilization, and the prognosis, thereby providing a basis for the identification and management of severe encephalitis with PSH in children.MethodsA retrospective analysis was conducted on the general clinical data, PSH-related manifestations, and resource utilization of children with severe encephalitis complicated by PSH who were admitted to the Pediatric Intensive Care Unit (PICU) of Hunan Children’s Hospital from January 2020 to December 2025.ResultsA total of 28 children with severe encephalitis complicated by PSH were included. The distribution of blood pressure rhythm phenotypes was as follows: a nondipper pattern in 16 patients (57.1%) and a reverse-dipper pattern in 12 patients (42.9%), with no dipper or extreme-dipper patterns observed. A poor prognosis was observed in 16 patients (57.1%), including 5 fatalities. Furthermore, the PSH group had a significantly longer PICU length of stay, an increased duration of ventilator-assisted ventilation, a higher rate of mechanical ventilation use, and greater total hospitalization costs (all P < 0.001). Within the PSH-complicated group, the subgroup with a poor prognosis demonstrated a significantly higher coefficient of variation for diastolic blood pressure (P = 0.030) and a significantly lower GCS score at admission (P = 0.011).ConclusionThe majority of children with severe encephalitis complicated by PSH exhibited a nondipper or reverse-dipper blood pressure rhythm phenotype. Diastolic blood pressure variability and the GCS score at admission were associated with the prognosis. Compared with those in the control group, the children in the PSH-complicated group were older, experienced prolonged PICU stays, required more mechanical ventilation, and incurred significantly higher hospitalization costs.

ObjectiveThis study aimed to investigate the causes and clinical characteristics of 980 cases of accidental pediatric injuries admitted to the pediatric intensive care unit (PICU) to provide clinical evidence to support the prevention and reduction of severe accidental pediatric injuries.MethodsA total of 980 patients with accidental pediatric injuries admitted to the pediatric intensive care unit (PICU) of Hunan Children's Hospital from 2017 to 2023 were included in this study.ResultsBetween 2017 and 2023, 980 patients with accidental pediatric injuries were admitted to the PICU, comprising 588 boys and 392 girls (boy-to-girl ratio: 1.5:1). During the study period, a total of 16,151 children were admitted to the PICU, of whom 980 were admitted due to accidental injuries and 15,171 due to non-accidental injuries. There were no statistically significant differences in sex distribution between the accidental and non-accidental injury groups. Accidental pediatric injuries were most common among infants, toddlers, and preschool children, with the number of PICU admissions decreasing with increasing age. Across all years, infants and preschool children were the most affected. Traffic accidents and falls showed an increasing trend over time, whereas poisoning and drowning showed a decreasing trend. Differences in the composition of causes by year were statistically significant. The overall mortality rate among children with accidental injuries was 4.39%. The mortality rates by cause were as follows: traffic accidents (4.2%), falls (3.2%), foreign objects (7.1%), carbon monoxide poisoning (0.0%), food poisoning (9.7%), drug poisoning (1.0%), other types of poisoning (4.2%), burns and corrosive injuries (0.0%), drowning (13.0%), suffocation syndrome (23.1%), and other causes (4.3%). Prognostic differences between causes were statistically significant.ConclusionAccidental pediatric injuries predominantly occur in boys, with infants and preschool children being the most affected. These injuries are more common in summer, with drug poisoning, traffic accidents, and falls being the main causes. Among the common causes, traffic accidents and falls showed an increasing trend, whereas poisoning and drowning showed a decreasing trend. Suffocation syndrome, drowning, and food poisoning were associated with high mortality rates.

