Background：Matching health and health-related information with International Classification of Functioning, Disability and Health, known more commonly as ICF can be helpful to describe and compare quantitative data, qualitative research results and patient report results. However, there are few literature about children and adolescents in this field. Objective：To provide support and suggestions for Clinical Practice Guidelines for Children and Adolescents with Cerebral Palsy (CANDLEP) by identifying the location, link, code of health and health-related information about children and adolescents in ICF for children and youth (ICF-CY) . Design：Scoping review. Methods：Literature was searched by using the keywords of "ICF" and "relate" in English databases of PubMed, Embase(Ovid), Cochrane and Chinese databases of SinoMed, CNKI and WanFang. Literature features were extracted from those matching health and health-related information with ICF-CY by six people with Fleiss kappa of 0.80. Main outcome measures：The matched content, the quality control of matching, presentation of matched results, the ICF-CY code distribution of matched cerebral palsy-related literature. Results：A total of 136 articles were enrolled in this scoping review. Among 110 articles focusing on specific populations, 31 were related to cerebral palsy; 107 used matching rules to promote quality control; 84 adopted the matching rules proposed by Cieza et al., among which 73 used the 2005 edition; and 93 reported the matching reliability. The matched content involved evaluation, intervention objectives, intervention methods, and outcome assessment. In 71 articles evaluation tools were matched with ICF-CY code. Frequency, breadth and density were main indicators for matched results report. Matched codes for cerebral palsy were mainly activities and participation. Conclusion：Matching health and health-related information about children and adolescents with ICF-CY is an important means to promote the clinical implementation of ICF-CY. Cerebral palsy has received the most attention within included articles focusing on population, which provides valuable evidence for the elaboration of ICF-CY elements in CANDLEP development.

Background：The severity of mycoplasma pneumoniae pneumonia (MPP) is related to the formation of mucus plugs (MUP) in the airway, but the current MUP detection mainly depends on bronchoscopy. Objective：To establish a nomogram predictive model based on clinical features and plasma cytokines for airway MUP formation in MPP children. Design：Case -control study. Methods：Children who were diagnosed as MPP and underwent bronchoscopy were classified into MUP and non -MUP groups. Clinical features, inflammatory markers and cytokines in both plasma and BALF were collected. Univariate analysis was performed to identify statistically significant clinical features, inflammatory markers, and cytokine risk factors between the two groups. Spearman correlation analysis was conducted to assess the correlation between inflammatory markers, plasma cytokines and BALF cytokines and to exclude collinearity issues. A receiver operating characteristic (ROC) curve was generated to assess the predictive performance of a multivariable logistic regressionbased predictive model using the R package of RMS. Main outcome measures：Predictive efficacy of the nomogram model for predicting the probability of airway mucus plug formation in children with MPP. Results：A total of 263 children with MPP were included in the analysis, including 134 males and 129 females, with an average age of (7.0 ± 0.2) years. There were 82 (31.2%) cases in the MUP group and 181 cases in the non -MUP group. Univariate analysis showed significant differences between the two groups in age, maximum temperature before bronchoscopy, decreased breath sounds upon auscultation at admission, chest CT showing pulmonary consolidation, imaging suggesting pleural effusion, extrapulmonary complications, proportion of severe pneumonia, neutrophil percentage, CRP, PCT, D -dimer, LDH, IgA, lymphocyte percentage, and ALT. Cytokine analysis revealed significant differences between the two groups in levels of IL -5, IL -6, IL -8, and IFN -γ in plasma, as well as in levels of IL -1β, IL -5, IL -8, IL -10, IFN -γ, and TNF -α in BALF. Spearman correlation analysis showed there was no collinearity in neutrophil percentage, CRP, PCT, LDH, D -dimer, IgA, plasma IFN -γ, plasma IL -6, plasma IL -5, and plasma IL -8; there was a certain correlation between blood inflammatory markers and BALF cytokines; plasma cytokines (IFN -γ, IL -6, IL -5, and IL -8) were positively correlated with their corresponding BALF cytokines. The nomogram predictive model for the formation of airway mucus plugs in MPP patients, based on age, pleural effusion, D -dimer, and plasma IFN -γ levels, had an AUC of 0.817 (95% CI: 0.747 -0.889) with the sensitivity of 79.0% and specificity of 69.1%. Conclusion：The nomogram predictive model based on age, pleural effusion, D -dimer, and plasma IFN -γ levels had a good predictive performance for the formation of airway mucus plugs in MPP patients.

Background Sitting height/leg length ratio (SH/LL) and Sitting height/height ratio (SH/H) are the important indicators of body proportion assessment. Their scientific assessment will supply valuable information in clinical practices, but the detailed data on their growth reference standards have not been reported. Objective To construct the SH/LL and SH/H growth charts for Chinese children and adolescents from birth to 18 years. Design A cross-sectional survey. Methods Stature and sitting height of 92 494 healthy urban children aged 0-18 years were measured in two national surveys in 2005 in China, which named The National Survey on the Physical Growth and Development of Children in the Nine Cities of China and The Chinese National Survey on Student's Constitution and Health. Leg length was calculated by height minus sitting height and the SH/LL ratio and SH/H ratio were calculated. Growth reference standards of SH/LL and SH/H were constructed using the LMS method. Main outcome measures Reference values of SH/LL and SH/H. Results The Z-scores growth charts of SH/LL and SH/H (-3SD, -2SD, -1SD, Median, +1SD, +2SD, +3SD) were constructed. The median of SH/LL declined from birth (2.00) to 13 years in boys (111) and to 11 years in girls (1.13), then increased slightly to the age of 18 (1.16 in boys and 1.18 in girls). A similar growth pattern was found in the SH/H, that is, the median of SH/H was 0.67 at birth and declined to the lowest point (0.53) with age, then increased slightly to 0.54 at 18 years old. Conclusions The growth charts of SH/LL and SH/H are used in assessing body proportions for Chinese children and adolescent individuals, and they could be used in conjunction with the growth charts of height, weight for Chinese children aged 0-18 years.

Background：Transcutaneous carbon dioxide partial pressure (TcPCO2) and transcutaneous oxygen partial pressure (TcPO2) monitoring make it possible to continuously monitor neonatal PCO2/PO2 and reduce the number of blood collections. However, clinicians are very concerned about its safety and accuracy. Objective：To reflect the consistency of TcPCO2/TcPO2 monitoring values and PaCO2/PaO2 monitoring values through a systematic review and meta-analysis. Design：Systematic review and meta-analysis. Methods：A systematic literature retrieval was performed in English databases of Ovid MEDLINE, Ovid Embase and Chinese databases of SinoMed, Wanfang and CNKI. Search strategy was developed using key words of neotate, TcPCO2 and TcPO2. After deduplication, the literature was first screened by reading titles and abstracts by two leading authors independently who then finished the full-text screening. A self-made excel form was used to extract the year of publication, gestational age at birth, gestational age at monitoring, birth weight, weight at monitoring, sample size and the number of monitored pairs, the probe temperature, monitoring site, duration and equipment, blood gas values difference by TcPCO2/TcPO2and PaCO2/PaO2 , correlation coefficient and adverse events. Meta-analysis was performed by Stata 17. Main outcome measures：Difference in blood gas results between TcPCO2/TcPO2and PaCO2/PaO2. Results：A total of 875 articles were retrieved in both Chinese and English. After deduplication, preliminary screening, and full-text screening, 40 articles were included in the analysis, including 14 in Chinese and 26 in English. The summarized differences between TcPCO2 and PaCO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were 2.37(95%CI: 2.17 to 2.67), 2.48(95%CI: 1.17 to 3.79), 4.47(95%CI: 3.03 to 5.92), and 5.96(95%CI: 5.27 to 6.64) respectively, and the Pearson coefficient ranged from 0.78 to 0.89 among the four subgroups. For the deviation from PaCO2, it was 5% in the 43℃ vs 44℃ subgroup, 118% to 14.8% in the 40℃ vs 41℃ subgroups, and 17% in the 38℃ vs 39℃ subgroups. The summarized difference between TcPO2 and PaO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were -7.28(95%CI: -12.92 to -1.63), -5.61(95%CI: -6.61 to -4.62), -28.85(95%CI: -35.12 to -22.58) and -31.42(95%CI: -35.97 to -26.88) respectively, and the Pearson coefficient was 0.35~0.91 among the four subgroups. Eight studies described mild skin redness and no adverse events of skin burns were reported. Conclusion：Without controlling the monitoring site, duration, time point, equipment, and neonatal diseases and conditions, TcPCO2 values are strongly correlated with the PaCO2 values, which is about 7mmHg higher than PaCO2. Under standardized operations, TcPCO2 can replace PaCO2. Within 38℃ to 44℃, the commonly used clinical probe temperature, the higher the probe temperature, the more accurately TcPCO2 can reflect PaCO2, the less skin redness adverse events will occur. Since TcPO2 is weakly related to PaO2, it is not recommended to use TcPO2 to reflect PaO2.

