Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal...Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).展开更多
INTRODUCTION
Pulmonary embolism is much less common in children than in adults.We encountered a 5-year-old girl with pulmonary embolism.She was finally diagnosed with combined methylmalonic acidemia and homocystinur...INTRODUCTION
Pulmonary embolism is much less common in children than in adults.We encountered a 5-year-old girl with pulmonary embolism.She was finally diagnosed with combined methylmalonic acidemia and homocystinuria,which is a rare disease that could cause pulmonary embolism.Pulmonary embolism in our patient may be considered a case of in situ thrombosis of pulmonary arteries rather than classical thromboembolic pulmonary embolism.The clinical experience in this patient suggests that the possibility of metabolic disease should be considered when encountering pediatric pulmonary embolism.展开更多
文摘Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).
文摘INTRODUCTION
Pulmonary embolism is much less common in children than in adults.We encountered a 5-year-old girl with pulmonary embolism.She was finally diagnosed with combined methylmalonic acidemia and homocystinuria,which is a rare disease that could cause pulmonary embolism.Pulmonary embolism in our patient may be considered a case of in situ thrombosis of pulmonary arteries rather than classical thromboembolic pulmonary embolism.The clinical experience in this patient suggests that the possibility of metabolic disease should be considered when encountering pediatric pulmonary embolism.