Objective:Optimal anticoagulation for pediatric acute liver failure (ALF) patients requiring continuous renal replacement therapy (CRRT) remains challenging due to concurrent bleeding risk and hypercoagulability. This study aimed to evaluate the efficacy and safety of various anticoagulation strategies in pediatric ALF. Methods:We retrospectively analyzed 51 children with ALF from January 2017 to December 2023. Patients were grouped based on anticoagulant: systemic heparin anticoagulation group (SHA group, n = 19), regional citrate anticoagulation group (RCA group, n = 15), and nafamostat mesylate group (NM group, n = 17). Primary outcomes were filter lifespan and the incidence of new clinical bleeding episodes. Results:Filter lifespan was shortest in the SHA group but similar between the RCA and NM groups [SHA: 37.0 [34.0, 42.0] h; RCA: 43.0 [39.0, 49.0] h; NM: 43.0 [40.5, 48.0] h; P = 0.003]. The SHA group experienced a significantly higher rate of new bleeding episodes (36.8%) compared with the RCA (6.7%) and NM (5.9%) groups (P = 0.036). Metabolic alkalosis and hypocalcemia were more frequent in the RCA group (46.7% vs. 10.5% vs. 11.8%; P < 0.001). Multivariate Cox regression showed that, relative to SHA, both RCA and NM significantly reduced filter clotting risk (HR = 0.108, 95% CI 0.047-0.248, P < 0.001). Additionally, higher pre-CRRT platelet count (HR = 1.014, 95% CI 1.007-1.021, P < 0.001), and higher initial transmembrane pressure (HR = 1.168, 95% CI 1.104 -1.236, P < 0.001) were associated with increased clotting risk. Conclusion:In ALF children undergoing CRRT, both RCA and NM demonstrate superior filter longevity and bleeding safety compared to heparin. NM may be preferred due to fewer metabolic disturbances than RCA.

There is currently no established optimal anticoagulation protocol for plasma exchange (PE) in pediatric patients at a high risk of bleeding. Therefore, we aimed to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) and nafamostat mesylate (NM) for PE anticoagulation in this patient group. This retrospective study analyzed data from 66 children with high bleeding risk who underwent PE in the Pediatric Intensive Care Unit of Hunan Children’s Hospital between June 2018 and January 2023. Patients were divided into two groups: RCA-PE (n = 45) and NM-PE (n = 21), and filter performance and adverse reaction rates were compared. Statistical analysis utilized SPSS 25.0, comprising two-sample t-tests, chi-square or Fisher’s exact tests, and Mann–Whitney U tests, as appropriate. Data visualization was performed using ggplot2 in R-studio. P < 0.05 was considered statistically significant. No statistically significant differences were found between the two groups in initial transmembrane pressure (TMP) [17.0 (14.0, 21.5) mmHg vs. 16.0 (14.0, 19.5) mmHg, P = 0.614], maximum TMP [46.0 (42.0, 49.5) mmHg vs. 43.0 (41.5, 49.5) mmHg, P = 0.689], and final TMP [40.0 (35.5, 45.0) mmHg vs. 38.0 (35.0, 42.0) mmHg, P = 0.298]. Filter grade distribution and bleeding events also showed no statistically significant difference between the groups. However, the NM-PE group had significantly lower overall adverse reaction and metabolic alkalosis rates (both P < 0.05) compared to the RCA-PE group. NM demonstrates similar efficacy but superior safety compared with RCA, making it a more suitable anticoagulation strategy for children with high bleeding risk. Study limitations include single-center design, selection bias, and uncertain NM dosage.

