Table of Content

10 January 2020, Volume 28 Issue 1

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Very early intervention with parents as mediators for autism spectrum disorder

KE Xiao-yan

2020, 28(1):  3-5.  DOI: 10.11852/zgetbjzz2019-1644

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Autism spectrum disorder is a neurodevelopmental disorder that seriously affects the development of children.For professional reference,this paper focuses on the research progress of very early intervention for autism spectrum disorder and the importance and necessity of parental involvement.

Research and intervention of eating behavior problems of children with autism

LIU Jie, DONG Ping, WANG Yi, XU Xiu

2020, 28(1):  6-9.  DOI: 10.11852/zgetbjzz2019-0714

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Objective To observe the eating behavior problems in children with autism spectrum disorder (ASD),and to explore the therapeutic effect of integrated diet intervention method based on family by parents education. Methods ASD children aged 18 to 72 months diagnosed in the Children′s Healthcare Department of Children′s Hospital of Fudan University were enrolled in this study from December 2017 to December 2018.A self-designed questionnaire was used to investigate the dietary behavior of children with ASD,and dietary guidance was given to the families of children with dietary behavior problems for one month.All children conducted physical measurement and their serum nutrition indexes were tested. Results Totally 310 ASD children were investigated,of whom 51.0% were picky eaters.Other behavioral problems included easily distracted by eating (35.3%),watching TV or playing with toys while eating (25.5%),and unwilling to eat at the table (19.0%).Overweight (11.6%) and obesity (11.2%) were of high prevalence in ASD children.And few children had decreasing levels of vitamin A,vitamin D,vitamin B₁₂ and zinc.The final intervention items in this study included 7 items.Different proportions of children improved in each item after intervention.It was found that the behavior improvement rate was higher when the caregivers were parents and the primary caregivers were highly educated(OR＞1,P<0.05). Conclusion Eating behavior problems in ASD children are high, and clinical intervention based on family is supposed to be promoted.

Application of eye tracking technology in clinical diagnosis of autism spectrum disorder

SUN Bin-bin, WEI Zhen, FENG Zhe, ZHANG Shi, LIU Ya-ling, YANG Jie, WAN Guo-bin

2020, 28(1):  10-14.  DOI: 10.11852/zgetbjzz2019-0974

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Objective To understand the eye track pattern and clinical behavior characteristics of autism spectrum disorder(ASD )children with eye track biased to look at social figures, and to provide an Objective basis for clinical diagnosis, thus to provide guidance for early intervention. Methods A retrospective analysis of the Results of eye track and behavioral scales of 107 ASD children in the department from January to June 2019 were conducted according to the consistency of eye movement Results and clinical diagnosis:consistent group (geometric gaze time > person gaze time, and clinical diagnosis of ASD), non-consistent group (geometric gaze time < character gaze time, and clinical diagnosis of ASD), using independent sample t test to compare differences between the two groups of ASD children. And a two-class Logistic regression was used to establish a model for assisted clinical diagnosis. Results 1)General situation:there was no significant difference in age between the two groups (P>0.05), but the Autism Rating Scale(CARS) score of children in the ASD group was significantly higher than that in the non-consistent group (t=2.39,P＜0.05).2)The Results of the relevant scales were consistent.The fine motor assessment and social skills assessment of children with ASD were significantly behind the non-consistent group (t=-1.61,-2.65,P＜0.05), and there was no significant difference between the two groups (P>0.05).3)Eye track results: two groups for the first time, children paid attention to the different areas of interest of their faces, and their gaze paths were different.Among them, the consistent group focused on the mouth area for the first time, and the non-consistent group initially focused on other areas; The eye track gaze time of the non-core area of the consistent group ASD children was significantly higher than that of the non-consistent group, and the fixation time(FT) of the eyes and mouth was significantly lower than that of the non-core group.In the consistent group (t=2.47,-2.21,-3.51,P＜0.05), there was no significant difference in eyetrack FT between the two groups in the nose and other areas (P>0.05).4)Establish the model:Ln(P/1-P)=β₀+β₁X₁+β₂X₂+β₃X₃+…+β_nX_n=0.09X_CARS-0.07X_Socialskills-0.05X_{Fine action}+0.01X_{First fixation time}+0.01X_{fixation time}, the sensitivity of this model was consistent with 79.4%, specificity with 74.2%, the total judgment rate was 75.9%. Conclusions ASD children biased towards social figures are more sensitive to social skills and fine motor skills than ASD children biased towards geometric figures, and their degree of disease is mild.The established auxiliary model has certain value for clinical diagnosis.

