Governed by:
Ministry of Education People's Republic of China
Sponsored by:
Xi’an Jiaotong University
Chinese Preventive Medicine Association
Published by:
Editorial Office of Chinese Journal of Child Health Care
Editor-in-Chief:
YANG Yufeng
ISSN 1008-6579   CN 61-1346/R
Special Issue More>>
10 January 2023, Volume 31 Issue 1
Guideline
Guidelines of health nurturing care for children under 3 years old (trial implementation)
National Health Commission of the People′s Republic of China
2023, 31(1):  1-9.  DOI: 10.11852/zgetbjzz2022-1446
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Expert Commentary
Cultivate healthy dietary behavior and keep away from childhood obesity
MA Guan-sheng, ZHANG Fan
2023, 31(1):  10-14.  DOI: 10.11852/zgetbjzz2022-1199
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Obesity has become an increasingly serious public health challenge endangering the childhood health in China. In recent 30 years, the continuous growth of childhood obesity rate in China is closely related to the improvement of living standards and the changes of dietary behavior. Dietary behavior refers to individuals′ habitual eating activities, including food selection and purchase, eating frequency, eating quantity, cooking method, eating place, etc. Eating frequency and regular eating, dining atmosphere, breakfast, western fast food and other dietary behaviors, drinking and snack eating behaviors are related to childhood obesity. Unhealthy dietary behaviors lead to weight gain and obesity in children by affecting energy intake. Parents, schools, society and the government must work together to create a healthy eating environment for children, help them cultivate healthy dietary behaviors, keep away from obesity, and provide necessary guarantees for the healthy growth of children.
Original Articles
Validation and evaluation of the structure of Chinese Preschoolers′ Caregivers′ Feeding Behavior Scale based on network analysis
ZHANG Hao, ZHANG Hai-yue, YUAN Jing, ZHANG Yu-hai, JIANG Xun, SHANG Lei
2023, 31(1):  15-20.  DOI: 10.11852/zgetbjzz2022-0879
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Objective To validate and evaluate the structure of Chinese Preschoolers′ Caregivers′ Feeding Behavior Scale(CPCFBS) using network analysis, so as to provide reference for further improvement and revision of the scale. Methods Network structure was estimated using Gaussian Graphical Model with a dataset of feeding behaviors in 768 preschoolers′ caregivers. Dimensionality was detected using exploratory graph analysis(EGA). The network structural consistency was tested using EGA bootstrap. Structural reliability and validity were examined using model fit indices and reliability coefficients. Results Based on the network loadings and structure consistency results, a seven-dimensional EGA network containing 34 items was explored. Compared with the original scale structure, one unstable item was deleted, and some items of the dimensions of "Encourage Healthy Eating" and "Behavior-restricted Feeding" were re-clustered, while the rest of the network dimensions remained unchanged. The structure consistency evaluation indexes were all greater than 0.75, meaning that the structure was stable. The absolute fit and relative fit of EGA structure were better than the original structure. The EGA structure had better reliability than the original structure. Conclusion After optimizing the structure of CPCFBS and improving the stability of the scale by network analysis, the revised CPCFBS is more applicable to the evaluation of feeding behaviors in China.
Trends of malnutrition, overweight and obesity in preschool children in Beijing from 2000 to 2020
YANG Xiao-chen, HE Hui, YUN Qing-ping, LI Yi-chen, CHANG Chun
2023, 31(1):  21-26.  DOI: 10.11852/zgetbjzz2022-0714
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Objective To analyze the trends of malnutrition, overweight and obesity of preschool children in Beijing, and to evaluate the urban-rural difference of children′s growth trends. Methods Data were extracted from five national physical fitness surveillance surveys in Beijing from 2000 to 2020, and the growth indicators of 31 117 children aged 3 to 6 years were calculated. Chi-squared and Cochran-Armitage tests were used to estimate trends in these indicators. Results Compared to 2000, the prevalence rates of stunting, underweight and wasting decreased from 1.5%, 1.4%, 0.9% to 0.6%, 0.6%, 0.8%, while the prevalence of overweight and obesity increased from 17.1%, 4.8% to 20.1%, 9.6%, respectively. Less than 1% of boys and girls in both urban and rural areas were stunted or underweight in 2020. Rural boys and girls have shown a higher prevalence of obesity than urban children since 2010, as well as the prevalence of overweight since 2014. From 2000 to 2020, rural boys and girls had declining trends in malnutrition(including stunting and underweight) rates, and rising trends in overweight and obesity rates(P<0.001). Urban girls had polarized nutrition status from 2000 to 2020, with an increasing rate of wasting(Z=2.426, P=0.015) and an increasing rate obesity(Z=3.405, P=0.001). Conclusions The prevalence of malnutrition decreases among rural children, while the sustained rising prevalence of overweight and obesity had surpassed that of urban children. Therefore, effective nutrition policies and health strategies are warranted to address the urban-rural disparities in child growth and development.