Sepsis is a common and life-threatening syndrome resulting from systemic and dysregulated immune response to severe infection, which contributes to morbidity and mortality in critically ill patients. This work aimed to evaluate the regulatory function of Breg cells in sepsis-associated pancreatic injury. We established mice model of sepsis-associated pancreatic injury by cecal ligation and puncture (CLP). Pancreatic injury was assessed by measuring the levels of amylase activity and histologic pancreatic injury scores. The proportions of Breg cells and T cell subsets were analyzed by flow cytometry, their secreted cytokines were detected by ELISA. The expressions of T-bet, RORγt and Foxp3 in spleen were determined by RT-PCR. The apoptosis of pancreatic cells was examined by LDH assay and Tunel, and the cell viability was detected by MTT assay. Compared to the sham group, a significantly lower percentage of Breg cells was observed in model mice. Anti-CD22 treatment exacerbated pancreatic injury, and significantly increased the percentages of Th1, Th17 cells along with the levels of IFN-γ, IL-17 in CLP-induced sepsis model, but did not affect the differentiation of Treg cells and expression of IL-10. Anti-CD22 administration promoted the expressions of T-bet and RORγt, but did not affect the Foxp3 expression. Adoptive transfer Breg cells remarkably alleviated pancreatic injury, and significantly decreased the percentages of Th1, Th17 cells along with the levels of IFN-γ, IL-17 and further promoted the percentage of Treg cells and expression of IL-10 in CLP-induced sepsis model. Moreover, adoptive transfer Breg cells inhibited the expressions of T-bet and RORγt, and promoted Foxp3 expression in model mice. Lipopolysaccharide (LPS) promoted the apoptosis in pancreatic acinar cells, which was inhibited after culturing with Breg cells in vitro. LPS remarkably upregulated the differentiation of Th1 and Th17 cells, and downregulated the differentiation of Treg cells, which could be significantly reversed by Breg cells in vitro. In conclusion, Breg cells may exhibit the protective effects by modulating T cell responses along with the cytokines in sepsis-associated pancreatic injury.

Purpose. A previously study proposed a three-step screening procedure for pediatric hemophagocytic lymphohistiocytosis (HLH). This procedure includes an HLH screening model referred to as HLH-screen. This study aims to validate the three-step screening procedure and the HLH-Screen in an independent cohort of children, as well as to optimize the screening process for HLH. Patients and methods. A multicenter retrospective study was conducted on children with fever or splenomegaly hospitalized in three hospitals in Hunan Province. The screening performance of the three-step screening procedure and the simplified procedure using HLH-Screen alone were evaluated. Clinical characteristics of patients misclassified as false negatives or false positives by HLH-Screen were analyzed. Results. Medical records of 5294 children with fever or splenomegaly were collected. The overall sensitivity and specificity of the three-step screening procedure were 91.0–93.7

To characterize Pneumocystis jirovecii pneumonia (PJP) in pediatric malignancy patients receiving chemotherapy or glucocorticoids, and provide guidance for timely diagnosis and effective treatment. A retrospective analysis of clinical features, laboratory findings, radiological characteristics, treatment approaches, and outcomes in pediatric malignancy patients who developed PJP. Ten patients (1:1 male-to-female ratio; median age 6.50 years, range 2.83–14.58 years) were followed for a median of 14 months (range 6–53 months). Eight developed PJP during chemotherapy and two post-completion. Nine received glucocorticoids in their chemotherapy regimen. PJP prophylaxis was either absent (n = 4) or discontinued > 1 month prior (n = 5). Clinical presentations included fever, dyspnea, and wheezing, often without significant cough. Laboratory findings showed elevated (1,3)-β-D-glucan(BDG)in 7 cases. Chest CT typically revealed bilateral diffuse patchy infiltrates, ground-glass opacities, and nodular shadows. All cases had a positive metagenomic next-generation sequencing (mNGS) or targeted next-generation sequencing (tNGS) result for P. jirovecii from sputum or bronchoalveolar lavage fluid (BALF) samples.Treatment included Trimethoprim-sulfamethoxazole(TMP/SMZ) with/without caspofungin and adjunctive corticosteroids. Eight patients required PICU admission (median stay 7.5 days, range 0–45 days) for respiratory support. Nine patients survived PJP, with one PJP-related death and one death from underlying disease. High clinical suspicion for PJP is warranted in pediatric malignancy patients presenting with fever, dyspnea, elevated BDG, and characteristic imaging findings, particularly in those with inadequate prophylaxis. Early pathogen detection and treatment initiation are crucial. While TMP/SMZ remains first-line therapy, combination with caspofungin may improve outcomes. Short-term adjunctive corticosteroids may benefit moderate to severe cases.