Mediating effect of social support in the mental health and suicidal ideation of overweight and obese adolescents

REN Meng-fei, LI Hai-yan, WANG Dan, CHEN Yun, HOU Ya-nan, ZHENG Wen-gui

2020, 28(1):  15-18.  DOI: 10.11852/zgetbjzz2019-0784

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Objective To explore the relationship between mental health, social support and suicidal ideation among overweight and obese adolescents, and to provide guidance for promoting the mental health development of overweight and obese adolescents and reducing the detection rate of suicidal ideation. Methods From April to March 2018,4 250 adolescents in Weifang City were selected and investigated using the Suicide Self-Assessment Scale (SIOSS), the Mental Health Self-Assessment Scale (K10), and the Social Support Scale (SSRS). Results The overweight detection rate of adolescents was 9.55% (406/4 250), and the detection rate of obesity was 6.94% (295/4 250).The mental health scores of rural overweight and obese adolescents were significantly higher than those of urban adolescents(P<0.001).The social support scores of urban overweight and obese adolescents were significantly higher than those of urban adolescents(P<0.001).In rural areas, the scores of suicidal ideation among overweight and obese adolescents were significantly higher than those in urban areas; Mental health and suicidal ideation were significantly positively correlated(r=0.639, P<0.01), and social support was significantly negatively correlated with mental health and suicidal ideation (r=-0.378 and -0.449, P<0.01); Mental health and social support had significant predictive effects on suicidal ideation in overweight and obese adolescents (β=0.278 and -0.197, P<0.01; R²=0.459), and social support played a partial intermediary role between mental health and suicidal ideation. Conclusion By improving their mental health status and improving the social support of overweight and obese adolescents, the suicidal ideation of overweight and obese adolescents can be reduced.

Amplitude of low frequency fluctuation study on brain in children with attention deficit hyperactivity disorder-based on near infrared imaging technology

LIAO Wen-jing, ZHU Zhao-jun, NIU Hai-jing, QIAN Qiu-jin, WANG Yu-feng

2020, 28(1):  19-22.  DOI: 10.11852/zgetbjzz2019-0958

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Objective Using near infrared spectroscopy (NIRS)to investigate spontaneous activity′s characteristics of the brain area in the resting-state and the correlation with clinical symptomsin in children with attention deficit hyperactivity disorder(ADHD), and then explore the pathological mechanism of ADHD. Methods A total of 20 ADHD children and 20 normal controls matched by sex and age were collected from March to June 2017.The Chinese Wechsler Intelligence Scale for Children, ADHD symptom rating questionnaire were used to access intelligence quotient and clinical symptoms.NIRS was used to collect brain images.The amplitude of low-frequency fluctuation (ALFF) and Pearson partial correlation analysis were used to explore the differences of brain function and the correlation with clinical symptoms of ADHD. Results 1)Children with ADHD had higher ALFF in right dorsolateral prefrontal cortex, right pre-motor and supplementary motor cortex, left dorsolateral prefrontal cortex and frontopolar area, left superior/ middle temporal gyrus and primary auditory association cortex, left inferior prefrontal gyrus, left orbitofrontal area than control subjects(t=-2.48,-2.41,-2.66,-2.12,-2.51,-0.039,P<0.05).2)In the ADHD group, the associations between the scores of hyperactivity and impulsivity with left inferior prefrontal gyrus, orbitofrontal area, frontopolar area(r=0.562,P=0.036)and left superior/middle temporal gyrus, primary auditory association cortex(r=0.541, P=0.046) were positive(P<0.05). Conclusions Brain functional abnormalities contributed to the emergence of ADHD.Children with ADHD probably have higher spontaneous activity of the brain area in the resting state.The brain functional connectivity was associated with the severity of hyperactivity impulsive symptoms in ADHD.

Influence of responsive caregiving at 2 months of age on the development of infants during the first 6 months:a birth cohort study

QI Yue, ZHANG Yu-di, JIANG Zi-han, MA Xue-mei, TAN Li-wei, SHI Hui-jing

2020, 28(1):  23-27.  DOI: 10.11852/zgetbjzz2019-1043

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Objective To analyze the influence of responsive caregiving at 2 months of age on the development of 2-month-old and 6-month-old infants and to provide evidence for the promotion of the nurturing care framework for early childhood development published by WHO in China. Methods From April 2016 to October 2018, the baseline information of pregnant women from Shanghai Maternal-Child Pairs Cohort was collected at enrolment and the infants were followed up until they were 6 months old.Information of maternal pregnancy-related condition and infants′ general condition were obtained from obstetric record.The practices of responsive caregiving at 2 months of age were evaluated by self-administered questionnaire.The infant development was assessed by the third edition of Ages and Stages Questionnaire (ASQ-3) at 2 months old and 6 months old. Results A total of 2 853 infants were followed up at the age of 2 months and 1 850 of them were followed up at 6 months of age.Apart from 2 items of offering infants skin-to-skin contact and positive interaction as 91.0% and 92.1%, respectively, the remaining 4 items reached relatively higher rates.Univariate analysis showed that annual household income, maternal educational level and maternal postpartum depression were significantly associated with the adequacy of responsive caregiving at age of 2 months (all P＜0.05).After adjustment for potential confounders, multivariable unconditional logistic regression analysis showed that compared to infants in adequate responsive caregiving group, the risk of developmental delay on gross motor, fine motor, problem solving, and personal-social scales among infants in the inadequate group increased significantly by 125%,442%,167% and 162% at 2 months of age, and the risk of developmental delay on personal-social scale increased significantly by 129% at 6 months of age.In addition, infants in the general group had a 222% increased risk on fine motor scale and a 136% increased risk on problem solving scale at 2 months of age. Conclusion Inadequate responsive caregiving at 2 months of age significantly stunted gross motor, fine motor, problem solving, and personal-social development of 2-month-old infants, and the negative impact on personal-social scale may continue to 6 months of age.