Correlation between the risk perception of parents of children aged 0-6 years and the use of child safety seats
SUN Ya-ru, YIN Lei, LIU Ting, RAN Ni, WANG Xin, GUO Kun, YANG Xiu-ling
2023, 31(1):  27-31.  DOI: 10.11852/zgetbjzz2022-0815
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Objective To investigate the use of child safety seats for children aged 0 - 6 years after child safety seats were first written into the Law on the Protection of Minors, and to understand the correlation between parents′ risk perception and children′s safety seat use behavior, so as to provide reference for follow-up intervention. Methods From January to April 2022, the convenience sampling method was used to select children′s health department of a third-class hospital in Qingdao, a kindergarten and a community health service center as the survey sites. The parents of children aged 0 - 6 years from families with private cars were investigated by using the questionnaire on the current situation of children′s riding safety and the diagnostic scale of children′s riding risk behavior. Results The utilization rate of child safety seats was 53.4%(222/416), and the high frequency utilization rate was 23.6%(98/416). The results of regression analysis showed that parents participation experience of children′s accidental injury training(OR=1.887, 95%CI:1.149 - 3.102), parents with college degree or above(college:OR=4.486, 95%CI:1.956 - 10.278; bacholor′ s degree:OR=5.249, 95%CI:2.307 - 11.953), perceived susceptibility(OR=1.701, 95%CI:1.220 - 2.373), response efficiency(OR=1.642, 95%CI:1.191 - 2.264), self-efficacy(OR=1.759, 95%CI:1.285 - 2.408), type selection cognition(OR=1.413, 95%CI:1.085 - 1.840) were significantly influencing factor of child safety seat use behavior(P<0.05). Conclusions After being included in national legislation for the first time, the usage rate of child safety seats increases slightly while high frequency usage rate was low. Higher levels of risk perception can promote parents to take active measures to avoid child car injuries. Therefore, parents′ subjective judgments about their perceptions and confidence in preventing car injuries caused by not using child safety seats should be strengthened so as to increase the use of child safety seats.
Analysis on the needs of family nurturing guidance for infants
YIN Chun-lan, XI Xiang-yun, TONG Mei-ling, ZHU Ling, ZHANG Hua, LIU Yun-fen, HUANG Yan, ZHANG Yong-hua, ZHANG Li-li, CUI Xin-hua, NI Yu, ZHONG Xin-wen, LI Xia, XU Pei-bin
2023, 31(1):  32-36.  DOI: 10.11852/zgetbjzz2021-1653
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Objective To investigate the needs and influencing factors of family nurturing for infants, so as to provide reference for promoting the combination of medical education and care services. Methods From September to November 2020, 3 439 infants were selected from 9 provinces and 12 cities in China for questionnaire survey. Parents were asked to fill in general information and family rearing questionnaire to collect the needs of infant families for nurturing guidance. Results Among 3 439 infants, 29.7% had the need for nurturing guidance, especially for responsive care and early learning opportunities. Logistics regression analysis showed that the main caregivers were father(OR=0.476,95%CI:0.361 - 0.629)and(maternal) grandparents(OR=0.455,95%CI:0.304 - 0.681), farmers(OR=0.395,95%CI:0.240 - 0.649)and retirement(OR=0.612,95%CI:0.500 - 0.750)were protective factors for guidance needs for infants and toddlers family nurturing care. Stem family(OR=1.295,95%CI:1.101 - 1.523), single-parent family(OR=2.631,95%CI:1.405 - 4.927), caregivers with educational level of college/graduate(OR=2.180,95%CI:1.600 - 2.971), postgraduate and above(OR=3.116,95%CI:2.109 - 4.811)and average monthly household income of >10 001 - 20 000 yuan(OR=1.815,95%CI:1.407 - 2.340), above 20 000 yuan(OR=2.846,95%CI:2.125 - 3.813)were risk factors for demand for high guidance needs for infants and toddlers family nurturing care. Conclusions At present, families in China have a certain need for guidance on the nurturing care of infants and toddlers. Medical and health care institutions, especially maternal and child health care institutions, should continue to improve their professional guidance and health services for the nurturing care of infants and toddlers in order to further improve the quality of family care.