ObjectiveTo summarize the management experience of inter-hospital transport of critically ill children with extracorporeal membrane oxygenation (ECMO) in our hospital and provide evidence for the mobile ECMO for inter-hospital transport of pediatric patients.MethodsCritically ill patients treated with ECMO transported to our hospital from January 2020 to July 2025 were included in this study and analyzed general information, disease types, cannulation methods, ECMO transport distances, patient conditions before and after ECMO deployment, complications during the transport, and outcome. The lesson was drawn up regarding individual protection, transport procedures, transport equipment, teamwork, monitoring during transport, and quality control, providing an evidence-based foundation for the mobile ECMO for inter-hospital transport process of critically ill children.ResultsA total of 22 critically ill pediatric patients were successfully transported to our hospital supported with ECMO by ambulance. The oldest child was 13-years-old, and the median age of the cohort was 76.00 (19.00, 132.00) months. The primary diseases included acute respiratory distress syndrome (ARDS), fulminant myocarditis, avian influenza, heart failure, and persistent pulmonary hypertension of the neonate. The median transport distance was 180.00 (134.00, 233.00) km, and the patients had no complications during the transport. Subsequently, 17 patients recovered and were discharged from the hospital. Five patients developed with multiple organ failure soon after the separation of ECMO. The ECMO duration was 126.50 (83.00, 155.00) h. No infection in any medical staff and nursing staff.ConclusionThe availability and safety of mobile ECMO for inter-hospital transport of critically ill children could be improved with the support of a well-equipped technical team in a time-effective manner, saving patient lives.

BackgroundHemophagocytic lymphohistiocytosis (HLH) and severe sepsis share similarities in their clinical manifestations, and both have high risks of developing multiple organ dysfunction syndrome (MODS). The aim of this study was to investigate the similarities and differences in organ dysfunction patterns among pediatric patients with HLH and severe sepsis.MethodsPediatric patients diagnosed with either HLH or severe sepsis from a tertiary children's hospital over a 5-year period were included. Eleven complications representing organ dysfunction in major systems (hepatic, cardiovascular, respiratory, renal, hematologic, neurologic, and gastrointestinal) were examined. The primary outcome was adverse outcome, defined as in-hospital death or discharge following withdrawal of advanced life-sustaining treatment. The incidence and adverse outcome rates of organ dysfunction among pediatric patients with HLH and severe sepsis were compared, along with the cumulated number of complications and the correlation networks of complications, as well as laboratory characteristics.ResultsThis study included 231 pediatric patients with HLH and 259 with severe sepsis. Adverse outcomes occurred in 15.2% of HLH patients and 18.9% of severe sepsis patients. In HLH, the most prevalent complications were hepatic injury (46.8%) and coagulopathy (43.3%), while adverse outcome rates were highest among patients who developed ARDS (81.8%) and heart failure (77.8%). In severe sepsis, the leading complications were shock (69.9%), respiratory failure (52.1%), and coagulopathy (51.0%); adverse outcome rates were highest among patients with heart failure (67.5%), hepatic failure (61.9%), and ARDS (50%). For most complications investigated, HLH showed lower incidences compared to severe sepsis, but with similar or higher adverse outcome rates. Under the same number of complications, HLH had a higher adverse outcome rates than severe sepsis. However, patients with severe sepsis tended to develop more complications (median 3 vs. 2, P < 0.0001), resulting in similar overall adverse outcome rates for these two conditions.ConclusionsThe incidence, adverse outcome rates, and clustering patterns of organ dysfunction differed between HLH and severe sepsis. Strategies to improve prognosis should vary for each condition. In HLH, preventing the development of severe organ dysfunction is crucial, whereas in severe sepsis, the emphasis should be on preventing the clustering of multiple complications.