Sequence expression of neonatal breast-seeking behavior and its influencing factors during skin-to-skin contact

CUI Min, TIAN Xiao-ming, WANG Ai-hua, ZHANG Xiao-yan, WANG Ying, ZHANG Yuan-yuan

2020, 28(1):  28-31.  DOI: 10.11852/zgetbjzz2019-0208

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Objectives To explore the sequence expression of neonatal breast-seeking behaviors during skin-to-skin contact,and to analyze influencing factors of locate breast, in order to lay the foundation for further exploring the neurobehavioral development early in newborn life. Methods A total of 71 mother-newborns pairs who gave birth naturally from March to June 2018 in a tertiary hospital in Shandong were recruited randomly in this study. The Widström nine stages were used to observe and record infants′ breast-seeking behaviors during skin-to-skin contact. Results Totally 39 neonates showed complete sequence of neonatal breast-seeking behaviors during skin-to-skin contact,including cry,eyes opened,legs kicked,arms stretched,head up or turned around,hand-to-mouth,moved towards the nipple,located the areola,latched the nipple,sucked,fell asleep in (90.5±21.3) minutes. Regression Results showed that labor analgesia (OR=3.874,95%CI:1.067-14.060) and interval time for skin-to-skin contact≥10min(OR=11.607,95%CI:1.318-102.214) were influencing factors for infants locating the areola(P<0.05). Conclusions Newborns show a fixed sequence of breast-seeking behaviors during skin-to-skin contact and can fall asleep after locating the areola and the first breast feeding successfully without artificial intervention. The main influencing factors of areola location include labor analgesia and interval time for skin-to-skin contact.

Association between CTLA-4 gene polymorphism with childhood bronchial asthmatic susceptibility and levels of IFN-γ, IL-4 and IgE in peripheral blood

XU Qing-rong, SONG Li, ZHANG Yan

2020, 28(1):  32-36.  DOI: 10.11852/zgetbjzz2019-0795

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Objective To explore the relationship between CTLA-4 gene polymorphism and susceptibility to bronchial asthma in children and peripheral blood IFN-γ, IL-4 and IgE, and provide theoretical and clinical basis for the diagnosis and treatment of bronchial asthma in children. Methods From April 2017 to February 2019,78 children with bronchial asthma in the Third Affiliated Hospital of Zhengzhou University were in the case group, and 67 healthy children in the physical examination were used as the control group.The rs231725 single nucleotide polymorphism of CTLA-4 gene was detected in both groups, and the levels of IFN-γ, IL-4 and IgE in peripheral blood of the case group were also detected. Results The proportion of CTLA-4 rs231725 AA genotype was higher in the case group than in the control group (66.7% vs 19.4%), and the proportion of CTLA-4 rs231725 GG genotype was lower than that in the control group (19.3% vs 73.2%) (P<0.05); CTLA-4 rs231725 A allele frequency ratio was higher than in the control group (73.7% vs 23.1%) (P＜0.05), and the CTLA-4 rs231725 G allele frequency ratio was lower than in the control group (26.3% vs 76.9%) (P <0.05); CTLA-4 rs231725 AG genotype IFN-γ, IL-4, IgE levels were higher than GG genotype, and the differences were statistically significant (P<0.05); At CTLA-4 rs231725 genotypes and allele frequencies, there were no significant correlation between bronchial asthma and urinary system damage, bronchial asthma with digestive tract reaction (P>0.05).CTLA-4 rs231725 AA genotype(OR=2.625,95%CI=1.273-5.138) and A allele(OR=1.987,95%CI=1.121-3.397) frequencie were associated with bronchial asthma with nephritis(P<0.05). Conclusion CTLA-4 rs231725 AA genotype and A allele are associated with increased susceptibility to bronchial asthma in children, which may be caused by the high levels of IFN-γ, IL-4, and IgE.

Relationship between family environmental characteristics, behavioral problems and social function impairment in children with attention deficit hyperactivity disorder

ZHANG Gui-xiang, XUE Li, ZHU Ping, CAI Ying, ZHU Mei, WANG Yu-qing, JIANG Ting-ting