Background：Constructing language development milestones and collecting milestone data are not only key steps in language development monitoring, but also the preliminary basis for the development of language screening and diagnostic tools. Objective：To construct language development milestones for Chinese-speaking children aged 0 to 5.5 years, providing a reference basis for language development screening and diagnostic tool development. Design：Cross-sectional survey. Methods：Based on existing developmental assessment tools and literature, a language development milestone item pool was established through expert consultation and cognitive interviews. From October 2022 to November 2022, 1,976 children aged 0 to 6 years were sampled from five provinces including Zhejiang, Sichuan, Liaoning, Jiangxi, and Hainan. Using stratification by urban and rural areas, gender, and age groups, developmental milestone data were collected through parent reports in both primary care settings (age <36 months) and kindergartens (age ≥36 months). The characteristics of language development milestones for children in different age groups were analysed descriptively using an item response theory model. Data comparisons were conducted between the data collected in the current study for Chinese-speaking children and data obtained from other published research on English-speaking children. Main outcome measures：Response rate, different item function, model fit, and estimated developmental age of each item when passing probabilities is 25%, 50%, and 75%. Results：A total of 63 language development milestone items were included in the item pool. After data cleaning, 1 659 children were included in the data analysis, including 827 boys and 832 girls, with an average age of (2.5±1.9) years. The response rate for all 63 language milestones was higher than 99%. Three items showed different item function based on maternal education, and 14 items showed poor model fit. Conclusions：The language development milestones for Chinese-speaking children aged 0 to 5.5 years established using the item response theory model provide a clear description of the language development trajectory of native Chinese-speaking children. This work offers valuable empirical data for the future development of language development evaluation tools for Chinese-speaking children, clinical monitoring of language development, and research into related neural mechanisms.

Background：Thoracic fluid content (TFC) is a volume indicator derived from electrical cardiometry (EC) based on the standardization of thoracic basic impedance. It can reflect the total fluid content in intravascular areas, extravascular areas, and pleural tissue gaps. There are very few clinical studies using TFC to evaluate volume status during continuous renal replacement therapy (CRRT) in critically ill children at home and abroad. Objective：To identify whether TFC can be used as an assessment indicator of volume status during CRRT and guide volume management during CRRT. Design：Prognosis study. Methods：Critically ill children with CRRT ≥ 24 hours in PICU were enrolled into the study. The internal jugular vein, femoral vein or subclavian vein double lumen tube were the vascular pathway for CRRT. We collected the baseline, laboratory, EC measurements, and clinical fluid status indicators. The occurrence of hemodynamic disturbance was taken as the outcome, including hypotension or arrhythmia, requiring volume expansion treatment, and the maximum inotropic score (ISmax) greater than IS. We evaluated the correlation between stroke volume variation (SVV), TFC, and B-type natriuretic peptide (BNP) with ultrafiltration volume at different time points of CRRT(start, 24 hours and end), and investigated whether volume indicators can predict the outcome. Main outcome measures：Predictive factors for hemodynamic disturbance. Results：A total of 43 children with 59 CRRTs were included into the analysis. Compared with the beginning of CRRT, there was a statistically significant difference in TFC, Hct, and Hb at 24 hours of CRRT ( P<0.05). Compared with the start of CRRT, there was a statistically significant difference in SVV, TFC, ICON, BNP, Hct, Scr, BUN, Hb, and ALB ( P<0.05) at the end of CRRT. FO is significantly positively correlated with TFC and SVV at the start of CRRT. There is a significant positive correlation between ultrafiltration volume/body weight and TFC (start), and a significant negative correlation with ΔTFC(24 h), ΔTFC(end), TFCd0% (24 h) and TFCd0%(end). The ultrafiltration rate was positively correlated with SVV, TFC, BNP at the start of CRRT,and was negatively correlated with ΔTFC(24 h),ΔTFC(end), and TFCd0% (24 h). The balance/weight was positively correlated with ΔTFC(24 h),ΔTFC(end), TFCd0% (24 h), TFCd0%(end) and ΔBNP(end), and was negatively correlated with BNP (start). A total of 33 hemodynamic disturbance events occurred during CRRT. There is a statistical difference in BNP (start), ΔBNP(end), ultrafiltration rate, TFCd0% (24 h) between groups with and without adverse hemodynamic events. Multivariate analysis showed that TFCd0%（24 h）≤-3.64 kΩ ^-1（OR=8.84，95%CI：1.16~67.44， P=0.036）and ΔBNP(end)≤-133.8 pg·mL ^-1（OR=5.67，95%CI：1.24~26.03， P=0.007）were more likely to cause hemodynamic disorders. Conclusion：TFC can be used to monitor the fluid status of critically ill children during CRRT treatment. TFCd0%≤-3.64 kΩ ^-1 after 24 hours of CRRT can be a predictive factor for hemodynamic disturbance.

Background：The Food and Drug Administration(FDA) Adverse Event Reporting System (FAERS) is an open database. After the outbreak of COVID-19, it is important to further evaluate the potential safety signals associated with the use of ibuprofen and acetaminophen. This is crucial for improving safety and protecting public health. Objective：To provide references for the clinical discovery, prevention, and management of adverse events (AEs) in children by performing signal detection of AEs related to ibuprofen and acetaminophen in children using the FAERS database. Design：Data mining analysis. Methods：The OpenVigil 2.1 software was used to extract AE reports with ibuprofen or acetaminophen as primary or secondary suspect drugs in patients aged ≤17 years, without restriction on gender or country. The reporting odds ratio (ROR) and Bayesian confidence propagation neural network (BCPNN) were used for signal detection. The AE reports were analyzed based on gender, country, year, and age groups (≤3 years, -11 years, and -17 years). The detected potential risk signals were classified according to SystemOrgan Classes (SOC) based on the Preferred Terms in the Medical Dictionary for Regulatory Activities. The changes in strong and mediumstrong potential risk signals were analyzed before and after the COVID-19 pandemic. Main outcome measures：Strong and mediumstrong potential risk signals before and after COVID-19. Results：A total of 7,552 (53.5 percent) reports were related to ibuprofen and 6,562 reports were related to acetaminophen in the FAERS database from the first quarter of 2004 to the third quarter of 2022. The number of AE reports for acetaminophen was higher in females, while the number of AE reports for ibuprofen was higher in males, with statistically significant differences. The number of AE reports for ibuprofen was higher than that for acetaminophen in the ≤3 years and -11 years age groups, while the number of AE reports for acetaminophen was higher than that for ibuprofen in the -17 years age group, with statistically significant differences. The United States accounted for 42.8% of ibuprofen-related AE reports and 41.7% of acetaminophen-related AE reports. Among the top 10 countries reporting AE, except for the United States and China, all were European countries. There were 358 potential risk signals for ibuprofen, including 2 strong signals, 58 medium-strong signals, and 298 weak signals. For acetaminophen, there were 283 potential risk signals, including 6 strong signals, 48 medium-strong signals, and 229 weak signals. Ibuprofen had more signals detected in the gastrointestinal system, skin and subcutaneous tissue, infectious and parasitic diseases, renal and urinary system, respiratory system, thorax, and mediastinum, and eye disorders by SOC compared to acetaminophen. Acetaminophen had more signals detected in the hepatobiliary system, psychiatric disorders, investigations, general disorders and administration site conditions, and nervous system disorders by SOC compared to ibuprofen. Three strong signals for ibuprofen were detected before the COVID-19 pandemic, including angioedema, extra dose administered, and accidental exposure to product. No strong signals were detected after the pandemic. However, attention should be paid to the change from weak to medium-strong signals in renal interstitial nephritis, acute kidney injury, nephrotic syndrome, toxic nephropathy, and membranous glomerulonephritis in the renal and urinary system disorders by SOC. Four strong signals for acetaminophen were detected before COVID-19, including liver necrosis, liver injury, acute liver failure, and liver failure. No strong signals were detected after the pandemic. However, attention should be paid to the medium-strong signals of suicide attempt, drug dependence, and drug abuse in the psychiatric disorders by SOC. Conclusion：Physicians, pharmacists, and patients are encouraged to actively report potential safety signals associated with the use of ibuprofen and acetaminophen, as there is an increased risk of renal adverse events with ibuprofen and an increased risk of intentional poisoning and suicide events with acetaminophen.

Background：There are few reports about the outcomes of neonatal hyperthyrotropin (HT) in China. Objective：To investigate the outcome and influencing factors of HT in neonatal intensive care units (NICU). Design：Case-control study. Methods：Consecutive cases of HT infants were enrolled in the NICU of Xinjiang Uygur Autonomous Region People's Hospital from January 1, 2011, to December 31, 2021. The inclusion criteria were as follows: the concentration of thyroid-stimulating hormone (TSH) was 6-20 mU·L ^-1at the first test between 3 and 21 days after birth and the free thyroxine (FT4) was within the normal range. During the follow-up after discharge, TSH<6 mU·L ^-1 was considered as the normal level and TSH≥10 mU·L ^-1 was the indicator for levothyroxine (LT4) as needed. A dosage less than 3 μg·kg ^-1·d ^-1 could be an indicator for considering discontinuation of LT4 treatment. The administration could be stopped if TSH was tested normal in the re-examination 1 month later. Main outcome measures：The influencing factors of abnormal TSH levels at 3 months of age (90±15 days) and LT4 treatment discontinuation at the age of 3 years. Results：A total of 836 neonates were included in this study. At 3 months of age, 390 cases were lost to followup or unable to be assessed. Normal thyroid function was found in 304 cases ［TSH: 3.6 (2.7,4.5) mU·L-1, FT4:18.3 (15.6,20.4) pmol·L ^-1］, and thyroid dysfunction was found in 142 cases［TSH: 17.7 (9.6,22.1) mU·L ^-1, FT4 is 15.7 (13.3,19.4) pmol·L-1］. The influencing factors of thyroid dysfunction were female (OR=1.68, 95%CI: 1.07-2.64), cesarean section (OR=0.52, 95%CI: 0.32-0.83), maternal thyroid disease during pregnancy (OR=0.31, 95%CI: 0.15-0.67), comorbid congenital malformation or syndrome (OR=7.92, 95%CI: 2.22-28.25), infectious disease at admission (OR=0.56, 95%CI: 0.33-0.96). At the age of 3 years, among 142 children with thyroid dysfunction, 18 (12.6%) were lost to follow-up, 48 (33.8%) turned into normal TSH levels without taking LT4, and 45 out of 76 cases taking LT4 stopped the administration and 31 still continued the treatment. The risk of not being able to discontinue LT4 treatment before the age of 3 years was 4.89 times higher in infants with congenital malformations or syndromes compared to those without the comorbidity (OR=4.89, 95% CI: 1.06-22.57). Conclusion：Special attention should be paid to the follow-up of thyroid function in HT infants in the NICU, especially for female infants and those with comorbid congenital malformations or syndromes.