Validity of capillary dried blood spot for assessment of vitamin A nutritional status in preschool children
MI La-la, ZHANG Shu-yi, ZHANG Min, WU Yi-ran, XIE Jun
2023, 31(1):  37-41.  DOI: 10.11852/zgetbjzz2022-0847
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Objective To assess the reliability and validity of dried blood spot(DBS) in the diagnosis of marginal vitamin A deficiency(MVAD) in preschoolers, in order to provide reference for scientifically assessing vitamin A nutritional status. Methods A total of 130 children aged 2 to 7 years were selected in the Zhao county in 2018 and their capillary bloods were collected to prepare DBS, of whom 48 children also collected venous plasma at the same time. The retinol levels in the 2 biological matrices were measured using high-performance liquid chromatography-tandem mass spectrometry method(HPLC-MS/MS). Two calibration methods were applied to convert DBS retinol to its homologous plasma retinol level. The agreement of the converted retinol with plasma retinol level was assessed using the intra-group correlation coefficient(ICC) and Bland-Altman analysis. The validity for the diagnosis of MVAD was assessed by sensitivity, specificity, accuracy index(AI), positive predictive value(PPV) and negative predictive value(NPV). Results After correction, DBS retinol was in good agreement with the level in homologous plasma, with ICC values greater than 0.8. Factor-corrected DBS retinol was closer to its plasma level. The prevalence of MVAD in the target population diagnosed by factor-corrected DBS retinol was 45.00%, which was close to the prevalence of MVAD diagnosed by plasma retinol(45.83%). The sensitivity, specificity, AI, PPV and NPV of factor-corrected DBS retinol predicting MVAD were 77.78%, 81.82%, 80.00%, 77.78% and 81.82%, respectively. The prevalence rates of VAD and MVAD in 130 children aged 2 to 7 years in Zhao county were 3.08% and 45.38%, respectively. Children aged 5 to 7 years had a higher prevalence rate of MVAD(51.22%, t=1.975, P=0.359). Conclusion Corrected DBS retinol can be used in the diagnosis of MVAD and the prevalence rate of MVAD is high in preschoolers in Zhao county.
Validation and norms of the Chinese Toddler Sleep Assessment Scale
FENG Wei-wei, ZHANG Tong, WANG Hui-shan, YANG Yu-feng, XU Zhi-fei, PAN Xiao-ping, WANG Guang-hai, XU Tao, Working Group on Norms Establishment of Chinese Infants and Toddlers Sleep Assessment Scales
2023, 31(1):  42-45.  DOI: 10.11852/zgetbjzz2022-0642
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Objective To verify the reliability and validity of Chinese Toddler Sleep Assessment Scale(TSAS), and to establish national norm and cut-off score. Methods Using multistage random sampling, totally 2 816 urban and rural caregivers whose child aged 12 to 35 months were selected in 14 cities of 7 provinces from May to December 2021. The internal consistency reliability, split-half reliability and confirmatory factor analysis were used to verify the reliability and validity of the scale. The percentile norm(P5, P15, P50, P85 and P95) was established, and the total TSAS scores exceeding P85 and P97 were determined as the cut-offs for identifying poor sleep and abnormal sleep. Results The Cronbach′s α coefficients of TSAS was 0.73, the split-half reliability was 0.81, and the factor structure models were stable, which showed good reliability and validity. The age norm of TSAS was established. The total score >40 indicated poor sleep, and > 45 indicated abnormal sleep. Conclusions TSAS has stable reliability and validity. The established norm and cut-off can provide Objective reference for its promotion and application.
Basic Experimental Articles
The effects of MiR-223-3p on the inflammatory response and cell damage in the intestinal tissue of neonatal rats with necrotizing enterocolitis by targeting NLRP3
CAI Dong, ZHOU Li-xia, XU Hua-fen
2023, 31(1):  46-51.  DOI: 10.11852/zgetbjzz2022-0252
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Objective To explore the effects of microRNA-223-3p(MiR-223-3p) on the inflammatory response and cell damage in the intestinal tissue of neonatal rats with necrotizing enterocolitis(NEC) and its possible mechanism. Methods The NEC model of neonatal rats was constructed and randomly divided into a model group, a negative control group, and a MiR-223-3p overexpression group. The normal rats of same number were taken as the normal group. Hematoxylin-eosin(HE) staining and TUNEL staining were used to detect intestinal histopathological changes and cell apoptosis; ELISA method was used to detect the levels of interleukin-6(IL-6), interleukin-1β(IL-1β) and interleukin-18(IL-18) in serum and intestinal tissues; SYBR Green Ⅰ real-time fluorescent quantitative PCR method was used to detect the expression of MiR-223-3p in intestinal tissues; Western Blot was used to detect the expression of NLRP3 and caspase-1 proteins in intestinal tissue. Dual luciferase reporter gene experiment was used to verify the target relationship between MiR-223-3p and NLRP3. Results Compared with the normal group, the levels of IL-6, IL-1β, IL-18 in the serum and intestinal tissues of rats in the model group and the negative control group were all significantly increased(F=215.525, 276.499, 354.826, 204.410, 261.474, 280.667, P<0.05), the expression of NLRP3 and caspase-1 proteins in the intestinal tissues and the apoptosis rate were all significantly increased(F=181.745, 137.553, P<0.05), the expression of MiR-223-3p in the intestinal tissue was significantly reduced(F=170.180, P<0.05), and there was obvious pathological damage in the intestinal tissue. Compared with the negative control group, the MiR-223-3p overexpression group was able to up-regulate the expression of MiR-223-3p in intestinal tissues, reduce the levels of IL-6, IL-1β, IL-18 and cell apoptosis in rat serum and intestinal tissues, inhibit the expression of NLRP3 and caspase-1 proteins(P<0.05), and the pathological damage of intestinal tissue was significantly improved. The results of the dual luciferase reporter gene experimental analysis showed that MiR-223-3p and NLRP3 was able to targetingly be combined. Conclusion MiR-223-3p reduces inflammation and cell damage in the intestinal tissue of NEC neonatal rats by targeting NLRP3.