2020, 28(1):  37-40.  DOI: 10.11852/zgetbjzz2019-0845

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Objective To explore the relationship between family environmental characteristics, behavioral problems and social function impairment in children with attention deficit hyperactivity disorder(ADHD), and to provide scientific evidence for clinical diagnosis and treatment of ADHD. Methods A total of 140 children with ADHD in Xuzhou Children′s Hospital from September 2017 to November 2018 were enrolled as the observation group, and 120 healthy children were recruited as the control group.Self-designed questionnaire, Chinese version of Family Environment Scale (FES-CV), Conners Parent Rating Scale (CPRS), Conners Teacher Rating Scale (CTRS) and Weiss Functional Deficit Scale Parental Edition (WFIRS-P), on-site Behavioral observations were used to assess children.Logistic regression model was used to predict risk factors for attention deficit hyperactivity disorder. Results The risk of ADHD in children increased with the decrease in education (OR=1.16,8.80,9.20), occupational status (OR=0.89,2.24,2.35,5.90)and emotional stability (OR=1.74); The level of occupational and educational levels, emotional state were similar to the above results.The difference in contradiction only in the ADHD Children′s Chinese Family Environment Scale (FES-CV) was statistically significant (t=4.342, P＜0.001).ADHD children showed impairment in all six Weiss Functional Deficit Scale Parental Edition (WFIRS-P) subscale tests [lowest dimension score (0.19 ± 0.22) points, healthy children highest dimension score (0.19 ± 0.20) points, P<0.001].The Conners Parental Rating Scale (CPRS) and the Conners Teacher Rating Scale (CTRS) had statistically significant differences except the dimensions of the psychosomatic disorder (P＜0.001). Conclusions Children with ADHD have a worse family environment, lower education levels, worse occupational status, and emotional instability in their parents than healthy children, which may increase children′s risk of ADHD and interact with child behavioral problems and social dysfunction.Therefore, early interventions focused on compromise factors can help improve the social behavioral function of children with ADHD.

Review of the main characteristics and measurement of restricted and repetitive behaviors in autism spectrum disorder

LIAO Shan, LI Meng-qi, DAI Ying

2020, 28(1):  41-44.  DOI: 10.11852/zgetbjzz2019-0211

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Restricted and repetitive behaviors(RRBs) is a common behavior pattern in childhood.In typically developing children,repetitive behavior is the repeated practice of children′s behavior,language and games,with the aim of mastering skills.But in other developmental disorders among children,RRBs is closely related to the abnormal developmental process.The clinical evolution and evaluation of these behaviors in children with different developmental states,especially in children with autism spectrum disorders (ASD),deserve much attention.This review aims to shed light on the problem obove and provide reference for further research by combing the relevant literature.

Research progress on the genetics of autism spectrum disorder

LI Sheng, JIANG Hong, FEI An-xing, ZOU Tian-tian

2020, 28(1):  45-47.  DOI: 10.11852/zgetbjzz2019-0454

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Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors,repetitive and stereotyped behaviors.ASD children usually have cognitive and emotional disorders,mainly caused by factors such as early development,genetic and abnormal brain functions.This review combs the advances in genetics of ASD.

Early prediction of autism spectrum disorders based on eye movement research

LI Fei-rong, CHEN You-qing

2020, 28(1):  48-51.  DOI: 10.11852/zgetbjzz2019-0273

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Autism spectrum disorder(ASD) is generally characterized by social disorders,narrow range of interests,behavioral stereotypes and eye fixation. Abnormal eye fixation is one of the clinical manifestations of ASD and an early biomarker for children with ASD. Eye movement technology has been gradually applied in clinical and related research of ASD. The current early predictions using eye movement technology mainly focus on the gaze time of the face,the eye movement characteristics of visual search and the attention to geometric figures. It is more consistent that the fixation time of the face and eye area is short,the fixation time of the geometric figure is long,and the advantage in visual search can be used as an early predictor of ASD. This review summarizes the early prediction of ASD using eye movement technology in the past few years in order to provide reference for the early detection of ASD.

Research advances on pathogenesis and interventions of sleep disorders for children with autism spectrum disorder

ZHAO Qin, SHAO Zhi

2020, 28(1):  52-56.  DOI: 10.11852/zgetbjzz2019-0471

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Sleep disorders are commonly reported comorbidities in children with autism spectrum disorder (ASD),which might not only exacerbate the core symptoms of ASD,but also adversely impact the intervention efficacy.The potential mechanism for sleep disorders of ASD is not clear so far,it might be due to the abnormal sleep regulation,ASD core symptoms,the co-occurring comorbidities,medical conditions,nutritional deficiency,and the medications commonly used.There are no specific therapeutic interventions for sleep problems of ASD currently,and parent education combined with behavioral interventions is recommended.

Research advances on early interventional programs for children with autism spectrum disorders

MA Chen-huan, WANG Yu

2020, 28(1):  57-60.  DOI: 10.11852/zgetbjzz2019-0614

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Autism spectrum disorder (ASD) is a complex,multidisciplinary neurodevelopmental disorder characterized by social communication disorders,repetitive and stereotyped behaviors,and narrow interests.At present,the prevalence of ASD is on the rise worldwide,and most ASD children have poor prognosis.Early intervention can significantly improve the poor prognosis of ASD children.This paper combs related intervention programs,including applied behavior analysis (ABA),pivotal response treatment (PRT),early start Denver model (ESDM),floortime,treatment and education of autistic and communications handicapped children (TEACCH) as well as social communication,emotional regulation and transactional support (SCERTS).