Background Nusinersen has been officially used for the treatment of 5q spinal muscular atrophy (SMA) in China recently. By now there are few domestic case reports on the treatment of SMA with nusinersen. Objective To investigate the efficacy, safety and levels of neurofilament light chain protein (NFL) in cerebrospinal fluid with treatment of nusinersen in children with 5q spinal muscular atrophy. Design Case series report. Methods Patients with 5q SMA who were initially treated with nusinersen as monotherapy for not less than 14 months in the Department of Neurology, Children's Hospital of Shandong University from January 2020 to June 30, 2023 were enrolled. Multiple ligation dependent probe amplification (MLPA) or fluorescence quantitative PCR (qPCR) methods were used to detect exon 7 of SMN1 gene. Clinical classification is based on the age of symptom onset and the maximum motor function achieved. Cerebrospinal fluid samples for the detection of neurofilament light chain protein (NFL) level were collected by routine lumbar punctures or ultrasound-guided lumbar punctures, and nusinersen was administrated via intrathecal injection. The Children′s Hospital of Philadelphia infant test of neuromuscular disorders (CHOP INTEND), the Revised Upper Limb Module Test (RULM), the Hammersmith functional motor scale expanded (HFMSE), and the 6-minute walk test (6MWT) were performed by a professionally trained and qualified rehabilitation physician before and after treatment. General information such as gender, date of birth, date of symptom onset, and adverse events during treatment were collected. Main outcome measures The scores of motor function scale after 14 months treatment with nusinersen. Results In total, 68 SMA pediatric patients with treatment duration not less than 14 months were included in this study, including 32 girls (47.0%). There were 9 cases of type I (13.2%), 40 cases of typeⅡ (58.8%), and 19 cases of type Ⅲ (27.9%). The median age of disease onset is 10 (7,13.8) months, and the median age of diagnosis is 17.5 (12,37) months. Homozygous deletion of exon 7 in SMN1 gene occurred in 64 cases (94.1%), and intragenic mutation of SMN1 gene occurred in 4 cases. The improvement of motor function in 60 children (88.2%) had clinical significance, including 7 cases of type I, 37 cases of typeⅡ, and 16 cases of type Ⅲ. In total, 90.0% (18/20) cases showed a score improvement by ≥4 points on the CHOP INTEND scale, while 97.8% (44/45) cases showed a score improvement by ≥3 points on the HFMSE scale. In total, 92.3% (12/13) cases showed a distance extension by ≥30 meters on the 6MWT; 66.7% (12/18) cases showed a score improvement by ≥2 points on the RULM scale. Two cases achieved new motor function milestones after treatment. The NFL level in the cerebrospinal fluid of 15 children with SMA typeⅡ declined to 69.2 (40.5, 89.3) pg·mL-1 after the loading dose therapy (184th day after first drug administration) comparing with 176.6 (104.5,199.6) pg·mL-1 before treatment, the difference is statistically significant. Adverse events during treatment included fever in 3 cases with 1 case of type Ⅲ, 2 cases of type Ⅱ, all of which were relieved spontaneously; respiratory tract infection in 2 cases with 1 case of type I and 1 case of type Ⅱ, which were relieved after treatment; constipation, myalgia, vertigo and cough occurred in 1 type Ⅱ case each, all of which were relieved spontaneously and 1 case of typeⅡ with abnormal liver function, which normalized after 7 days treatment. No serious adverse event occurred. Conclusions Nusinersen can improve the motor function of children with 5q SMA after 14 months of treatment with good safety. The NFL level in cerebrospinal fluid of children with SMA typeⅡ can be significantly decreased after the nusinersen loading dose therapy.

Background Over the past two decades, implementing perioperative feeding protocols in infants with critical congenital heart disease (CCHD) has a certain effect on fostering their physical development and enhancing their clinical outcomes. Nevertheless, the existence of diverse feeding protocols and their appropriate application to different infant populations and feeding stages remains a pending issue. Objective To evaluate the effect of standardized perioperative feeding protocols on the physical development and clinical outcomes of critically ill infants with CCHD. Design Systematic review and meta-analysis. Methods Systematic retrieval was conducted across foreign language databases, including PubMed, Embase, The Cochrane Library, and Web of Science, as well as Chinese databases, such as SinoMed, China National Knowledge Infrastructure, and Wanfang Database. CCHD infants adhering to a standardized feeding protocol during the perioperative period were included. The outcomes evaluated included the incidence of necrotizing enterocolitis (NEC), physical development indicators, hospital length of stay (LOS), ICU LOS and mechanical ventilation duration. The study type consisted of randomized controlled trial (RCT), non-randomized trial, cohort study, case series report, and systematic review/meta-analysis. The literature was searched from the inception of the database up to December 11, 2022. Three individuals conducted literature screening and data extraction based on the predefined criteria. The risk of bias assessment for non-randomized studies and randomized clinical trials was performed using ROBINS-I and ROB 2, respectively. Meta-analysis was carried out using RevMan 5.4 and R version 4.2.2. Main outcome measures The incidence of NEC. Results A total of 11 studies conducted in the US from 2000 to 2020 were included. One article employed a non-randomized control trial, 9 used case before-after study design, and 1 used self-before-after study design. The standardized feeding protocol was implemented in 3 studies during the pre-operation period, 4 during the post-operation period, and 5 during the perioperative period. The gestational age of participants ranged from 35 to 41 weeks. Among the included articles, 8 reported the incidence of NEC as the primary outcome. Separate meta-analyses were conducted by different stages of intervention implementation. In a meta-analysis of two articles that implemented standardized protocols during the peri-operation period, the result revealed that there was no statistically significant difference in the incidence of NEC between the two groups［odds ratio (OR)=0.57 (95% CI: 0.19-1.76)］. The results of the other 2 meta-analyses were as follows: one for 3 articles implementing intervention during the pre-operation period showed no statistically significant difference［OR=0.95 (95% CI: 0.48-1.88)］ , and the other for 3 articles during the post-operation also showed no statistically significant difference［OR=0.69 (95% CI: 0.35-1.34)］. Among the 4 articles that reported the weight-for-age z-score at discharge, a meta-analysis of 3 of them found no statistically significant difference between the two groups, WMD=-0.10 (95% CI: -0.37- 0.17). Ten articles reported LOS. A meta-analysis of LOS for intervention during the pre-operation period revealed that LOS was significantly shorter in the study group, WMD=-6.83 (95% CI: -12.13--1.53). However, other meta-analyses of ICU LOS (2 articles) and mechanical ventilation duration (3 articles) all revealed no statistically significant differences between the two groups. The critical appraisal of the included articles indicated that 4 of them were at moderate risk of bias, 6 were at high risk, and 1 was at critical risk. Conclusions A standardized perioperative feeding protocol implemented in surgical infants with CCHD can not reduce the incidence of NEC, improve the weight-for-age z-score at discharge, and cut down the LOS, ICU LOS, and mechanical ventilation duration.

Background：Premature infants are prone to hemodynamically significant patent ductus arteriosus (hsPDA), which can lead to changes in cerebral blood flow parameters. However, there is limited research on the recovery of cerebral blood flow after ductus arteriosus ligation. Objective：To analyze the impact of hsPDA on cerebral blood flow in premature infants and the recovery of cerebral blood flow after ductus arteriosus ligation using bedside transcranial Doppler ultrasound measurements. Design：Case series report. Methods：Cases who were diagnosed with hsPDA, born at a gestational age of less than 37 weeks, and admitted to the NICU of Zhejiang University School of Medicine Children's Hospital from July 2022 to January 2023, were selected from the HIS system as the case group. The control group consisted of infants with gestational age<37 weeks at the same period in NICU who were confirmed to have no PDA by echocardiography after 72 hours of birth. Cases with concurrent cyanotic or complex congenital heart diseases, severe intracranial hemorrhage or hydrocephalus, and cases undergoing surgical treatment for intestinal infection, necrosis, and perforation were excluded from both groups. Cerebral blood flow parameters of the middle cerebral artery (MCA) and basilar artery (BA) were measured using echocardiography. Main outcome measures：Blood flow parameters of MCA and BA after ductus arteriosus ligation. Results：There were twenty-eight cases in the case group. Arterial duct closure was achieved through medical treatment in 7 cases and surgical intervention in 21 cases. Fourteen cases （50%）were male, and the internal diameter of the PDA was measured to be 2.77±0.53 mm. The control group consisted of 30 cases, and 14 cases (46.7%) were male. No statistically significant differences were found in gender, birth weight, and age between the two groups. The gestational age at birth in the case group was lower than that in the control group, and this difference was statistically significant. For the MCA and BA, the preoperative systolic peak flow velocity (Vs) between the case group and control group had no statistically significant differences; the enddiastolic velocity (Vd) in the case group were lower compared to that in the control group; the preoperative resistance index (RI) and the ratio of Vs to Vs (S/D) were both higher in the case group than that in the control group. These differences were statistically significant. The cerebral blood flow parameters (Vs, Vd, RI and S/D) of MCA and BA in case group after surgery (within 72 hours after PDA ligation surgery in 21 cases) have no statistically significant differences compared to that in the control group. Conclusion：hsPDA causes the abnormities of blood flow parameters in the anterior and posterior circulation of cerebral artery in premature infants. After ductus arteriosus ligation, cerebral blood flow can rapidly recover.

