Table of Content

10 April 2020, Volume 28 Issue 4

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Further attention to the diagnosis, treatment and the prevention of children and adolescents with neurally mediated syncope

MA Le, LIN Jing

2020, 28(4):  361-365.  DOI: 10.11852/zgetbjzz2020-0295

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Neurally mediated syncope is a transient loss of consciousness caused by transient ischemic hypoxia in the brain, which was often accompanied by loss of muscle tone and cannot maintain the posture.It is a common emergency in pediatric clinics.About 15% of children and adolescents have had at least once syncope before 18 years old, and syncope accounts for 1% of all pediatric emergencies.With the introduction of head-up tilt test and diagnostic protocol of syncope in the past 30 years, the proportion of children with unexplained syncope has gradually decreased, but still around 14% children or adolescents with syncope could not be explained, and the pathogenesis of syncope still needs to be further explored.Based on the recent developments in related fields in recent years, this review introduces the epidemiological characteristics, pathogenesis, diagnostic procedures and future research directions of children′s neuro-mediated syncope, with a view to improving clinicians′ understanding of children′s neuro-mediated syncope and further improving diagnosis and treatment of syncope in China.

Suggestions on physical activities for children aged 0-6 at home during COVID-19

Early Childhood Development Professional Committee, Society for Research in Maternal and Child Health

2020, 28(4):  366-369.  DOI: 10.11852/zgetbjzz2020-0246

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Psychological impact of coronavirus disease 2019 on children and adolescents and recommendations for family intervention (1st version)

The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, the Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Doctor Association

2020, 28(4):  370-373.  DOI: 10.11852/zgetbjzz2020-0200

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The coronavirus disease 2019(COVID-19) has spread rapidly throughout the country, which has caused great harm to the whole society′s production, life and even health, and also caused serious psychological trauma.Children and adolescents, as the vulnerable groups of stress events, need to be given timely and appropriate psychological crisis intervention to prevent psychological problems.Aiming at COVID-19 epidemic, it is suggested that the parents should timely identify and help children to prevent psychological problems, based on the psychological development characteristics of children and adolescents at different ages.

Survey and intervention study of sleep in children with postural tachycardia syndrome

GU Ying, WANG Jia-qi, JIA Wan-ru, WU Min, JIAO Fu-yong, SHEN Jie, LIN Jing

2020, 28(4):  374-378.  DOI: 10.11852/zgetbjzz2020-0296

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Objective To explore the effects of sleep improvement intervention on the clinical symptoms of children with postural tachycardia syndrome (POTS) by investigating the sleep status.Methods Totally 40 children diagnosed with POTS from May 2018 to May 2019 were selected as the POTS group, and meanwhile 20 healthy children for physical examination in child healthcare department were selected as the control group.The diagnosis of POTS were based on the results of head-up tilt test (HUTT).The Pittsburgh Sleep Quality Index (PSQI) was used to investigate sleep status.POTS group received sleep improvement intervention for 3 months.A decrease of orthostatic intolerance score> 2 indicated that the sleep intervention was effective, and ≤2 indicated ineffective.Results Significant differences were found in supine heart rate (t=-2.117), upright maximum heart rate (t=3.88) and upright heart rate difference (t=-7.86) between POTS group and control group(P＜0.05).Compared with the control group, 77.5% of children in POTS group had a total PSQI score of > 5.Except from sleep drugs, significant differences were found in PSQI score (t=8.31,P＜0.001) and six factors of PSQI (P＜0.001) .There was no statistical difference on blood pressure before and after sleep improvement intervention in POTS group.While supine heart rate (t=-2.707), upright maximum heart rate (t=2.656), upright heart rate difference (t=4.771) and clinical symptoms score(Z=-5.083) dramatically decreased after intervention (P＜0.05).Furthermore, 60% of POTS children had a decrease of symptom score > 2.The ROC curve showed that the sleep improvement intervention for POTS would be predicted to be effective when the patients more than 10 years old, yielded a sensitivity of 91.7% and specificity of 43.7%. Conclusions Most children with POTS suffered from poor sleep quality, and sleep intervention therapy can effectively improve the clinical symptoms of POTS children.