Prevalence and the risk factors of television viewing by infants and toddlers in Ma′anshan city

ZHOU Shan-shan, YAN Shuang-qin, CAO Hui, GAO Guo-peng, CAI Zhi-ling, GU Chun-li, LIU Ting-ting, QIAN Zhi-kan, WANG Hao, LIU Zi-jian, TAO Fang-biao

2020, 28(1):  61-64.  DOI: 10.11852/zgetbjzz2019-1087

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Objective To assess the prevalence of childhood television viewing in the urban area of Ma′anshan city and analyze the affecting factors. Methods Children were recruited from December 2016 to December 2017 in Ma’anshan Maternal and Child Health Care Hospital, an open sedentary behavior questionnaire was used to collect the television viewing time of children aged 12 months and 18 months who underwent 4-2-1 physical examination, and social demographic characteristics, video exposure with parents and other information were also collected. Results The total television viewing revalence of children aged 12 months and 18 months was 63.2% and 89.4%, respectively, and child mean daily screen time was (15.0±25.3) minutes and (41.2±49.5) minutes, respectively.According to the Results of multivariate binary Logistic regression analysis, parents believed that children watching TV was beneficial to infants′ cognitive development, family TV was often played, parents accompany children to watch TV, and children were often controlled to watch TV, which were risk factors for improper video exposure of children aged 18 months, and the OR values were 3.15,6.30,7.64 and 6.57(P<0.05) respectively. Conclusions Television viewing of infants and toddlers is common in Ma ′anshan city.The beliefs and behavior of parents and the household media environment are the risk factors of children′s television viewing.Parents should be taught to lead by example and reduce family screen time to reduce the television viewing of children to promote healthy growth.

Association between interleukin-1β single nucleotide polymorphisms and sepsis in full-term neonates

ZHAO Xiao-fen, ZHOU Xing, ZHANG Yan, HU Hao, QIU Li-ling, LI Yang-fang

2020, 28(1):  65-68.  DOI: 10.11852/zgetbjzz2019-0513

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Objective To study the association between single nucleotide polymorphisms(SNP) in interleukin-1β(IL-1β) and sepsis in full-term neonates,in order to provide theoretical evidence for the prevention of neonatal sepsis. Methods A total of 50 neonates with positive result of blood culture and diagnosed with sepsis in Kunming Children′s Hospital were selected as sepsis group from January to December 2017,and 50 children with clinical symptoms and negative Results of blood culture were selected in clinical sepsis group.Meanwhile,50 children without infection were in control group.The polymorphisms of IL-1β(rs1143627 and rs1143643) were analyzed using the Sequenom SNP,and the genotypic and allelic frequencies among three groups were compared.The relationship between IL-1β genotypes and sepsis was analyzed by Logistic regression. Results No significant differences were found on genotypic frequencies of IL-1β rs1143627(C/T)(P＞0.05)among sepsis group,clinical sepsis group and control group.But the genotypic frequencies of IL-1β rs1143643(C/T) were significantly different among three groups(χ²=15.94, P<0.05).Moreover,there were no significant differences on the allelic frequencies of the SNPs among the three groups(P>0.05).Logistic regression analysis indicated that gestational age was closely associated with neonatal sepsis(OR=0.6,95%CI:0.418-0.915),while the influences of gender,age,polymorphisms in rs1143627 and rs1143643 genes on neonatal sepsis were not significant(P>0.05). Conclusion Gestational age is the influencing factor of neonatal sepsis.IL-1β polymorphisms(rs1143627 and rs1143643) may not have any association with neonatal sepsis.

Correlation study of S-S language retardation test to evaluate the developmental characteristics of children with language developmental retardation

YAO Dan, LI Fang-fang, SHEN Ji-yang, GAO Min-jie, ZHAO Zheng-yan

2020, 28(1):  69-72.  DOI: 10.11852/zgetbjzz2019-0898

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Objective To explore the developmental characteristics of language developmental retardation children in different age groups, and to provide scientific basis for early detection and comprehensive intervention. Methods A total of 652 children aged 1-3 years who were admitted due to language development retardation were evaluated by S-S language retardation method from Janurary 2018 to March 2019.They were divided into four groups according to different age groups, and the developmental characteristics of children in different groups were analyzed and described. Results 1) With the growth of age, the number of children seeking medical treatment for language problems was increasing, and the peak age was >1.5-2.5 years old.Boys were significantly more than girls(male 526, female 126), and there was no difference between each of the two groups(P=0.102).2) Abnormal communication attitude in 1-1.5 years old group was 11.1%,>1.5-2 years old group was 15.7%,>2-2.5 years old group was 12.2%,>2.5-3 years old group was 21.9%.There was no statistical difference in the proportion of abnormal communication attitude between each group(χ²=6.171,P=0.104).Abnormal motor subject and abnormal language understanding in 1-1.5 years old group were 26.7% and 66.7%,>1.5-2 years old group were 46% and 82.8%,>2-2.5 years old group were 68.1% and 93.9%,>2.5-3 years old group were 78.1% and 99.0%.There was statistically significant differences among the four groups (P<0.001).3) As the age increases, the proportion of abnormal motor task and language comprehension ability increases gradually, and the most significant difference was around 2 years old. Conclusions Language retardation is most common in children around age 2, and is more likely to have comprehension abnormalities and other developmental problems after age 2.Therefore, it is necessary to do early screening and early intervention training for this age group.