Background：Cardiovascular complications have become the leading cause of death in children with Duchenne muscular dystrophy(DMD). Electrocardiography(ECG) is emerging as an early sensitive indicator for monitoring myocardial involvement in this population. Objective：To analyze ECG characteristics in children with DMD. Design：Retrospective cohort study. Methods：The characteristics of 486 ECG in 304 children with genetically diagnosed DMD were retrospectively analyzed, and compared with 112 ECG indices of 112 normal children in each age group. Main outcome measures：The incidence and type of ECG abnormalities in children with DMD. Results：The overall incidence of abnormal ECG in children with DMD was 38.7% (188/486). ECG abnormalities mainly include sinus tachycardia, left ventricular hyper voltage/left ventricular hypertrophy, right ventricular hypertrophy, double ventricular hypertrophy, STT changes, T wave changes, pathological Q waves,incomplete right bundle branch block(ICRBBB), complete right bundle branch block(CRBBB), ventricular block, atrial premature beats/ventricular premature beats and short PR syndrome.No long QT syndrome and other types of conduction block were identified. The incidence of abnormal ECG in children with DMD regardless of LVEF increased significantly with age (P<0.05), and children with DMD had significantly faster heart rate, significantly shortened PR interval, and significantly increased amplitude of RV1 and RV5, compared to agematched healthy children (P<0.05). Conclusions：ECG abnormalities are common manifestations in children with DMD, and their incidence gradually increases with age, and increased heart rate, shortened PR interval, and increased RV1 amplitude are early characteristic changes in ECG abnormalities in children with DMD.

Background：Retinopathy of prematurity (ROP) can cause irreversible visual impairment in severe cases, and there is a lack of appropriate risk prediction model for identifying severe ROP specifically tailored to the Chinese preterm population. Objective：To construct and validate an early risk prediction model for severe ROP in premature infants with gestational age ≤ 34 weeks based on the Chinese neonatal population. Design：Retrospective cohort study. Methods：From January 2020 to March 2022, premature infants admitted to the Neonatal Intensive Care Unit (NICU) with a gestational age of ≤ 34 weeks and who underwent a complete eye examination were included. The cohort was divided into training and validation sets using the June 2021 admission time as the cutoff point. Clinical information was collected at the time of the first postnatal eye examination, and regular screenings and followups were conducted according to the ROP screening guidelines. Severe ROP is defined as having stage 3 or higher lesions, positive for plus disease, or requiring laser and cryotherapy treatment. All other cases are categorized as mild ROP. In the training set, clinical variables with collinearity were excluded based on the Pearson correlation coefficient and the final predictive factors were determined through Lasso regression and logistic regression analysis, then the prediction model was constructed and presented as a nomogram. In the validation set, the area under the curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the discrimination and determine the optimal cutoff value of the prediction model, in which the sensitivity and specificity of the model were calculated. Based on the total population, clinical efficacy of the model was finally assessed by decision curve analysis (DCA). Main outcome measures：The predictive performance of the model for identifying premature infants who will progress to severe ROP. Results：There were 1,380 cases in the training set (76 cases with severe ROP) and 592 cases in the validation set (36 cases with severe ROP). The differences in the distribution of baseline information between these two groups were not statistically significant. The nomogram prediction model established by including five predictors of gestational age, birth weight, prenatal corticosteroids, invasive mechanical ventilation, and lateonset sepsis had an AUC of 0.87 (95% CI: 0.83 to 0.90) and 0.88 (95% CI: 0.82 to 0.94) in the training and validation sets, respectively. When the predictive threshold was set at 0.04, the model had a sensitivity of 0.833 (95% CI: 0.7120.955) and a specificity of 0.786 (95% CI: 0.7520.820) in the validation set. The clinical decision curve demonstrates that the model has good clinical utility and provides higher net benefits when the threshold probability ranges from 5% to 40%. Conclusions：The severe ROP prediction model established has a certain reference value for evaluating the risk of severe ROP in neonates with gestational age ≤ 34 weeks.

Background：Preschoolers are experiencing a key period of shaping healthy dietary behaviors, for which daily monitoring and timely intervention is urgently required. However, there is a lack of efficient tools for quantifying this level in China so far. Objective：To introduce a scale questionnaire named Nutrition Quotient for Preschoolers from the South Korea (NQ-P), and evaluate its reliability and validity. Design：Crosssectional study. MethodsThe Chinese version of NQ-P was obtained after forward and backward translation, research group review and modification. Guardians of preschoolers in two kindergartens were crosssectionally investigated and the data was collected for reliability and validity analysis. Main outcome measures;NQ-P(Chinese version) scores. Results:The Chinese version of NQ-P used the same scoring and weighting method as the original version, which included 14 items and 3 dimensions (balance, moderation, environment). A total of 440 guardians of preschoolers aged 36.5 years completed the study (97.3%). Among 440, 51.8% were boys, and among those who filled the questionnaires, 317(72.0%) were mothers, 115(26.1%) were fathers, and 282 of them were primary meal planners. Confirmatory factor analysis showed CFI were 0.768 for NQ-P total score, 0.9050.909 for 3 dimensions, RMSEA were 0.063 for NQ-P total score and 0.0310.043 for 3 dimensions. Cronbach's α were 0.7060.774 for NQ-P scores. Retest Kappa were 0.790.98 for 14 items. Conclusions:The Chinese version of NQ-P has acceptable validity and reliability, and can be used to initially evaluate the dietary quality of preschoolers by investigating their guardians.

Background：The clinical characteristics of neonatal vocal cord paralysis (VCP) and the factors influencing shortterm prognosis remain uncertain. Objective：To investigate the factors influencing the discharge outcomes of neonatal VCP. Design：Retrospective cohort study. Methods：The study included neonates diagnosed with VCP by medical history, clinical signs, and bronchoscopy results in the Neonatal Intensive Care Unit (NICU) of Jinan Children's Hospital between April 2013 and January 2022. The cases were divided into two groups: the improved discharge group (those who did not require invasive ventilation and were able to suckle independently at discharge) and the nonimproved discharge group. The data collected for univariate analysis included maternal data of age, gestational hypertension, gestational diabetes, mode of delivery, premature rupture of membranes, nuchal cord, umbilical cord torsion, and amniotic fluid conditions; neonatal data of gender, gestational age, birth weight, 1minute Apgar score, associated malformations, and laryngeal obstruction; VCP etiology of birth injury, neurogenic, iatrogenic, and idiopathic; unilateral VCP and bilateral VCP (complete paralysis and incomplete paralysis) by bronchoscopy; and prognosis at the time of discharge. Variables with a P-value <0.10 in the univariate analysis were included as independent variables in the multivariate logistic regression analysis. Main outcome measures：Factors influencing the improved discharge. Results：A total of 133 cases of neonatal VCP were included in the analysis. The age of the first bronchoscopy examination was 6 (4, 12) days, the admission age was 13.0 (3.0, 20.5) days, and the gestational age was 39.0 (38.0, 40.0) weeks. There were 71 cases (53.4%) with associated malformations, 43 cases (32.3%) with unilateral VCP and 90 cases with bilateral VCP including 57 cases of incomplete paralysis and 33 cases of complete paralysis. The improved discharge group consisted of 96 cases (72.2%), while the non-improved discharge group had 37 cases, including 28 cases with difficulty weaning, 8 cases with tracheostomy (7 cases of bilateral incomplete paralysis and 1 case of bilateral complete paralysis). All tracheostomized patients were successfully weaned from positive pressure ventilation and discharged. Among them, 4 cases had restored vocal cord mobility within 9 months, and the remaining 4 cases were lost to follow-up. Thirty-seven cases had feeding-swallowing-breathing coordination disorders. Multivariate logistic regression analysis was performed on variables with a P-value <0.10 in the univariate analysis, including cesarean section, polyhydramnios, birth weight, low Apgar score, neurogenic injury, laryngeal obstruction, and type of vocal cord paralysis. The results showed that bilateral incomplete paralysis was a negative factor for improved discharge in neonates with VCP (OR=6.785, 95% CI: 2.191-21.013, P=0.001). Conclusion：Neonates with bilateral VCP, especially for the incomplete ones have poorer discharge outcomes, and tracheostomy can be used as a palliative treatment option.

