Hoist the Sails, Promote the Hopes
The field of pediatrics in China has witnessed remarkable progress over the years, driven by the collective efforts of pediatric medical practitioners. This advancement is reflected in the significant improvement in children’s health levels and the standards of pediatric disease treatment. The mortality rates of infants and children under the age of 5 have decreased substantially, and life-supportive technologies, including newborn care and the management of difficult and critical cases, have developed by leaps and bounds. The clinical diagnosis, treatment, and scientific research levels of pediatric subspecialties in China have now become comparable to those in developed countries. Collaboration with international colleagues has led to the development of guidelines and expert consensus on various pediatric conditions, which are being promoted globally. Chinese expertise has become indispensable and influential in the field of international pediatrics.
The Chinese Medical Journal, a prestigious medical journal in China, has dedicated a special issue to compile key and hot topics in pediatrics. This issue includes nine articles on basic and clinical research, which are of great significance for the development of the field. The articles cover a wide range of topics, reflecting the current focus on high-quality developments in children’s health, moving beyond mere survival requirements to comprehensive physical, psychological, and behavioral health.
Under the leadership of the government, China’s child health and development have continuously progressed. This includes tertiary-level prevention of birth defects, neonatal and infant follow-up and community management, prevention and control of children’s infectious diseases, optimization of vaccination, and child health promotion. The introduction of developmental pediatrics and pediatric nutrition has greatly improved children’s health levels and nutritional status in China. The pediatric nutrition and child development specialist team has been expanding, and the overall health status of children in China has significantly improved. Nutritional deficiencies, which were a major health concern among children and adolescents before 1995, have been effectively controlled and prevented. From 1990 to 2015, the age-standardized prevalence of nutritional deficiencies declined by 7.03%, and the age-standardized mortality declined by 93.80%, from 6.13 per 100,000 to 0.38 per 100,000. However, the percentage change in the age-standardized years lived with a disability rate of nutritional deficiencies among children and adolescents was less than 8.0 between 1990 and 2015, with no obvious decline. Nutritional deficiencies still affect the health of Chinese children and adolescents, necessitating continuous interventions.
The COVID-19 pandemic has brought new challenges and demands to the field of pediatrics, particularly in the area of vaccination. Two articles in the journal focus on vaccine-related issues. One study introduces the epidemiology and etiological characteristics of hand-foot-and-mouth disease (HFMD) before and after the introduction of the enterovirus 71 vaccine. This is the first study to demonstrate the epidemiological and etiological characteristics of HFMD in Sichuan Province, before and after the introduction of EV-71 vaccines. The other paper emphasizes the necessity and importance of COVID-19 vaccines in children, providing new ideas for scientific research regarding COVID-19 vaccine inoculation in children.
The spectrum of disease in pediatrics has changed significantly in recent years, especially after the COVID-19 pandemic, bringing to light many hot topics and key clinical issues. The rapid progress of various diagnostic technologies, particularly gene sequencing technology, has promoted the development of pediatric genetics, highlighting the disciplinary characteristic that “children are not the epitome of adults.” The research on pediatric disease spectrum and mechanism is expanding rapidly, especially in view of the rapid progress in the research of children’s conditions caused by congenital, genetic, or epigenetic factors. This issue includes an impressive paper that introduces research progress on epigenetic age, discussing the interpretation for epigenetic age deviations in the pediatric population and their association with external factors, developmental trajectories, and pediatric diseases. This paper provides a new perspective on the pathogenesis of children’s diseases.
The development of new management options and medicine therapy has introduced new pediatric subspecialties, including gene therapy and minimally invasive interventions. These subspecialties encourage the development of therapeutic technology for difficult, critical, and rare diseases in pediatrics, and support standardized diagnosis and treatment in various aspects of pediatrics. Pediatric surgical methods have also become more refined. The multi-dimensional and precise management of the perioperative period improves the success rate of children’s surgery, including neonates. A study comparing different ways of perfusion in 146 neonates who underwent on-pump heart surgery with single-shot histidine-tryptophan-ketoglutarate perfusion found a suitable and safe heart perfusion method for newborns.
A rationalized treatment plan, balancing efficacy and safety, maximizing the success rate, and reducing long-term complications are major concerns in pediatric clinical treatment. This issue contains a systematic review of the preventive and therapeutic effects of azithromycin mass drug administration on trachoma in different districts, exploring possible methods to enhance the effectiveness of azithromycin mass drug administration in hyperendemic districts. The safety and efficacy of salmeterol/fluticasone versus montelukast, or a combination of montelukast and fluticasone in children and adolescents aged 4 to 18 years with bronchial asthma, which is increasing in incidence, was systematically reviewed, providing evidence for pediatricians to determine their clinical strategy.
China has greatly increased the recovery and remission rate of hematological malignancies in children. For children with chronic myeloid leukemia in the chronic stage (CML-CP), the long-term follow-up results of 58 pediatric patients with CML-CP treated with Imatinib mesylate as the first-line and second-generation tyrosine kinase inhibitors as the second-line treatment are significant, providing evidential value for the standardized diagnosis and treatment of children with myeloid leukemia.
The rapid advance of pediatric research and the improvement of treatment have produced remarkable achievements in promoting standardized paths for common and frequently pediatric diseases and the treatment of critically ill children. However, many new medical issues have emerged, such as the long-term medical support after the survival of extremely preterm infants and children with genetic or congenital diseases, the optimization of multidisciplinary diagnostic, management, and long-term follow-up of extremely critical patients, optimized treatment, and long-term management of children with hematological conditions, and multidisciplinary management and subsequent follow-up of children undergoing organ transplantation. There are a large number of pediatric patients in China, and the methodological quality of the evidence-based guidelines for pediatrics published in Chinese journals from 2010 to 2017 is not adequate. The emergence of new clinical problems prompts higher evidence data requirements for the release of various clinical guidelines and treatment modalities.
Innovation has a long way to go in the field of pediatrics. Children’s health is the foundation of national health, and it relies primarily on the efforts of pediatricians. The high-quality articles in this special issue can arouse the curiosity and interest of people involved in pediatrics and encourage them to forge ahead and carry further basic and clinical research to promote sustainable and distinguished development of pediatrics.
doi.org/10.1097/CM9.0000000000001953
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