Clinical analysis of necrotizing enterocolitis in small for gestational age and appropriate for gestational age neonates

DONG Hui-fang, ZHANG Xiao-li, LI Wen-Li, XU Fa-lin

2020, 28(1):  73-77.  DOI: 10.11852/zgetbjzz2019-0522

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Objective To observe the difference on clinical characteristics between small for gestational age(SGA) and appropriate for gestational age(AGA) infants with necrotizing enterocolitis(NEC),so as to provide evidence for the prevention of NEC. Methods A total of 236 cases with NEC(stage Ⅱand Ⅲ) hospitalized from January 1st,2014 to December 31th,2018 were enrolled in this study,and were divided into SGA group(55 cases) and AGA group(181 cases).The differences on clinical characteristics between the two groups were analyzed. Results 1) The proportions of cesarean section(83.6%vs.59.7%),maternal hypertention during pregnancy(56.4% vs.24.9%) and fetal distress(32.7% vs.11.6%)in SGA group were significantly higher than those in AGA group(P＜0.05).2) The proportions of clinical stage Ⅲ(41.8% vs.26.5%) and poor prognosis(abandonment and death)(25.5% vs.13.3%) of AGA were significantly higher than those of AGA,and the hospitalization duration[25(16,23) vs.17(12,24)] of SGA was significantly longer than that of AGA(P<0.05).There were no significant differences on the age of start feeding,the onset of NEC,the ratio of RBC transfusion within 72 hours before the onset of NEC,the levels of WBC,CRP and PLT,the positive rate of etiological examination(stool culture and blood culture) and the number of cases of surgical treatment between SGA and AGA groups(P＞0.05).Logistic regression analysis showed that the risk factors for the poor prognosis of SGA included clinical stage Ⅲ of NEC(OR=15.211,95%CI:2.998-26.107),sepsis after diagnosis of NEC(OR=10.440,95%CI:1.627-19.377),shock(OR=12.256,95%CI:2.896-21.058) and intestinal perforation(OR=6.305,95%CI:1.473-8.240).Meanwhile,risk factors for the poor prognosis of AGA were clinical stage Ⅲof NEC(OR=13.352,95%CI:1.866-18.540),sepsis after diagnosis of NEC(OR=9.662,95%CI:2.508-16.004) and shock(OR=11.254,95%CI:2.183-17.005). Conclusions NEC in SGA infants is more serious than that in AGA,and the prognosis is poorer in SGA infants.Thus,complications after NEC should be treated actively in order to reduce the mortality.

Preliminary study on responsive feeding of preterm infants during food conversion period

SUN Ya-lian, HE Xiao-ying, ZENG Jia-ying, WU Cui-ling, LIU Ke, ZENG Ling-yan

2020, 28(1):  78-81.  DOI: 10.11852/zgetbjzz2019-0155

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Objective To understand the status of responsive feeding of preterm infants during food conversion period,in order to provide theoretical evidence for the appropriate and scientific feeding. Methods Totally 268 preterm infants aged 18 months (including 60 high-risk infants,55 moderate-risk infants and 153 low-risk infants) were recalled for the study from January to December 2018.And 117 full-term infants in the meantime were chosen as control.A retrospective survey was conducted,and the data were analyzed by chi-square test or one-way analysis of variance. Results 1) The proportion of adverse feeding behaviors in preterm infants was higher than that in full-term infants.Among three feeding behaviors,mixed feeding behavior accounted for the highest proportion.Weight and height under adverse feeding behavior were lower than those under good feeding behavior at the age of 18 months.2) Preterm infants had more complementary meals than full-term infants at the corrected age of 4-5 months old and 6 months old (F=75.86,26.75,P<0.05),and totally 35.4% of them did not follow the recommended time to arrange complementary meals.3) The proportion of feeding difficulty in preterm infants was significantly higher than that of full-term infants (46.6% vs.35.0%,P<0.05). Conclusion Preterm infants are prone to suffering from adverse feeding behaviors,inappropriate complementary meal arrangements and feeding difficulty during food conversion period.

Association between child rearing environment and autistic traits

QIAN Sheng, XU Yong, YAN Bo-qiu, XU Xin, WANG Ying-quan, LI Jia-yu, JIA Rui-xia, LI Jing

2020, 28(1):  82-85.  DOI: 10.11852/zgetbjzz2019-1044

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Objective To investigate the relationship between autistic traits and family nurture environment and supply reference for reducing the occurrence of autistic traits among children. Methods Random cluster sampling method was used to select children from 8 kindergartens in Suzhou City.Clancy Autism Behavior Scale (CABS) and Child Home Nurture Environment Scale was used to conduct cross-sectional investigation among the children and their parents.Epidata version 3.1 and IBM SPSS 20.0 were used to analyze data. Results There were significant differences on the scores of language/cognitive information, emotional warmth/ self-expression, social adaptation/self-care, neglect/intervention punishment, activity diversity/game participation and environmental atmosphere between the group with autistic symptom and without symptom(t=-7.608,-6.251,-7.008,-6.008,-5.219,-8.550,P<0.01).Male gender(OR=1.695,95%CI:1.207-2.381), period of separation(OR=2.153,95%CI:1.225-3.782), social adaptation/self-care(OR=1.049,95%CI:1.002-1.098), neglect/intervention punishment(OR=1.147,95%CI:1.073-1.226), environment atmosphere(OR=1.053,95%CI:1.029-1.079) were the risk factors of children autistic traits(P<0.05). Conclusions Male gender,period of separation, social adaptation/self-care, neglect/intervention punishment and environment atmosphere are risk factors of autistic traits.It is necessary to pay more attention to improve family nurture environment in early childhood.