Background：The Swanson, Nolan, and Pelham, version scale (SNAP-Ⅳ) is the most widely used assessment tool for evaluating the core symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. However, there is still a lack of systematic review of the measurement properties of the SNAP-Ⅳ scale, which may introduce bias and potentially affect the assessment validity of the measurement tool. Objective：To evaluate the measurement properties of the SNAP-Ⅳ based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN), and to provide evidence-based measurement instrument recommendations for the screening, diagnosis and efficacy evaluation of children with ADHD. Design：Systematic review. Methods：Related literature was systematically searched in databases of China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, China Biomedical Literature Database (CBM), PubMed, Cochrane Library, EMBASE, and Web of Science from the inception to April 21, 2022. Two reviewers independently screened the literature, and the measurement properties of the SNAP-Ⅳ scale were objectively evaluated according to the COSMIN manual. Main outcome measures：Content validity and internal consistency of the SNAP-Ⅳ scale. Results：A total of 14 studies involving 6 language versions were included. The content validity of the SNAP-Ⅳ scale was rated as "sufficient" (moderate quality evidence) in terms of relevance, comprehensiveness, and comprehensibility. However, there was no reported content on the development of the SNAP-Ⅳ scale. The parent and teacher versions of the SNAP-Ⅳ scale showed "sufficient" internal consistency (high-quality evidence). There was no high-quality evidence indicating "insufficient" measurement properties. The overall recommendation was classified as level A. Conclusion：The SNAP-Ⅳ scale is recommended for the screening, diagnosis, and treatment evaluation of children with ADHD, and its results can be considered reliable.

Background：Overuse and misuse of empiric antibiotic use for early onset sepsis (EOS) in neonatal intensive care units (NICUs) is widespread, which is associated with adverse outcomes in preterm infants and increased risk of immunerelated diseases in children. The Antimicrobial Stewardship Program (ASP) targeting at EOS can effectively reduce the irrational use of antimicrobial drugs in premature infants. Objective：To carry out multidisciplinary collaborative ASP to shorten the course of empiric antimicrobial drug treatment for EOS, and to explore the effect of ASP in reducing the use of antimicrobial drugs in the early postnatal period in extremely premature infants. Design：Quality improvement research. Methods：Consecutive cases of premature infants who were admitted to the NICU at Children's Hospital of Fudan University within 24 hours after birth from November 1, 2020 to July 31, 2023 and had a gestational age of <32 weeks were included. Those with major congenital anomalies, death or discharge within 7 days, or definite indications for antibiotic prescription within 3 days after birth were excluded. The ASP program was implemented on October 31, 2022. Infants were divided into a control group (before the ASP) and an intervention group (after the ASP). Both two groups have the same subgroups of ruleout sepsis, clinical sepsis and confirmed sepsis. Multidisciplinary ASP team was established to evaluate whether to prescribe empirical antibiotics according to the risk factors of EOS (low, medium, high risk) and the illness severity. ASP team conducted weekly audit of antibiotics for each very premature infant, and provided recommendations and feedback under the supervision of the chief of NICU. Main outcome measures：Discontinuation rate of early antimicrobial drug (within 72 hours after birth). Results：From November 1, 2021 to October 31, 2022, 186 cases were retrospectively included in the control group with 102 ruleout sepsis cases and 80 clinical sepsis, and from November 1, 2022 to July 31, 2023, 135 cases were prospectively included in the intervention group with 58 ruleout sepsis cases and 70 clinical sepsis. There was no significant difference between the two groups and ruleout sepsis subgroups in the two groups in terms of infant and maternal characteristics and NICU treatment. Clinical sepsis neonates showed significant differences in gestational age, prenatal hormone use, prenatal intravenous antibiotic treatment, and mechanical ventilation within 7 days after birth. Among the ruleout sepsis infants, the proportion of infants who discontinued initial antibiotics within 72 hours in the preand postASP period showed a statistically significant difference (P=0.008). Ruleout sepsis neonates in the intervention subgroup had a 2.8 times higher early antibiotic discontinuation rate than those in the control subgroup (OR=2.76,95% CI: 1.285.94). The ASP program had no effect on antimicrobial drug use (length of treatment/1,000 patient days), the rate of early antimicrobial use, mortality, the incidence of late sepsis, and necrotizing enterocolitis. Conclusions：Among very preterm infants with ruleout sepsis, ASP increased the proportion of infants who discontinued empiric antibiotics within 72 hours after birth. Attention should be paid to the diagnosis of clinical sepsis and the time of empirical antibiotic discontinuation, which may increase the rate of early antibiotic discontinuation and reduce the length of treatment during hospitalization.

Background：There is limited research on long-term follow-up studies of isolated ventricular septal defect (VSD) from the fetal to postnatal period at home and abroad. Objective：To provide data support for prenatal counseling and prognosis assessment of isolated VSD. Design：Retrospective cohort study. Methods：This study included children with isolated VSD, who were diagnosed at the outpatient clinic of the Cardiac Center of Guangdong Women and Children Hospital from January 2017 to December 2019 and had regular postnatal follow-up and documented records. Those with maternal termination of pregnancy, chromosomal or genetic abnormalities (identified through amniocentesis or umbilical blood sampling), or those who were lost to follow-up for more than 1 year were excluded. A routine follow-up form was established to collect the maternal age, gestational age, VSD diameter and location, and aortic diameter during the first echocardiographic examination. Follow-up echocardiograms were conducted within 48 hours after birth, at 3 months, at 6 months, and annually thereafter, until March 31, 2023. Patients were categorized into the spontaneous closure group, surgical closure group, and persistent defect group. Main outcome measures：Closure rate and closure time of isolated VSD for spontaneous or surgical closure. Results：A total of 264 cases were included in this study, including 154 cases (58.3%) in the spontaneous closure group, 78 cases (29.5%) in the surgical closure group, and 32 cases (12.1%) in the persistent defect group. The males were 109（41.3%）. At the time of VSD detection, the gestational age of the fetus was 28.3 (20-38) weeks, and the defect diameter was 2.6 (1.0-7.5) mm. There were 75 cases of muscular VSD (28.4%), 186 cases of perimembranous VSD (70.5%) and 3 cases of subarterial VSD. In total, 60 cases were large (22.7%), 179 cases were medium (67.8%), and 25 cases were small (9.5%).The 264 cases were followed up for 7 (0.1-69) months. The closure time was 8 (0-48) months in the spontaneous closure group and 4 (1-53) months in the surgical closure group.The time of followup was 45 (38-69) months in the persistent defect group. The proportions of musclar VSD and small VSD in the spontaneous closure group were higher than those in the surgical closure group and the persistent defect group. The proportions of perimembranous VSD and large VSD, R-value and defect diameter in the spontaneous closure group were lower than those in the surgical closure group and the persistent defect group. The follow-up time of the spontaneous closure group was longer than that of the surgical closure group and shorter than that of the persistent defect group, and the differences were statistically significant. The spontaneous closure rates of muscular VSD and perimembranous VSD were 92.0% and 45.7%, respectively, with a statistically significant difference. The spontaneous closure rates of large VSD, medium VSD and small VSD were 26.7%, 63.1% and 100%, respectively, and the differences of spontaneous closure rates between small and medium VSD,and between small and large VSD were statistically significant. In the surgical close group of 78 patients, 23 cases of medium VSD (12.8% of all medium VSD cases) progressed to large VSD by the time of operation. Conclusion：Perimembranous VSD was the most common type of VSD in fetuses, followed by muscular VSD. Spontaneous closure was observed in 58.3% of VSD cases, with higher rates in muscular VSD and small VSD. An increase in size was observed in 12.8% of medium VSD cases after birth.

Background：Chinese Infectious Disease Surveillance of Pediatrics (ISPED) program collected and summarized the data of antibiotics resistance from 12 member hospitals every year to monitor the bacterial drug resistance and pathogen changes among Chinese children. Objective：To investigate the antimicrobial resistance profiles of pathogens and bacteria infection in Chinese children and guide the reasonable use of antibiotics. Design：A cross-sectional survey. MethodsFrom January 1st to December 31rd in 2022, clinical isolates were collected from children hospitals in China enrolled in ISPED program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by E-test. All of the antimicrobial susceptibility testing results were interpreted according to the criteria set by Clinical and Laboratory Standards Institute (CLSI) in 2022. Main outcome measures：Distribution of bacteria strains in children, changes of bacteria drug resistance to isolated strains, and detection of multi-drug resistant organisms (MDROs). Results：A total of 50,399 isolates were collected, of which 38.8% was gram-positive organisms and 61.2% was gram-negative organisms. Top ten pathogens were as follows, Escherichia coli (14.3%), Haemophilus influenza (11.8%), Straphylococcus aureus (11.4%), Streptococcus pneumonia (11.3%), Moraxella catarrhalis (7.3%), Coagulase-negative staphylococci (6.8%), Klebsiella pneunoniae (5.3%), Pseudomonas aeruginosa (4.4%), Acinetobacter baumannii(2.3%) and Enterococcus faecalis (2.1%). E. coli was the most common pathogen in neonates and children over 5 years old. H. influenza was the major pathogen in children from the age of >28 days to 1 year. S. pneumoniae was the main pathogenic bacteria in children at the age of 1 to 5 years old. The proportion of penicillin-insensitive S. pneumoniae (PNSP) from cerebrospinal fluid and non-cerebrospinal fluid were 88.9% and 6.6%, respectively. The ratios of methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CR-PA), carbapenem-resistant A. baumannii (CR-AB) were 32.8%, 4.5%, 7.6% and 24.3%, respectively. The detection rates of MRSA, CRE and CR-PA in the neonatal group were 33.2%, 6.4% and 11.3%, much higher than those in the non-neonatal group (32.6%、4.2% and 7.5%). CR-AB in the neonatal group accounted for 10.9%, which was lower than that in the non-neonatal group (26.3%). Conclusions：The detection rate of MDROs in 2022 shows the continuous decrease compared to the previous years. More attention should be paid to the colonization, infection and spread of MRSA, CRE and CR-PA in the neonatal population.