Review
Research progress on the influencing factors and treatment of communication disorder in children with cerebral palsy
WU Xi-xi, HAO Chao-li, ZENG Pei, GUO Jin
2023, 31(1):  52-57.  DOI: 10.11852/zgetbjzz2022-0325
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Cerebral palsy(CP) is a common neurological disorder in children, and its core manifestation is abnormal postural development and motor disturbance. Communication disorder, as a common accompanying disorder in children with cerebral palsy, has a high incidence rate and a serious impact on their mental health and social communication. In recent years, how to effectively improve the communication ability of children with cerebral palsy is a key point of rehabilitation therapy. On the other hand, communication disorder is caused by multiple factors and has various clinical manifestations, so early assessment and interventions are particularly important. The article reviews the influencing factors, clinical manifestations, assessment and treatment of communication disorder in children with cerebral palsy, so as to provide more clinical ideas for improving the communication of children with cerebral palsy.
Research advances in tummy time during infancy
WANG Xiao-tong, CHANG Jia-hui, LIU Ai-hua, ZHANG Jian, WU Qiong, ZHANG Yan-feng, ZHANG Ting, ZHU Zong-han
2023, 31(1):  58-61.  DOI: 10.11852/zgetbjzz2021-1813
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Tummy time is defined as awake prone positioning that is encouraged and supervised by an adult and infants can move unrestrictedly. Since the positive association with gross motor development and prevention of plagiocephaly, promotion of tummy time in China is of great significance. This review combs the concept, research advances and guidelines of tummy time, aiming to provide reference for further research and guideline development of tummy time in China.
Responsive care in early childhood development nurturing care systems
NI Xue-fei, FAN Li-chun
2023, 31(1):  62-65.  DOI: 10.11852/zgetbjzz2022-0049
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The early childhood development nurturing care consists of five major contents:child health, adequate nutrition, safety and security, responsive care and early learning opportunities. Among them, responsive care is an important way to promote early childhood development. This article summarizes and reviews the connotation, challenges, implementation and evaluation of responsive care, and explores the influence of responsive care on early childhood development.
Research progress in developmental characteristics of children with minimal and mild hearing loss
XIAO Zheng-lu, LIU Pan-ting, JI Hui, HONG Qin
2023, 31(1):  66-70.  DOI: 10.11852/zgetbjzz2022-0173
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Minimal and mild hearing loss(MMHL) includes unilateral sensorineural hearing loss, bilateral mild sensorineural hearing loss and high-frequency sensorineural hearing loss. Children with MMHL may have trouble locating sound sources, experience frequent weariness, have difficulty discriminating speech in noisy environments, and experience various symptoms that influence their language, psychological education and daily living. Currently, it is often assumed that this form of hearing loss is so mild that it has received insufficient attention, resulting in a significant percentage of children with MMHL not obtaining timely assistance. The review aims to summarize the effects of MMHL on children′s auditory, language, speech, cognition, school performance and daily life, to reveal the developmental characteristics of children with MMHL, and to find an objective basis for early detection and active intervention of these children.
Research progress in responsive caregiving for infants and toddlers
XU Yu-ying, WANG Xue-na, LI Jia, AN Zi-fen, YU Li-ping
2023, 31(1):  71-75.  DOI: 10.11852/zgetbjzz2022-0343
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Responsive caregiving plays an important role in the early development of infants and toddlers. It can not only promote brain development, emotional and language development of infants and toddlers, but also enhance parent-child attachment and promote their social development. This paper focuses on the researches on responsive caregiving for infants and toddlers at home and abroad from three aspects:measurement tools, influencing factors and intervention measures, in order to provide theoretical reference for further study of responsive caregiving for infants and toddlers.