Relationship between thyroid function and iron overload in children with β-thalassemia major

DUAN Li, LI Tong, WANG Feng

2020, 28(1):  86-88.  DOI: 10.11852/zgetbjzz2019-0844

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Objective To study the relationship between thyroid function and iron overload in children with β-thalassemia major(β-TM) and to improve the thyroid function. Methods From January to December 2018,44 children with β-TM were treated in Zhuhai Municipal Maternity and Child Health Care Hospital.Their free T3(FT3), free T4(FT4), thyrotropin(TSH) and serum ferritin(SF) were detected by chemiluminescence.The incidence of hypothyroidism in children was investigated and the relationship between SF and TSH was analyzed. Results Among 44 children with β-TM, there were 0 case of hypothyroidism and 6 cases of subclinical hypothyroidism(13.6%).There was a positive correlation between SF and TSH(r=0.399,P＜0.05).The level of SF [(5 933.00±2 405.41)μg/L]in subclinical hypothyroidism children was significantly increased(t=-3.174,P＜0.05).In irregular iron removal group,there were higher levels of SF,TSH[(5 322.50±1 956.37)μg/L,(9.95±9.27)mU/ml] and incidence of subclinical hypothyroidism(33.3%)(t=6.186,2.678,χ²=8.273,P<0.05). Conclusions Thyroid function in children with β-TM is related to SF and irregular iron removal.It is necessary to regulate iron removal to prevent thyroid dysfunction.

Investigation of influenza vaccination rate and related factors among children under 5 years old in Binzhou of Shandong

LI Guang-jing, SHEN Xin-hua, YANG Yan-hong, QIU Shou-fang, LIU Ke-na

2020, 28(1):  89-92.  DOI: 10.11852/zgetbjzz2019-0247

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Objectives To investigate the influenza vaccination rate of children under 5 years old in 10 outpatient vaccination clinics in Binzhou City of Shandong Province from 2015 to 2017,and to analyze the influencing factors,in order to provide data for the influenza vaccination. Methods A total of 480 parents of children under 5 years old in Binzhou were investigated by self-made questionnaire and analyzed retrospectively.The influencing factors of influenza vaccination among children under 5 years old were analyzed by Logistic regression model. Results Influenza vaccination rate of children under 5 years old in 10 vaccination clinics in Binzhou City decreased from 42.29% (203/480) in 2015 to 20.21% (97/480) in 2017,among which the vaccination rate of children aged 3 to 5 years old decreased from 26.87% (129/480) in 2015 to 13.13% (63/480) in 2017,and the vaccination rate of infants under 3 years old decreased from 15.42% (74/480) in 2015 to 7.08% (34/480) in 2017,with significant downward trends (χ²=11.073,14.312,P< 0.05).Parents with educational level higher than middle school (senior high school/secondary vocational college/higher vocational college OR=1.49,95% CI: 1.08-2.04;undergraduate/college OR=2.45,95% CI: 1.61-3.73;master degree or above OR=3.90,95% CI: 1.70-8.87),family monthly per capita income higher than 3 000 yuan (3 000-5 999 yuan OR=1.35,95% CI: 1.07-1.71;≥6 000 yuan OR=2.37,95% CI: 1.25-4.51),employees of government,enterprises and institutions (OR=3.15,95% CI: 1.71-5.80)and having knowledge on influenza vaccine(OR=2.24,95%CI:1.56-3.21) were factors which can promote the vaccine coverage rate in children. Conclusions Education level,family income and knowledge on influenza vaccine are the important factors affecting the influenza vaccination rate of infants and young children.Thus,it is suggested to conduct health education on influenza vaccination.

Composition and clinical significance of bacteria in sputum of children with severe pneumonia

XU Hui-min, MA Yong-tao, LI Jie

2020, 28(1):  93-95.  DOI: 10.11852/zgetbjzz2019-0295

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Objective To analyze the bacterial composition and clinical significance of sputum in children with severe pneumonia,in order to provide scientific evidence for clinical treatment. Methods A total of 1 136 children in Pediatric Intensive Care Unit of Children′s Hospital of Kaifeng were selected from May 2013 to January 2018.The drug resistance characteristics of the isolates were analyzed. Results A total of 921 pathogens were detected in 667 sputum specimens,mainly Gram-negative bacteria(708 strains). Bacterial distribution was not significantly different in different age groups.Klebsiella pneumoniae and Pseudomonas aeruginosa mainly existed in spring,summer and autumn.Staphylococcus aureus was mainly in winter.Klebsiella pneumoniae and Pseudomonas aeruginosa showed high resistance to AMK,GEN,CIP(87.86%,83.24%,81.50%) as well as CAZ,CPD and FOX(77.18%,77.18%,66.44%),respectively.And Staphylococcus aureus was primarily resistant to IPM,COT,FOX and ERY(82.68%,73.23%,70.08%,70.08%). Conclusion The pathogens in children with severe pneumonia are characterized by a clear seasonal distribution,and treatment should be based on past experience and drug resistance.