Background:The efficacy and safety of combining extracorporeal membrane oxygenation with continuous renal replacement therapy remain controversial. This study aimed to evaluate the efficacy and safety of extracorporeal membrane oxygenation combined with continuous renal replacement therapy in the treatment of pediatric acute respiratory distress syndrome. Methods:This retrospective study, conducted at Hunan Children's Hospital between January 2019 and December 2023, included 30 pediatric patients with acute respiratory distress syndrome who underwent extracorporeal membrane oxygenation treatment. The patients were divided into two groups based on whether continuous renal replacement therapy was used during treatment: 21 in the extracorporeal membrane oxygenation with continuous renal replacement therapy group and nine in the extracorporeal membrane oxygenation-only group. The groups were compared using t-test or Wilcoxon rank-sum test. Results:This study included 19 (63.3%) male and 11 (36.7%) female patients (mean age: 63.33 ± 54.41 months). The ratios of arterial partial pressure of oxygen to fraction of inspired oxygen before and at withdrawal of extracorporeal membrane oxygenation were 58.50 (40.75-70.31) and 257.00 (113.25-358.33) mmHg, respectively (P < 0.05). In the extracorporeal membrane oxygenation with continuous renal replacement therapy group, 21 patients (70.0%) underwent continuous renal replacement therapy, including those with acute renal injury (n = 5), fluid overload (n = 13), hyperkalemia (n = 3), and removal of inflammatory mediators (n = 3), and improvement was observed. Conclusions:The combination of extracorporeal membrane oxygenation and continuous renal replacement therapy provides safe and effective respiratory support for pediatric patients with severe acute respiratory distress syndrome and enables effective fluid-balance management, removal of inflammatory factors, and maintenance of electrolyte equilibrium.

This study aimed to analyze the epidemiological characteristics of severe Mycoplasma pneumoniae in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from 2020 to 2023. This study investigated the epidemiological patterns related to different years, seasons, ages, and sexes, as well as the correlations of PM2.5, PM10, and NO2 concentrations, temperature, and humidity with severe Mycoplasma pneumoniae. The goal is to increase awareness of the prevention and control of severe Mycoplasma pneumoniae in the Changsha region, thereby improving clinical outcomes, reducing mortality rates among patients with severe cases, and providing evidence-based guidance for clinical practice. A retrospective analysis was conducted on children diagnosed with severe Mycoplasma pneumoniae in the PICU of Hunan Children's Hospital from January 2020 to December 2023. The study compared the positivity rates of Mycoplasma infections across different years, seasons, age groups, and sexes. The correlations between PM2.5 (µg/m3), PM10 (µg/m3), NO2 (µg/m3), average temperature (°C), and average relative humidity (%) and the number of cases of severe Mycoplasma pneumoniae were also analyzed. Among 2,047 children with severe pneumonia, the overall MP-IgM positivity rate was 9.5%. Annual positivity rates increased from 6.3% in 2020 to 15.7% in 2023. Rates were highest in summer (15.8%), and preschool children (3-7 years) showed the greatest positivity (30.0%). At pollutant concentrations above thresholds (PM2.5 ≥35 µg/m3, PM10 ≥ 50 µg/m3, NO2 ≥ 25 µg/m3), moderate positive correlations with severe cases were found, with risk ratios of 1.28, 1.31, and 2.04 per 10 µg/m3 increase, respectively. The positivity rate and number of cases of severe Mycoplasma pneumoniae in the PICU tended to increase from 2020 to 2023. The condition was most prevalent in summer and among preschool-aged children. When the PM2.5 concentration was ≥ 35 µg/m3 or the PM10 concentration was ≥ 50 µg/m3, moderate positive correlations were observed between the PM2.5 and PM10 concentrations and the number of severe Mycoplasma pneumoniae cases.