Correlation between salivary cortisol levels with sleep quality and severity of clinical symptoms in children with postural tachycardia syndrome

ZHANG Qi-yi, WU Min, WANG Jia-qi, JIA Wan-ru, SHEN Jie, ZHANG Xiao-yan, LIN Jing

2020, 28(4):  379-384.  DOI: 10.11852/zgetbjzz2020-0299

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Objective To evaluate the sleep quality and salivary cortisol level in children with postural tachycardia syndrome (POTS), and to analyze the correlation among salivary cortisol level, sleep quality and the severity of clinical symptoms. Methods This prospective study included 40 children with POTS (case group) from May 2018 to May 2019, and 20 healthy children who took health examination in the same period were selected as controls.Saliva samples were collected from two groups of children at six time points (awakening, 30 minutes after awakening, at 12:00 p.m., 4:00 p.m., and 8:00 p.m., and at bedtime), and the concentration of salivary cortisol was determined by enzyme-linked immunosorbent assay.The Pittsburgh Sleep Quality Index (PSQI) and POTS symptom scale were filled in to evaluate the sleep quality and the severity of clinical symptoms of POTS. Results The systolic blood pressure in supine position (t＝2.194), systolic blood pressure in upright position(t＝2.351), diastolic blood pressure in upright position (t＝2.227), stable heart rate in supine position(t＝2.117) in control group were significantly higher than those in POTS group, while the maximal heart rate in the upright position(t＝-3.88)and the difference in the resting and standing position (t＝-7.86) were significantly lower than those in POTS group(P＜0.05).The concentration of salivary cortisol in POTS group was significantly higher than that in the control group(P＜0.05) when waking up in the morning, 30 minutes after waking, at12:00, 4:00 pm and 8:00 pm.POTS group had poorer sleep quality (PSQI score) than control group[(7.2±3.0)vs.(1.35±1.39), t＝-10.370, P＜0.001], including sleep quality score, sleep time, sleep hours, sleep efficiency, sleep disorder, daytime dysfunction and overall comparison between groups.Symptom score and PSQI score were positively correlated with cortisol concentration in saliva after waking(r＝0.62, 0.60, P＜0.001).Moreover, symptom score and PSQI score were positively correlated(r=0.58,P＜0.001). Conclusionss Salivary cortisol concentration was positively correlated with the severity of clinical symptoms and PSQI score.To some extent, salivary cortisol concentration can reflect the sleep quality and clinical symptoms of children with POTS.

Clinical effect of recombinant human growth hormone on the treatment of children with prepubertal growth hormone deficiency based on different body mass indexes

LIU Ying, LIU Cui, NING Jing, GUO Yong, WU Jie-ling

2020, 28(4):  385-388.  DOI: 10.11852/zgetbjzz2019-1125

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Objective To explore the clinical effect of recombinant human growth hormone(rhGH) on treatment of children with prepubertal growth hormone deficiency(GHD) based on different body mass index(BMI),in order to provide basis for individualized treatment. Methods Totally 76 children with GHD accepting more than one year treatment of rhGH in Guangdong Women and Children′s Hospital from January 2016 to December 2018 were involved in this study.According to the BMI threshold of obesity and overweight published by China Obesity Task Group in 2004, children with GHD were divided into three groups:normal BMI group(30 cases), overweight group(23 cases) and obesity group(23 cases).Before and after treatment, height, BMI, bone age, insulin-like growth factor(IGF-1) and insulin-like growth factor-binding protein 3(IGFBP-3) levels were tested. Height velocity(HV), height standard deviation scores(HtSDS), fasting blood glucose, insulin, thyroid stimulating hormone(TSH), FT3, FT4 were measured. Results After one year of treatment, the HV and HtSDS of the three groups were significantly improved(P<0.05), and the therapeutic effect of the normal BMI group was better than that of the overweight and obesity group(P<0.05).There was no significant difference on treatment efficacy between the overweight and obesity group(P>0.05).The BMI of overweight and obesity group significantly decreased after treatment(P<0.05).Compared with those before treatment, fasting glucose, insulin, TSH, FT3 and FT4 levels did not show significant differences after treatment(P>0.05). Conclusionss RhGH can significantly improve the growth rate of GHD children in prepuberty.After correcting other factors, when rhGH is used to treat overweight and obese children with GHD, it is speculated that a larger dose of rhGH may be needed to obtain a better growth rate.