Meta Analysis
Qualitative evidence-based study of the association between drinking water and childhood obesity
LIN Guo-tian, CHENG Qiu-yun, ZHANG Fan, the Committee of Guidelines for Childhood Obesity Prevention and Control
2023, 31(1):  76-80.  DOI: 10.11852/zgetbjzz2022-1198
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Objective To systematically evaluate the association of drinking water with children's energy intake and obesity, in order to provide evidence-based reference for the formulation of relevant policies. Methods The relevant literature published from 1998 to 2021 was retrieved from China Biomedical Literature Database (CBM), CNKI, Wanfang Data Knowledge Service Platform and PubMed. The keywords included "preschool children, infant, toddler, school-age children, teenagers, adolescents, overweight, obesity, weight gain, body mass index (BMI), body fat rate, sufficient drinking water, water intake, water displacement and drinking water". The quality of the randomized controlled trial (RCT) study was evaluated by referring to the GRADE evidence quality evaluation method of WHO and using the JBI evidence-based health care center (2016) quality evaluation standard. Result After literature screening, a total of 4 articles were included in this systematic evaluation, of which one article showed that drinking water increased the consumption of resting energy, one study indicated that drinking water reduced weight, one study showed that drinking water reduced BMI, and one study showed that drinking water reduced the incidence of overweight and obesity, but reduced the intake of sugary drinks. Conclusion Preferred intake of water may help reduce total energy intake, body weight and BMI in children and adolescents.
Clinical Research
Nutrient biomarkers and their feeding factors for preterm children after introduction of complementary foods
HE Xiao-ying, WU Cui-ling, ZENG Ling-yan, QI Mei-jiao, SUN Ya-lian
2023, 31(1):  81-85.  DOI: 10.11852/zgetbjzz2022-0187
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Objective To investigate the feeding practices and their effects on the nutrient biomarkers of the preterm children after introduction of complementary foods, so as to give effective nutrition advice during introduction of complementary foods. Methods A total of 210 preterm children at the corrected age of 8 to 24 months old were enrolled in this study from Foshan Women and Children Hospital from March to August, 2020. Feeding practice and nutrient biomarkers data were collected. The correlation between nutrient biomarkers and feeding factors was analyzed by multiple linear regression analysis. Results 1) Totally 16.2% and 9.0% of the subjects took less cereal or milk than recommended respectively, while 29.0% took less animal food, 19.5% did not regularly intake vitamin D. Meanwhile, 66.2% could not guarantee at least 1 hour of outdoor activity per day, only 19.0% still took iron supplement as recommended. 2) Totally 5.2% of the subjects suffered from anemia, but 42.4% were with serum iron < 12 μmol/L and 11.9% with ferritin < 12 μg/L, 9.0% were with alkaline phosphatase > 350 U/L, 4.3% were with calcium-phosphorus product < 4, none suffered from vitamin D insufficiency, hypoalbuminemia or hypoglycemia. 3) After adjusting multi-factors, it was found that increase of cereal intake could raise hemoglobin(β=3.434,P=0.001) level, but reduce serum vitamin D(β=-5.858,P=0.002) level. Increase of animal food could raise serum iron(β=1.471,P=0.002) and ferritin(β=13.075,P=0.003) level, but reduce triglyceride(β=-0.267,P=0.029) level. Supplement of iron could raise serum ferritin(β=26.042,P=0.019), phosphorus(β=0.157,P=0.024) and calcium-phosphorus product(β=0.614,P=0.007) level. Increase of milk intake could raise calcium-phosphorus product(β=0.237,P=0.039) level and reduce alkaline phosphatase(β=-55.171,P=0.007) level. Conclusions The risk of iron deficiency might be higher than other nutrition related diseases for the preterm children after introduction of complementary foods. Cereal, animal food and milk intake, as well as iron supplements could mutually affect the homeostasis of calcium, phosphorus, iron, vitamin D and lipid metabolism. Therefore, dietary balance should be emphasized when giving nutrition advice.