Background：Changes in diastolic function are usually the first to occur when there is abnormal cardiac function. Currently, although there are many studies on ventricular systolic function, there is limited research on the changes in left ventricular diastolic function in congenital heart disease (CHD). Objective：To assess left ventricular diastolic function indices of CHD with lefttoright shunt before and after interventional therapy using echocardiography. Design：Selfcontrolled beforeafter trial. Methods：The case group of this study included pediatric patients under 18 years old who were diagnosed with patent ductus arteriosus (PDA), ventricular septal defect (VSD), or atrial septal defect (ASD) and underwent interventional treatment at the Children's Hospital of Chongqing Medical University. Patients with complex CHD, congenital developmental abnormalities, or genetic metabolic diseases were excluded from the study. Healthy children were recruited as the control group. Multiplesectional echocardiographic scans were performed on the lower sternal border, parasternal area, and suprasternal area to collect left ventricular diastolic function parameters (including left ventricular structure, blood flow spectrum for mitral valve and pulmonary veins, and tissue Doppler motion spectrum for mitral annular) as well as general information (age, height, weight, body surface area) during the ultrasound examination. Left ventricular function parameters in the case group were compared within 1 week before intervention surgery, 1 day after the surgery, and 1 month after the surgery to analyze the changes by taking the parameters of healthy children as the reference. Main outcome measures：Recovery levels of left atrial volume index (LAVI), early diastolic mitral flow peak velocity(E)/late diastolic mitral flow peak velocity(A) ratio, E/early diastolic mitral annular peak velocity at ventricular septum(E') ratio, and E/early diastolic mitral annular peak velocity at lateral wall(e') ratio after interventional therapy. Results：A total of 163 cases of CHD patients were included. There were 60 cases in the PDA subgroup, 42 cases in the VSD subgroup, and 61 cases in the ASD subgroup. A total of 61 healthy children were recruited for the control group. The PDA and VSD subgroups had significantly lower age, height, weight, and BSA compared to the control group. In the PDA, VSD, and ASD subgroups, LAVI, E/A ratio, E/e' ratio and E/E' ratio for mitral annular by tissue Doppler motion spectrum were significantly higher than those in the control group before the procedure with statistical significance. These indices decreased 1 day after the procedure and returned to the level of the control group 1 month after the procedure. The pulmonary vein flow spectrum D showed a decreasing trend before the procedure, 1 day after the procedure, and 1 month after the procedure, with a lower level in the control group 1 month after the procedure. Conclusion：Echocardiography can be used as an assessment tool for left ventricular diastolic function in children with common left-to-right shunt type CHD. There are varying degrees of left ventricular diastolic dysfunction in PDA, VSD, and ASD, which can be improved by interventional treatment, and can recover to almost normal levels after 1 month.

Background: Executive functions (EFs) are crucial for the physical and psychological development of children, and exercise is a cost-effective method to enhance EFs in children. Studies have shown that exercise combined with cognitive training (ECT), which involves higher cognitive engagement, may have a more significant effect on children's EFs. However, existing research conclusions are inconsistent. Objective: To systematically analyzed the intervention effect of ECT on EFs in children. Design: Systematic review. Methods: A systematic search was conducted on PubMed, Web of Science, Cochrane, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI) databases from the inception to October 17, 2023. Inclusion criteria were: randomized controlled trials (RCT) or non-randomized controlled trials（NRCT）; healthy child participants; ECT intervention with both exercise and at least one explicit cognitive task component for the experimental group; any form of exercise other than cognitive engagement or traditional physical education (PE) for the control group; intervention duration longer than 6 weeks; at least one EF-related assessment outcome; articles in Chinese or English. Risk of bias was assessed using the 2010 Physiotherapy Evidence Database (PEDro) scale. The percentage change in each outcome measure before and after the intervention ［(post-test-pre-test) / pre-test × 100%］ was extracted or calculated, with a P-value < 0.05 indicating significant results. The overall effect size of the indicator was evaluated by the proportion of significant results in all included literature, with > 2/3 indicating a significant effect of the intervention strategy. Main outcome measures: Percentage change in EF indicators before and after the intervention. Results: Nine English articles were included. Four articles had aerobic exercise (AE) control groups, and 8 had PE control groups. The intervention lasted from 6 to 40 weeks with 1 to 10 times per week and 10 to 150 minutes for single exercise. PEDro scale scores were 5 in 3 articles, 6 in 5 articles and 7 in 1 article.The improvement in working memory in the ECT group was more significant than that in PE group, with an effectiveness of 71.4%. Improvement in cognitive flexibility were more significant in the ECT group compared to both AE and PE groups, with effectiveness of 100% and 75%, respectively. Conclusions: ECT significantly improves EFs in school-aged healthy children, with a greater enhancement in cognitive flexibility compared to AE and PE, an improvement in working memory superior to PE, and equivalent improvement in inhibitory control when compared to AE and PE.

Background：Neck circumference is a new anthropometric measurement parameter in recent years. However, there is no published study on the reference standard values and the growth charts of neck circumference for children and adolescents in China. Objective：To establish the reference standard values of neck circumference of children and adolescents aged 3-16 years and then to explore the cut-off values of neck circumference in predicting abdominal obesity in children and adolescents so as to provide a new index and reference for the clinical application of physical assessment in children and adolescents. Design：A cross-sectional study. Methods：The subjects were children and adolescents aged 3-16 years who underwent physical examination in the Children's Health Clinic of the Children's Hospital Affiliated to Nanjing Medical University from July 2021 to September 2022. Children with diseases that may affect neck circumference, growth and development, or limb disability, abnormal posture, or deformity were excluded. The neck circumference, height, weight, waist circumference and body composition were measured by 3 surveyors strictly according to the operating manual which was made by ourselves. Ten percent of samples were randomly selected for repeated verification, and the coincidence rate before and after verification should be ≥99%. Double track entry and logical check were carried out for data entry and arrangement. The neck circumference reference standard values of children and adolescents aged 3-16 years were established according to gender and age groups, and the growth charts were constructed by Lambda-median-sigma (LMS) method. Abdominal obesity was defined as waist-to-height ratio (WHtR) >0.48 in boys aged 6-16 years and girls aged 6-9 years, and WHtR >0.46 in girls aged 10-16 years. The association of neck circumference with other physical measures and abdominal obesity was analyzed. The area under the receiver operating characteristic (ROC) curve was used to analyze the accuracy of neck circumference reference in predicting abdominal obesity. Main outcome measures：The reference standard values of neck circumference for children and adolescents aged 3-16 years and the cut-off values of neck circumference for assessing abdominal obesity for children and adolescents aged 6-16 years. Results：A total of 18 371 children and adolescents aged 3-16 years were included in the analysis, including 10 701 boys (58.2%) and 7 670 girls. There were 5 407 (29.4%) children with abdominal obesity. In addition to body fat mass, neck circumference, age, height, weight, BMI, waist circumference, WHtR, skeletal muscle and skeletal muscle percentage (PSM) of boys were significantly greater than those of girls, body fat percentage (PBF) of girls was greater than that of boys, and the differences were statistically significant (all P<0.05). The neck circumference of boys and girls aged 3-16 years increased with age, and the neck circumference of boys was always greater than that of girls at each age. The average growth rate was 0.85 cm/year for boys and 0.65 cm/year for girls, which was similar for boys and girls aged 7 to 8 years. The annual growth rate of boys was greater than that of girls before the age of 7 and after the age of 8, and it was more obvious after the age of 12. For boys and girls, neck circumference was positively correlated with abdominal obesity (r male=0.614, r female=0.541), BMI (r male=0.824, r female= 0.800), waist circumference (r male=0.827, r female=0.801), WHtR (r male=0.729, r female=0.683) and PBF (r male=0.669, r female=0.679), and was negatively correlated with PSM (r male=-0.497, r female=-0.470). The optimal cut-off values of neck circumference for assessing abdominal obesity were 27.15-37.05 cm for boys and 26.25-30.50 cm for girls aged 6-16 years, both of which were located in the P75 of all gender and age groups. The area under the curve(AUC) of neck circumference in assessing abdominal obesity were ≥0.83 in boys and ＞0.79 in girls of all ages. Conclusions：The neck circumference of boys was greater than that of girls in all age groups and it increased with age from 3 to 16 years old. The optimal cut-off values of neck circumference for assessing abdominal obesity were 27.15-37.05 cm for boys and 26.25-30.50 cm for girls aged 6-16 years, and the AUC was≥0.83 in boys and ＞0.79 in girls of all ages, with high accuracy.