Effect of pre-pregnancy body mass index and gestational weight gain on perinatal outcomes

XING Meng-meng, WEI Guo, WANG Zhi-long, REN Lu-zhong

2020, 28(4):  389-394.  DOI: 10.11852/zgetbjzz2019-0407

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Objective To investigate the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on pregnancy outcomes,in order to provide evidence for pregnancy health care and prenatal weight management. Method A historical cohort study of 95 849 single full-term pregnant women from 26 midwifery hospitals in Longgang District of Shenzhen City from 2014 to 2017 was conducted on the influence of pre-pregnancy BMI and gestational weight gain on perinatal outcomes. Results The average pre-pregnancy BMI was (20.49±2.83) kg/m² in 95 849 pregnant women,the average gestational weight gain was (14.49 ±5.89) kg.Compared with pregnant women with normal BMI and suitable weight gain during pregnancy,the emaciation (BMI<18.5 kg/m²) (OR=1.80,95%CI: 1.61-2.00) and insufficient gestational weight gain (OR=1.83,95%CI: 1.63-2.05) were risk factors for low birth weight infants.Pre-pregnancy overweight (BMI≥24 kg/m²) was a risk factor for gestational diabetes mellitus (GDM) (OR=1.84,95%CI: 1.68-2.02),gestational hypertension(OR=2.40,95%CI: 1.90-3.04),preeclampsia/eclampsia(OR=3.07,95%CI: 2.39-3.96),macrosomia(OR=2.70,95%CI: 2.49-2.92),cesarean section(OR=1.89,95%CI: 1.81-1.97),birth asphyxia(OR=1.33,95%CI: 1.05-1.67).Excessive weight gain during pregnancy was a risk factor for macrosomia (OR=2.59,95%CI: 2.40-2.79),cesarean section(OR=1.45,95%CI: 1.40-1.50),pregnancy hypertension (OR=2.83,95%CI: 2.21-3.62),preeclampsia/eclampsia(OR=2.18,95%CI: 1.69-2.81),premature rupture of membranes(OR=1.26,95%CI: 1.13-1.40) and postpartum hemorrhage(OR=1.26,95%CI: 1.07-1.48). Conclusionss Pre-pregnancy BMI and pregnancy weight gain are the influencing factors of cesarean section,gestational hypertension,preeclampsia/eclampsia,low birth weight and macrosomia.Therefore,it will be conducive to a good pregnancy outcome by controlling pre-pregnancy BMI and gestational weight gain.

Randomized controlled study on the effect of multimodal therapy and drug therapy on children with attention deficit hyperactivity disorder