Changes of neuron specific enolase, transcutaneous hour bilirubin, total bilirubin/albumin levels in full-term infants with hyperbilirubinemia and their correlation with long-term neurodevelopment
CHEN Yu-xia, LIU Hua-yan, FAN Qian-qian
2023, 31(1):  86-90.  DOI: 10.11852/zgetbjzz2021-1637
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Objective To investigate the changes of serum neuron specific enolase(NSE), transcutaneous hour bilirubin(hTcb) and total bilirubin/albumin(B/A) in full-term infants with hyperbilirubinemia and their correlation with long-term neurodevelopment, in order to provide reference for predicting the long-term outcome of neurodevelopment of full-term infants. Methods A total of 240 full-term newborns with hyperbilirubinemia in the Department of Pediatrics, Longhua District Central Hospital of Shenzhen City from January 2017 to June 2020 were selected into the observation group, meanwhile 240 healthy full-term infants were selected into the control group. The general data, serum levels of NSE, hTcb and B/A, and serum levels of NSE, hTcb and B/A in the observation group before and after treatment were compared. Logistic regression analysis was used to explore the relationship between serum indices and the incidence of hyperbilirubinemia. Children in the observation group were observed for 12 months, then were divided into good outcome group(n=214) and poor outcome group(n=26). Serum levels of NSE, hTcb and B/A of children in good outcome group and poor outcome group were tested before and after treatment, and the predictive value of serum NSE, hTcb and B/A in long-term neurodysplasia was observed. Results Serum levels of NSE, hTcb and B/A in the observation groupwere higher than those in the control group (t=57.464,14.967,38.399,P<0.001),and those in the observation group after treatment were lower than those before treatment(t=46.855,43.201,32.847,P<0.001). Logistic regression analysis showed that serum levels of NSE(OR=5.008,95%CI:3.263 - 7.685), hTcb(OR=5.051,95%CI:3.028 - 8.426)and B/A(OR=5.298,95%CI:2.856 - 9.829)were all important factors affecting the pathogenesis of hyperbilirubinemia in full-term infants(P<0.05). After treatment, serum levels of NSE, hTcb and BCMA in the observation group with good neurodevelopmental outcome were lower than those with poor outcome(t=28.441,5.190,17.499, P<0.05). The area under the curve(AUC) of the combined serum NSE, hTcb and B/A to predict long-term neurodevelopment was greater than that of the single indicator, the sensitivity and specificity of combined prediction were 88.46% and 91.12%, respectively. Conclusion The serum levels of NSE, hTcb and B/A in full-term infants with hyperbilirubinemia are abnormally increased, and the combined detection of the above three indicators can provide basis for the prediction of long-term neurodevelopment.
Epidemiological survey on neonatal congenital heart disease in Hainan Province in 2020
ZHANG Du-fei, ZHANG Xiang-yun
2023, 31(1):  91-95.  DOI: 10.11852/zgetbjzz2021-1797
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Objective To investigate the prevalence and risk factors of neonatal congenital heart disease(CHD) in Hainan Province, and to obtain epidemiological information on neonatal CHD, so as to provide support for the establishment of a neonatal CHD prevention and treatment programme in Hainan Province. Methods A multicenter, multiple-ethnic, cross-sectional screening study was performed. A total of 117 005 neonates consecutively born at delivery institutions in 17 urban and rural regions in Hainan from January 1st to December 31st, 2020 were enrolled. Cases of CHD were identified using transcutaneous pulse oximetry(POX) combined with cardiac auscultation screening, echocardiography and follow-up. Results A total of 572 newborns(50.7% male) were diagnosed with CHD. The overall prevalence of CHD among live births in Hainan Province was 4.89‰, with the prevalence of insignificant, significant, severe and critical CHD being 2.13‰、2.25‰、0.28‰ and 0.23‰, respectively. The most common CHD is atrial septal defect(ASD) with a prevalence rate of 1.889‰. The proportion of preterm infants with significant CHD and critical CHD was significantly higher compared with newborns without CHD(χ2=4.088, 4.923, P<0.05), and the proportion of low birth weight infants with severe CHD and critical CHD was significantly higher compared with newborns without CHD(χ2=24.284, 110.556, P<0.001). Among preterm infants with CHD, the total proportion of preterm infants with CHD at gestational age of 28 to 32 weeks was 60.3%(47/78), which was higher than that of preterm infants at gestational age of 33 to 36 weeks(39.7%(31/78)(χ2 =6.564, P<0.05). Among low birth weight children with CHD, the total proportion of those with birth weight of 1 500 -<2 000 g was 63.0%(29/46), higher than that of those with birth weight of 2 000 -<2 500 g(37.0%, 17/46)(χ2=6.261, P<0.05). The prevalence of CHD was significantly higher in some other ethnic groups(Miao, Hani and Yi) compared to the Chinese Han population(χ2=5.327, 8.233, 8.821, P<0.05). Correlation analysis showed that the prevalence of CHD in newborns was positively correlated with altitude(r=0.513, P<0.05). Conclusions POX combined with cardiac auscultation is suitable for CHD screening of newborns in remote areas. Premature birth, low birth weight and high altitudes are risk factors for CHD, which should be paid attention to during CHD screening.