Background：The disturbance coefficient(DC) is the main technical parameter of noninvasive brain edema dynamic monitoring instruments, and there is no normal reference value for children and adolescents at home abroad. Objective：To establish the reference intervals of DC for children and adolescents aged 116 years. Design：Multicenter prospective crosssectional survey. Methods：From March 2020 to March 2023, children and adolescents aged 116 years without craniocerebral injury were recruited from 6 hospitals 2 kindergarten and primary schools in Chongqing, Sichuan and Shenzhen. The noninvasive brain edema dynamic monitor was used for continuous monitoring for 15 minutes, and the monitoring average was taken as the final DC value of the subjects. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were used to draw P1, P5, P10, P25, P50, P75, P90, P95, P99 percentile values and percentile curves for disturbance coefficients of different ages. Independent sample ttest was used to analyze the difference of DC between boys and girls, and analysis of variance was used to calculate the DC mean value in different age groups and the difference of DC in different age groups. The changes of DC with age, weight and head circumference were explored by drawing scatter plots and Loess local weighted nonparametric regression curves. Main outcome measures：Disturbance coefficient. Results：A total of 1 247 children and adolescents with no cranial injuries were included in the study, including 787 males (63.1%) and 460 females. The observed fitted percentile curves of disturbance coefficients for children and adolescents of different ages showed that the level of disturbance coefficients gradually increased with age, and the growth of disturbance coefficient curves slowed down and eventually stopped after 5 years of age. In the overall population, there was no significant difference in DC levels between males and females (P>0.05), and there was no significant difference in DC among children and adolescents of different ages and genders. Correlation analysis showed that when age＜5 years old, body weight<18.0 kg and head circumference<51.0 cm, DC was significantly positively correlated with age, body weight and head circumference (r=0.663, 0.454 and 0.474, respectively). On the contrary, when age≥5 years old, body weight≥18.0 kg and head circumference≥51.0 cm, DC did not change significantly and gradually stabilized at 107. Conclusions：The study constructed the percentile curve of DC in children and adolescents aged 1 to 16 years old. When the age was ＜5 years old, the DC increased with age, and when the age was ≥5 years old, the DC gradually stabilized at 107.

Background：Antibiotics are a frequently used drug category in NICU. The Antibacterial Drug Management Project (ASP) can promote the rationalization of the use of antibiotics in NICU. Objective：To explore the effectiveness of implementing ASP to reduce the use of antibiotics in newborns with pneumonia. Design：Quality improvement research. Methods：This study focuses on infants with neonatal pneumonia and divides them into a control group and an intervention group before and after the implementation of ASP starting from January 1, 2019. The control group was treated with antibiotics selected by the attending physician based on empirical antimicrobial spectrum, and special pathogens or drugs were used after consultation with infectious disease physicians. The intervention group implemented NICU's characteristic ASP through the MDTASP team, which includes neonatologists, clinical pharmacists, infectious disease physicians, microbiology laboratory physicians, and radiologists. The MDTASP team conducted regular rounds, medication evaluations, and guidance on antibiotic use. When the sample size of the intervention group and the control group meet a 1∶1 ratio, inclusion will be terminated. Main outcome measures：Proportion of combined use of antibiotics in newborns with pneumonia. Results：From January 1, 2018 to June 30, 2018, 229 cases were retrospectively included in the control group, and from January 1, 2019 to May 30, 2019, 229 cases were prospectively included in the intervention group. There was no statistically significant difference between the two groups in terms of general information of the child and basic information of the mother. The proportion of combined use of antibiotics in the control group and intervention group was 24.5% (56/229) and 7.0% (16/229), respectively（χ2=26.367, P＜0.001). Compared with the intervention group, the days of antimicroial therapy was shortened from 12 (360) days to 8 (035) days (P＜0.001), and the length of hospital stay was shortened from 10 (733) days to 9 (546) days (P=0.005). There was no statistically significant difference in the proportion of necrotizing enterocolitis and death between the two groups after the use of antibacterial drugs. Conclusions：ASP can reduce the use of antimicrobial agents so as to decrease unnecessary antimicrobial exposure in neonatal department.

Background Prenatal screening for congenital heart disease (CHD) can not only reduce the number of critical birth defects with poor prognosis, but also facilitate the early evaluation, tracking and management of CHD fetuses. Objective To investigate the diagnostic accuracy of fetal CHD by ultrasound screening in the first and second trimester. Design Diagnostic test accuracy. Methods This research covers the pregnant women and their fetuses who registered, received examinations and gave birth in Jiangsu Kunshan Maternity and Child Care Centre between Aug.2018 and Dec. 2021. The fetal or neonatal cardiac ultrasound was used as the gold standard for diagnosis, and the standard to be further tested was the positive ultrasound result in the first and second trimesters. Main outcome measures Diagnostic accuracy parameters. Results During the study period, a total of 18 326 pregnant women underwent birth examination in our hospital, among which 3 534 (19.3%) had incomplete delivery data, and 14 960 fetal data were included in the analysis. Among 882 fetuses positive for ultrasound screening in the first and second trimester, 92 were lost to followup (10.2%), and 790 fetuses underwent ultrasound, cardiac ultrasound, or chromosome examination with induced labor and abortion in 182 cases. Of the 608 live births, 103 were diagnosed with CHD by fetal echocardiography and 4 were diagnosed with CHD by postnatal echocardiography.Based on 14 868 cases of fetal CHD screening, 171 cases were true positive, 48 cases were false negative, 14 030 cases were true negative, and 619 cases were false positive. The sensitivity was 78.1%(95%CI:71.9%83.3%), and the specificity was 95.8%(95%CI:95.4%96.1%). The false negative rate was 21.9%(95%CI: 16.7%28.1%).There were 14 078 negative fetuses in the first and second trimester of pregnancy with no lost followup cases, and 505 fetuses in the first and second trimester of pregnancy with positive ultrasound screening but normal results by cardiac ultrasound or chromosome examination. Screened by dual index method after birth, 14 335 negative fetuses and 244 positive fetuses were found, and 52 CHD cases were confirmed by neonatal cardiac ultrasound.In 219 cases of confirmed CHD, (1) CHD featured by atrial septal defect (secondary perforation) and congenital bilobal aortic valve malformation could not be found by fetal ultrasound and needed to be diagnosed by neonatal ultrasound; (2) Among 64 cases of induced labor, the 100% induced labor rate was found in CHD of complex type, right ventricular double outlet, ventricular septal defect (coarctation of aorta), atrial septal dilatation tumor, aortic valve stenosis, aortic arch rupture, pulmonary artery suspension, absence of inferior vena cava, ventricular septal defect (pulmonary stenosis), endocardial fibroplasia, right heart dysplasia, single ventricle, severe tricuspid valve stenosis, right pulmonary artery abnormality originating from the ascending aorta, and 80% induced labor rate was found in CHD of tetralogy of Fallot (8/10), complete atrioventricular septal defect (5/6), complete transposition of great arteries (4/5);(3)There were 9 cases of CHD with chromosomal abnormalities with 2 cases of ventricular septal defect (2.4%), 1 case of complex CHD (5%), 1 case of tetralogy of Fallot (10%), 1 case of right heart dysplasia (50%), and 1 case of single ventricle (100%). Conclusions After CHD screening in the first and second trimester, even fetuses with negative screening should be screened with two indicators after birth. Fetuses with positive screening should be closely examined with fetal cardiac ultrasound so as to fully realize the integrated prenatal and postpartum management mode of CHD.

Background: Children undergoing cancer treatment experience varying levels of symptom distress. It is crucial for clinical intervention that a scientific, rapid and accurate assessment is conducted to accurately identify the true symptoms in these children. Objective: To introduce the Symptom Screening in Pediatrics Tool（SSPedi）and to test the reliability and validity of its Chinese version in children with cancer and their parents. Design: Cross-sectional study. Methods: The Brislin translation model was employed to covert the scale into Chinese. Six experts were enlisted to conduct cultural adjustments, and a pre-survey was executed to formulate the Chinese versions of SSPedi for children and parents（SSPedi-C and SSPedi-P）.The formal survey targeted children aged 8-18 undergoing cancer treatment and their parents, who were hospitalized in the Department of Pediatrics at Nanfang Hospital of Southern Medical University and the Department of Pediatric Hematology at Zhujiang Hospital of Southern Medical University from December 1, 2022, to May 26, 2023. After obtaining consent from the hospital and relevant departments, a uniformly trained investigator from each hospital entered the ward on the day of admission or the following day to distribute SSPedi-C and SSPedi-P in Chinese to the children and their parents. After the questionnaire data were entered and verified by the investigators on the same day, item analysis, reliability analysis, and validity analysis were conducted. Main outcome measures: The reliability and validity of the Chinese versions of SSPedi-C and SSPedi-P. Results: A total of 220 (95.65%) valid questionnaires were included in the analysis. The age of the 220 children with cancer ranged from 8 to 17 years old （11.26±2.28）, with 130 males (59.1%) and 90 females. The parents' ages ranged from 28 to 59 years （40.15±5.23）, comprising 50 fathers (22.7%) and 170 mothers. Item analysis revealed that the critical ratio for all 15 items in the Chinese versions of SSPedi-C and SSPedi-P were between 3.987-8.824 (all P<0.001) and 4.817-3.829 (all P<0.001), respectively. The correlation coefficients between each item and the total score of the Chinese versions of SSPedi-C and SSPedi-P were between 0.431-0.701 (all P<0.001) and 4.817-3.829 (all P<0.001), respectively. The correlation coefficients between each item and the total score were 0.431-0.701 (P<0.001) for the Chinese SSPedi-C and 0.482-0.787 (P<0.001) for Chinese SSPedi-P. Reliability analysis showed that the total Cronbach's α coefficients of Chinese SSPedi-C and SSPedi-P were 0.877 and 0.893, respectively, and the split-half reliability coefficients were 0.843 and 0.806, respectively. Content validity analysis showed that the item-level content validity index and averaging scale-level content validity index of Chinese SSPedi-C and SSPedi-P were both 1.000. For both two Chinese scales, confirmatory factor analysis showed that the chi-square degree of freedom ratio (χ2/df was <3.000, RMSEA was <0.080, and fitting index was >0.900. Conclusion: The Chinese version of SSPedi demonstrates good reliability and validity among children with cancer and their parents. Its simplicity and ease of operation make it a valuable tool for evaluating the level of symptom distress in children aged 8-17 undergoing cancer treatment.