QIAN Yun, LIU Yue, JIANG Wen-qing, ZHAO Zhi-min, LI Yan, CHEN Jing, DU Ya-song

2020, 28(4):  395-398.  DOI: 10.11852/zgetbjzz2019-1488

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Objective To explore the improvement of symptoms and executive dysfunction in children with attention deficit hyperactivity disorder (ADHD) by multimodal therapy and medication alone,so as to provide evidence reference for the treatment of ADHD. Methods A total of 61 children with ADHD from Shanghai Mental Health Center were enrolled in this study from January 2018 to February 2019,and were randomly divided into multimodal group and medication group.The changes of symptoms and executive function were evaluated. Results 1) After treatment,scores of attention deficit,hyperkinetic and oppositional factor in SNAP-IV in the multimodal intervention group were significantly lower than those before treatment (t=7.339,5.637,7.211,P<0.001).The accuracy of Stroop Test B after treatment was significantly higher than that before treatment (t=-3.036,P<0.001).And the number of persistent errors (t=5.961,P<0.001) was lower than that before treatment.The scores of classification,conceptualization and sustained response were significantly higher than those before and after treatment (t=-2.465,-5.585,-3.524,P<0.05).2) After treatment,attention deficit,hyperkinetic,and oppositional factors in SNAP-IV in multimodal therapy group were significantly lower than those in drug treatment group (F=8.270,6.818,10.786, P<0.05).There were significant differences on Stroop color-word Test A between the two groups (F=11.125,P=0.001).And the sustained errors of WCST were significantly lower in the Stroop test group than in the drug treatment group (F=5.567,P<0.05).The level of conceptualization and the number of sustained response were significantly higher than those in the drug treatment group (F=5.775,4.436,P<0.05). Conclusionss Multimodal therapy can improve the core symptoms and executive dysfunction of ADHD children,which can be the priority for ADHD treatment.

Study on the effect of group music therapy on children with attention deficit hyperactivity disorder

LIU Yue, QIAN Yun, JIANG Wen-qing, ZHAO Zhi-min, LI Yan, CHEN Jing, DU Ya-song, DAI Yue-ning

2020, 28(4):  399-402.  DOI: 10.11852/zgetbjzz2019-1489

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Objective To explore the effect of music therapy on children with attention deficit hyperactivity disorder (ADHD),in order to provide new ideas for the treatment of ADHD. Methods Children with ADHD first diagnosed from January 2017 to January 2019 at the children′s clinic of Shanghai Mental Health Center were randomly divided into three groups,including music therapy group(n=47),drug therapy(n=46) and combined therapy group(n=43).The improvement of clinical symptoms and executive function among the three groups were evaluated and compared before and after intervention. Results 1) After music therapy,the scores of conduct question,learning question,hyperactive impulse and hyperactive index of Conners Scale in music therapy group were significantly different(t=2.242-3.687,P<0.05).There were significant differences on the number of sustained errors,the level of conceptualization and the number of sustained responses in WCST(t=2.312-4.695,P<0.05).2) Univariate analysis indicated that there were significant differences on the number of persistent errors,the number of complete classification,the level of conceptualization and the number of persistent responses in WCST(F=3.432-6.610,P<0.05). Conclusionss Music therapy is effective in improving the clinical symptoms and executive function of ADHD children,and the effect of combined intervention is better than single intervention.

Study on screening,diagnosis,treatment and genotype in primary carnitine deficiency

WU De-hua, YANG Ru-lai, ZHENG Jing, WU Ding-wen, CHEN Chi, ZHOU Ying

2020, 28(4):  403-406.  DOI: 10.11852/zgetbjzz2019-1637

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Objective To investigate the clinical diagnose,treatment and genetical features of infant and maternal primary carnitine deficiency (PCD) in newborn screening,so as to provide basis for clinical diagnosis and treatment of PCD. Methods Heel prick blood samples of newborns were collected on 3 days after birth for the genetic metabolic diseases screening by tandem mass spectrometry (MS/MS) in Zhejiang from January 1st 2009 to December 31st 2018.The infants with lower free carnitine(C0) and their mothers were recalled for diagnosis. Results A total of 4 459 infants were detected with lower C0 compared with the cut-off value (10 mol/L),and eventually 121 subjects were diagnosed with PCD (55 males and 66 females) in 3 040 815 newborns screening program.The prevalence rate was 1/25 131.The results of 111 PCD patients with complete follow-up data after diagnosis showed the initial screening C0 value was (5.94±2.01) mol/L,the recalled C0 value was (5.70±1.99)mol/L,and the difference was not significant (t=1.05,P>0.05).After treatment with L-carnitine,the C0 level at maintenance dose was (24.94±10.26) mol/L,which was significantly higher than that of pre-treatment (t=20.728,P＜0.001).A total of 64 maternal PCD were identified with a prevalence of 1/47 513 and an average C0 level of (3.31±1.79) mol/L.Furthermore,111 PCD patients had homozygous or compound heterozygous mutations by the genetic analysis of SLC22A5 gene.Consequently,a total of 42 cases were identified with SLC22A5 variants,of which c.1400C>G (p.S467C) was the most common mutation with the allelic frequency of 33.33%(74/222),followed by c.51C>G(p.F17L)with a frequency of 14.73%.There were 93.75% mothers undergoing genetic testing (60/64),and the SLC22A5 c.1400C>G (p.S467C) mutation accounted for 35.83% (43/120).Except for 2 deaths due to unknown reasons,other PCD children showed normal growth and development. Conclusionss PCD can be detected early by newborn screening and diagnosed by genetic analysis,but maternal carnitine deficiency should be excluded.SLC22A5 c.1400C>G (p.S467C) is the most common mutation in PCD patients in Zhejiang province.The treatment of L-carnitine is effective,but long-term treatment and follow-up are warranted.