Physical and neurological development of necrotizing enterocolitis in very low birth weight infants
WANG Hui-ping, WANG Li, GAO Qiong, BAI Bo-liang, MA Ying-jun
2023, 31(1):  96-100.  DOI: 10.11852/zgetbjzz2022-0621
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Objectives To investigate physical and neurodevelopment of neonatal necrotizing enterocolitis(NEC) in very low birth weight(VLBW) infants at correct gestational age of 3, 6, 9, and 12 months, in order to provide reference for the intervention of NEC. Method A retrospective case-control study was performed to collect data of VLBW infants with NEC and without NEC who were followed up in the Neonatal Outpatient of the Second Affiliated Hospital of Xi′an Jiaotong University from April 2018 to April 2021. The perinatal characteristics of infants in different NEC stages were analyzed, the physical and neurological development of infants in each group were compared at correct gestational age of 3, 6, 9 and 12 months. Results 1) A total of 122 cases were enrolled, including 51 cases in non-NEC group and 71 cases in NEC group. According to the modified Bell staging, there were 39 cases in NEC Stage Ⅱ and 32 cases in NEC Stage Ⅲ. There were no significant differences in birth weight, gestational age, head circumference, body length and gender among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(P>0.05). 2) There was significant difference in the physical development at correct gestational age of 3, 6, 9, and 12 months among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(birth weight F=13.31, 11.16, 10.28, 8.56; body length F=11.14, 7.32, 4.72, 8.18; head circumference F=9.69, 6.88, 10.42, 7.71, P<0.05). 3) There was significant difference in the mental developmental index(MDI)/psychomotor developmental index(PDI) scores of Bayley Scales of Infant Development-Ⅱ(BSID-Ⅱ) at correct gestational age of 3 month(F=17.58,16.72), 6 month(F=15.32,13.25), 9 month(F=18.66, 18.58), and 12 months(F=15.43, 11.45) among the NEC-stage Ⅱ group, stage Ⅲ group and non-NEC groups(P<0.05). Conclusions Neurodevelopmental outcomes in children with NEC are related to multiple factors, including gestational age, birth weight and complications, etc. Therefore, it is supposed to pay more attention to the delicacy management of children at high risk of NEC to reduce the occurrence and severity of NEC, so as to improve the long-term prognosis of these children.
Experience Exchange
Relationship between cord blood miR-431 and congenital hearing disorder in neonates
YUAN Yuan, CHEN Mi
2023, 31(1):  101-104.  DOI: 10.11852/zgetbjzz2021-1734
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Objective To study the relationship between cord blood miR-431 and congenital hearing disorders in neonates, so as to provide reference for clinical prevention and treatment of congenital hearing impairment. Methods From May 2017 to June 2019, 80 neonates with congenital hearing disorder admitted to the Department of Obstetrics and Gynecology, Pidu District People′s Hospital were enrolled as case group, while another 30 neonates with normal hearing were selected into normal group. The threshold of auditory brainstem response(ABR) test, and expression levelsof cord blood miR-431, miR-183 and miR-96 were compared between the two groups. The identification value of miR-431 and miR-183 for mild, moderate and severe hearing disorder was analyzed by ROC curve. Results After click, thresholds of left and right ears in ABR test in case group were significantly higher than those in normal group(t=22.166, 19.741, P<0.05). The miR-431 level in case group was significantly higher than that in normal group, while miR-183 level was significantly lower than that in normal group(t=15.445, 19.607, P<0.05). The miR-431 level in severe hearing disorder group was significantly higher than that in mild-to-moderate hearing disorder group, while miR-183 level was significantly lower than that in mild-to-moderate hearing disorder group(t=10.047,11.816,P<0.05). When the cut-off value of miR-431 was 0.48, the area under the curve(AUC) in discriminating mild, moderate and severe hearing disorder was 0.835(95%CI: 0.735 - 0.908, P<0.001).The sensitivity and specificity were 77.78% and 86.36%, respectively. When the cut-off value of miR-183 was 0.25, the area under the curve(AUC) in discriminating mild, moderate and severe hearing loss was 0.804(95%CI: 0.700 - 0.884, P<0.001).The sensitivity and specificity were 72.22% and 84.09%, respectively. Conclusions The left and right ear ABR thresholds of newborns with congenital hearing disorder are significantly higher than those of normal neonates, while the expression level of miR-431 in cord blood is abnormally up-regulated, while expression level of miR-183 is down-regulated. The miR-431 and miR-183 have better efficacy in discriminating mild, moderate and severe hearing disorder.