Influence of intellectual protection training on neonatal behavioral neurological assessment level among asphyxiated term infants

YE Wen-ya, ZHANG Li-ping, ZHAO Yi-wei, BAO Yu-li, MAO Xu-jie

2020, 28(1):  96-99.  DOI: 10.11852/zgetbjzz2019-0475

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Objective To observe the influence of intellectual protection training on the neonatal behavioral neurological assessment(NBNA) score of asphyxiated term infants. Methods Totally 79 term infants treated in a tertiary hospital from January to December 2018 were enrolled in this study,and were divided into control group(n=39) and intellectual protection training group(n=40) by random number table.Routine newborn care was given to the control group,while intellectual protection training group received intellectual protection training additionally.NBNA score of two groups were assessed and compared in 3,7,14 and 28 days after birth. Results NBNA score significantly increased in the intellectual protection training group than the control group in 7,14 and 28 days after birth(P＜0.05),but there was no significant difference between the two groups in 3 days after birth.Moreover,the ratios of abnormal NBNA result in intellectual protection training group was significantly higher than those in control group in 14 and 28 days after birth(P＜0.05),but the difference was not significant in 7 days after birth. Conclusion It is beneficial to improve the neurodevelopment by insisting on long-term intellectual protection training for asphyxiated term infants.

Effects of budesonide on the level and immune function of chemokin-like factor-1 in children with acute asthma induced by infection

WANG Xiu-li, ZHAO Yan, LIU Ping, GUAN Li-xia

2020, 28(1):  100-103.  DOI: 10.11852/zgetbjzz2019-0004

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Objective To analyze the effect of budesonide on the level of chemokin-like factor-1 (CKLF-1) and immune function in children with acute asthma induced by infection. Methods The clinical data of 100 cases of acute attack of infection-induced asthma treated in our hospital from March 2015 to May 2018 were selected for analysis, and were divided into two. The control group received routine treatment. The observation group was given with budesonide on the basis of the control group, and the clinical efficacy of the two groups of patients after treatment was analyzed. Results The scores of daytime and nighttime symptoms in the observation group were lower than those in the control group and the number of acute attacks was lower than those in the control group within 6 weeks and 12 weeks, and the difference was statistically significant (t=23.276,20.732,53.137,48.590,12.514,P<0.001).There were no statistically significant difference in levels of inflammatory cytokines, T-lymphocyte subsets and pulmonary function levels between the two groups before treatment (t=0.097,0.020,0.251,1.299,1.301,0.272,0.151,0.208,0.100,0.294,P＞0.05). After treatment, the levels of interferon (IFN-γ), T lymphocyte subsets, forced expiratory volume in 1 second (FEV1), vital capacity (VC), FEV1 percentage of expected value (FEV1 %), and the levels of forced vital capacity (FVC) were higher in the observation group observation group than the control group, chemotaxis sample factor 1 (CKLF-1), tumor necrosis factor alpha (TNF-α), interleukin 4 (IL-4) level were lower than those in the control group (t=3.940,7.707,7.740,3.909,5.289,17.220,3.885,6.932,5.028,19.941,17.665,P＜0.01). Conclusion The treatment of budesonide in children with acute attack of infection-induced asthma can reduce the IL-4 level of CKLF-1TNF-α, increase the level IFN-γ in patients, and effectively improve the clinical symptoms, lung function and immune function of children.

Analysis of the status of fathers′ participation in parenting in children with type 1 diabetes and its correlation with quality of life in children

LIN Li-na, LI Qian-ting, LIN Juan, JIANG Ping-hu, HUANG Hong

2020, 28(1):  104-107.  DOI: 10.11852/zgetbjzz2019-0750

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Objective To understand the status of fathers′ participation in parenting in children with type 1 diabetes,and analyze the correlation between the awareness and degree of father′s participation in parenting with the life quality of children. Methods During september and december in 2017,a total of 35 children with type 1 diabetes and their fathers were recruited from a follow-up group of children with type 1 diabetes in grade Ⅲ-a hospital in Fujian province by convenience sampling method.The Iventory of Father Involvement and Diabetes Specific Quality of Life Scale were used. Results The total score of father′s participation in parenting was 146.09±19.46.The sorting of each dimension′s ratio was encouragement and praise, support and planning, discipline and restraint, and daily care from high to low.The total score of diabetes specific quality of life was 61.28±17.42.The sorting of each dimension′s ratio was psychology,society,physiology,therapy from high to low.Univariate analysis showed that the score of father′s support and planning in excellent academic performance was higher than score of average academic performance(F=3.667,P<0.05).The total scores(t=-3.102) and the scores of encouragement and praise(t=-3.861),support and planning of father′s participation in parenting(t=-23.049) were lower than those of the norm (n=745),but the scores of governance and constraints (t=7.150) were higher than those of the norm (n=745)(P<0.05).There was no correlation between the father′s participation in parenting and the children′s quality of life (P>0.05). Conclusion The awareness and degree of father′s participation in parenting about children with type 1 diabetes is better, especially in encouraging and praise and support and planning, but the level of participation in daily care needs to be further strengthened,and avoiding excessive restraint meanwhile.