Background：Human serum albumin infusion was empirical therapy after neonatal gastric perforation surgery. It is unclear whether excessive supplementation is beneficial. Objective：To investigate whether prolonged human serum albumin infusion treatment in newborns with gastric perforation after abdominal surgery can improve the short-term outcomes. Design：Retrospective cohort study. Methods：The newborns who received intravenous infusion of albumin(1-2 g·kg-1) after gastric perforation were divided into short course group (≤5 days) and long course group (>5 days) according to the time of empirical application of albumin. The perinatal condition, main symptoms, signs, and laboratory results before operation, preoperative and postoperative complications, surgical condition (perforation site, pathological findings, etc.), postoperative treatment and hospital prognosis were collected. Main outcome measures：Postoperative nutritional status and hospitalization outcomes. Results：There were 37 cases in the short course group and 26 cases in the long course group. There was no significant difference in perinatal general condition, preoperative symptoms and signs, preoperative laboratory results, complications, perforation location and pathological findings between the two groups（P＞0.005）. In the short course group compared with the long-term treatment group, the gestational age was younger (P=0.005), the proportion of diabetes in pregnancy was higher(P=0.034), the age of onset was earlier (P=0.035), the age of operation was younger (P=0.035), the total amount of albumin infusion after operation was less (P=0.000), the 70% total enteral nutrition time was longer (P=0.019), the total enteral nutrition time was longer (P=0.005), and the hospital stay was shorter (P=0.012). However, there was no significant difference in secondary operation, length of stay, status of improvement or curation and weight at discharge between the two groups. Neonates with the difference of birth weight < 250 g, gestational age < 1 week and age of onset < 1 d in short course group and long course group were matched at 1:1. Twenty-two cases were included in each group. There was no significant difference in postoperative antibiotic use time, postoperative invasive respiratory support, times of plasma transfusion, gastrointestinal decompression time, fistulostomy tube indwelling time, postoperative enteral feeding time, 70% total enteral nutrition time, total enteral nutrition time, secondary operation, hospital stay and discharge weight between the two groups. Conclusion：Prolonged treatment time of human serum albumin infusion is not beneficial to the nutritional status and hospitalization outcomes of newborns with gastric perforation.

Background：Primary testicular lymphoblastic lymphoma(LBL) in children is rare and mostly secondary, and the previous treatment regimens were mainly chemotherapy combined with local radiotherapy of testis. Modern treatment regimens use high dose methotrexate (HDMTX) and other systematic chemotherapy without testicular radiotherapy. Objective：To summarize the clinical features of pediatric lymphoblastic lymphoma (LBL) with testicular involvement and to investigate the clinical efficacy and prognosis of ALLlike regimen containing HDMTX. Design：Case series report. Methods：The clinical data were collected from 17 pediatric LBL patients with neoplastic lesions and testicular involvement who were treated from January 2009 to April 2017, and chemotherapy was performed with NHL2009LBL regimen (from the modified BFM90 protocol) in lymphoma treatment regimen at Beijing Children's Hospital (BCH) Affiliated to Capital Medical University. The clinical characteristics and the curative effect were analyzed. Main outcome measures：5year overall survival rate(OS) and eventfree survival rate (EFS). Results：Of 277 children with LBL in the same period, 17 were associated with testicular involvement(6.1%), including 5 cases of TLBL and 12 cases of BLBL, with a median age of 6.2(2.613.7) years old. The clinical stages were stage Ⅲ (4 cases) and stage Ⅳ (13 cases). There were 5 cases with mediastinal mass, 3 cases with central nervous system involvement, 12 cases with bone marrow involvement (8 cases of which had reached the leukemia stage), 11 cases of inguinal, pelvic, sciatic/pubic area invasion and 7 cases of giant tumor. Primary testicular lymphoma was found in 1 case and secondary in 16 cases. Bilateral testicular invasion occurred in 6 cases and unilateral testicular invasion in 11 cases. After induction remission treatment, the testicular tumor was evaluated to disappear. The median followup time was 103(3129) months. Among the 17 children, 6 cases relapsed (only 1 case of testicular relapsed who had complete remission after treatment according to the standard protocol and longterm diseasefree survival). Two cases died of recurrence. The 5year OS was (87.5±8.3)%, and the 5year EFS was (68.8±11.6)%. Compared with the overall survival rate of LBL during the same period, the difference was not statistically significant. Conclusions：The clinical symptoms of testicular involvement in pediatric LBL are hidden. Routine Bultrasound examination before chemotherapy can improve the diagnosis rate. The risk of testicular involvement is increased in patients with groin area, pelvis and pelvic invasion. Continued complete remission can be achieved with regular chemotherapy without testicular radiotherapy, and testicular function can be preserved.

Background：In adult asthma studies, salmeterol/fluticasone propionate combination(FSC) has been shown to achieve better efficacy and comparable safety than fluticasone propionate alone(FP), but reliable clinical evidence is still lacking in children with asthma. Objective：To conduct a systematic review and meta-analysis on salmeterol/fluticasone propionate combination and fluticasone propionate alone in the step-up treatment of children with asthma, and to explore the efficacy and safety of the two groups. Design:Systematic review and meta-analysis. Methods:Randomized controlled trials(RCTs) of salmeterol/fluticasone propionate combination versus fluticasone propionate alone were systematically searched in Cochrane, MEDLINE (via PubMed), Embase, Web of Science, CBM, CNKI and Wanfang databases from the inception to September 2023. Two researchers independently finished literature screening, data extraction, risk of bias assessment, and evidence quality summary. Data analysis was completed through R Studio1.4.1717. Main outcome measures:Asthma exacerbations and adverse events related to inhaled corticosteroids (ICS) and FSC. Results:A total of 11 RCTs with 9 438 children with asthma were included. The comparison between fluticasone propionate/salmeterol combination and fluticasone propionate alone showed a statistical difference in the improvement in maximal expiratory flow at 50% vital capacity(MEF50) (MD=0.17, 95%CI: 0.16-0.18,P<0.000 1), mean morning peak expiratory flow(PEF) (MD=4.84, 95%CI: 4.53-5.15,P<0.000 1) before and after treatment, improved percentage of symptom-free days (MD=1.39, 95%CI: 1.36-1.41,P<0.05) and albuterol-free days (MD=1.09, 95%CI: 1.06-1.12, P<0.05) before and after treatment. But there was no statistically significant difference in the reduction in asthma exacerbations(RR=0.87, 95%CI: 0.70-1.09, P=0.22),the incidence of reduced ICS and FSC-related adverse events(RR=0.99, 95%CI: 0.61-1.60, P=0.95) and other adverse events(RR=0.98, 95%CI: 0.91-1.05, P=0.55). Conclusions:Compared with fluticasone propionate, salmeterol/Fluticasone propionate combined therapy significantly improved lung function (MEF50, mean morning PEF) and asthma symptoms, and reduced the use of salbutamol in treatment, but there was no difference in the reduction in asthma exacerbations. The safety was similar in both groups, with no additional drug-related adverse events or increased incidence of adverse events due to the addition of salmeterol.

Background: Platelet transfusion efficacy affects clinical outcomes and clinical decision making, and there is a lack of specific efficacy prediction models for platelet transfusion in children with acute lymphoblastic leukemia (ALL). Objective: To develop and validate a predictive model for platelet corrected count increment (CCI) in pediatric ALL after platelet transfusion. Design: A retrospective cohort study. Methods: Hospitalized ALL children who had been transfused with platelets in the Department of Hematology and Oncology at Affiliated Children's Hospital of Chongqing Medical University from January 2022 to March 2023 for initial diagnosis and treatment were included, and were divided into the modeling group (before December 31, 2022 ) and the validation group (after December 31, 2022). The history data that might affect the efficacy of platelet transfusion were collected including gender, age, splenomegaly or hyper-splenism, hemorrhagic grade, degree of anemia, platelet storage days, medications, morphology, risk grouping, and treatment stage. Univariable COX regression and Lasso regression analysis were performed, followed by multivariable COX regression to determine the final predictors. The column-line graph prediction model was established built on the results. To detect the predictive efficacy, the model was then evaluated for its differentiation and calibration. Main outcome measures: Predictive efficacy of the CCI line graph model for platelet transfusion efficacy. Results: A total of 133 cases with 247 platelet transfusions were included in this study during the study period. There were a total of 198 transfusions in the modeling group and 49 transfusions in the validation group, and the baseline differences in the variables between the two groups were not statistically significant. Six factors, namely, gender, age, ALL risk grouping, pre-transfusion leukocyte count, splenomegaly or hypersplenism, and infection status, were finally incorporated to construct a column-line graph prediction model. When CCI was 11.4 (P25), 18.5 (P50), and 28.2 (P75), the area under curve (AUC) values were respectively 0.783, 0.695, and 0.654 in the modeling group, and 0.765, 0.714, and 0.580 in the validation group. The calibration curves showed that the model-predicted incidence rates and the actual incidence rates were basically the same in the modeling and validation group when CCI was 11.4, 18.5, and 28.2. Conclusion: A predictive model for platelets CCI after platelet transfusion in children with ALL was established. Good predictive efficacy for platelet transfusion efficacy in children with ALL was confirmed by a column-line graph predictive model using influencing factors of gender, age, pre-transfusion leukemia count, infection, ALL risk grouping, and splenomegaly or hypersplenism.