Screening and follow-up analysis of retinopathy of prematurity in three maternal and child health care hospitals in 2019
WANG Hui-ran, LUO Rong, HU Wen-ling
2023, 31(1):  105-108.  DOI: 10.11852/zgetbjzz2022-0141
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Objective To investigate the screening and follow-up stituation of retinopathy of prematurity (ROP) in maternal and child health care hospital, so as to provide suggestions for improving the quality of screening and follow-up. Method Screening, follow-up and intervention data of 3 579 premature infants, who were screened for ROP and met the screening criteria in triple A maternal and child health hospitals from January 1st to December 31st in 2019, were retrospectively investigated by referring to inpatient medical records, outpatient registration and ROP management files. Result The detection rate of ROP was 11.2%(400/3 579), 3.4% in stage 1, 6.2% in stage 2, and 1.6% in stage 3 and above. With the decrease of gestational age and birth weight, the detection rates of ROP and severe ROP increased. The detection rate of ROP in infants at corrected gestational age (week)of 31 ~ and 32 ~ group was higher in the first screening. The intervention rates of infants with ROP stage 1 and stage 2 were 1.6% and 1.7%, respectively, lower than 30.9% for ROP stage 3. The main intervention method was vitreous injection of drugs (91.3%). The settlement rate of all positive cases was 41.2%. The case settlement rate of infants with ROP stage 1 and stage 2 was 51.7% and 40.8%, respectively, higher than 21.8% for stage 3. Conclusion Maternal and child health care hospitals should improve the service capacity of eye care, strengthen ROP screening, improve the project management, regular follow-up, intervention of children with ROP and referral of positive cases to reduce the occurrence of adverse outcomes.
Clinical features and influencing factors of feeding intolerance in premature infants
SUN Xing, HU Xiao-shan, LIU Feng, LIU Bei-bei
2023, 31(1):  109-112.  DOI: 10.11852/zgetbjzz2022-0292
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Objective To analyze the clinical features and influencing factors of feeding intolerance(FI) in preterm infants with gestational age <37 weeks, in order to provide reference for early identification and early intervention in clinic. Methods The clinical data of 814 premature infants with gestational age <37 weeks who were hospitalized in Nanjing Maternal and Child Health Hospital from January to December 2020 were retrospectively analyzed. Infants were divided into FI group and feeding tolerance group. The clinical characteristics and influencing factors of FI in premature infants were analyzed. Results There were 128(15.7%) infants in FI group and 686(84.3%) infants in feeding tolerance group. The prevalence rates of FI in infants with gestational age <32 weeks, 32~<34 weeks and ≥34 weeks were 30.3%(70/231), 20.4%(28/137) and 6.7%(30/446), respectively. The prevalence rates of FI in infants with birth weight <1 500 g, 1 500 - < 2 500 g and ≥2 500 g were 32.6%(56/172), 12.7%(64/503), and 5.8%(8/139), respectively. The smaller the gestational age and the lower birth weight, the higher prevalence rate of FI(χ2=66.593, 50.621, P<0.001). The clinical manifestations of FI were mainly gastric retention(85.9%), abdominal distension(66.4%) and vomiting(43.8%). The clinical manifestations of FI in super/extremely preterm infants were mainly gastric retention and abdominal distension, which were mainly abdominal distention and vomiting in late preterm infants.Univariate analysis showed that the average gestational age and average birth weight of infants in FI group were significantly lower than those in feeding tolerance group(t=8.028, 8.588, P<0.001). The proportions of asphyxia, intrauterine infection, invasive respiratory support within 24 hours after birth, non-invasive continuous postive airway pressure(CPAP) support within 24 hours after birth, apnea, small-for-gestational-age infants and abnormal umbilical cord in FI group were significantly higher than those in feeding tolerance group(χ2=16.676, 24.771, 7.961, 83.757, 86.275, 3.878, 5.259, P<0.05).Multivariate Logistic regression analysis showed that non-invasive CPAP support within 24 hours after birth(OR=3.269, 95%CI:1.821 - 5.868) and apnea(OR=3.405, 95%CI:2.106 - 5.505) were independent risk factors of FI in premature infants(P<0.05). Conclusions The prevalence rate of FI in preterm infants decreases with the increasing gestational age and birth weight, and the clinical manifestations also vary according to gestational age. Non-invasive CPAP support within 24 hours after birth and apnea are independent risk factors of FI in preterm infants. Infants with those risk factors should be intervened early as soon as possible to improve feeding tolerance.
Case Report
Case report and literature review of PUF60 gene de novo mutation related Verheij syndrome
ZHONG Yao-yao, ZHANG Li-qin, LI Shuo, JI Yong-juan, LI Jun-xin
2023, 31(1):  113-116.  DOI: 10.11852/zgetbjzz2022-0356
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