Investigation on the influencing factors for anxiety related emotional disorders of children and adolescents with home quarantine during the prevalence of coronavirus disease 2019

LI Shao-wen, WANG Yue, YANG Yuan-yuan, LEI Xiao-mei, YANG Yu-feng

2020, 28(4):  407-410.  DOI: 10.11852/zgetbjzz2020-0169

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Objective To evaluate the mental health status of students aged 8 to 18 during the period of home isolation in the prevalence of coronavirusdisease 2019(COVID-19), so as to provide a basis for psychological counseling for students in special periods. Methods A total of 396 students aged from 8 to 18 were assessed for anxiety/depression by Questionnaire Star survey on February 6th to 8th, 2020.All subjects filled out general information and the Screen for Child Anxiety Related Emotional Disorders(SCARED) were analyzed for the impact of COVID-19 on children′ and adolescents′ mood and anxiety during home isolation. Results 1) The total score of SCARED in 396 students was 16.44±12.30, 87 (22.0%) with scores≥25 and 309 (78.0%) with scores＜25.The mean scores of 5 factors(somatization/panic, generalized anxiety, dissociative anxiety, social phobia and school phobia) and the total scores were compared between the two groups, and the differences were statistically significant (t=13.156, 19.524, 10.381, 13.964, 7.325, 23.371, P＜0.001).2) Binary Logistic regression analysis showed that female students (OR=2.258, 95%CI:1.370—3.721, P＜0.001) and considering themselves in danger (OR=1.978, 95%CI :1.185—3.301, P=0.009) were risk factors for anxiety among students isolated at home during the epidemic. Conclusionss The prevalence of COVID-19 has some influence on students′ mood, especially for girls.Parents, schools and society should take timely measures to guide students to avoid anxiety in special times.

Study on expression of N-acylethanolamine-related receptors and metabolic enzymes in hippocampus of autism spectrum disorder model rats

LI Ling, LI De-xin, LIU Yu, XIE Shu, ZOU Ming-yang, SUN Cai-hong, WU Li-jie

2020, 28(4):  411-415.  DOI: 10.11852/zgetbjzz2020-0010

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Objective To test the expression of N-acylethanolamines (NAEs) related receptors and the metabolic enzymes in the hippocampus of autism spectrum disorder (ASD) model rats, and to explore the correlation between NAEs signals and ASD, so as to provide new insight for the etiological study of ASD. Methods ASD model rats induced by sodium valproate (VPA) were studied for growth, development and behavioral tests. Western Blot and real-time quantitative PCR (RT-PCR) were used to detect the protein and mRNA expression of NAEs-related receptors, namely endocannabinoid receptor (CB1R and CB2R), and their metabolic enzymes, namely N-acylphosphatidylethanolamine-specific phospholipase D (NAPE-PLD) and fatty acid amide hydrolase (FAAH). Results The results of self-grooming experiment, three-box experiment and water maze experiment showed that VPA rats had repetitive behavior patterns, social interaction dysfunction, and learning and memory dysfunction. Western Blot results revealed there were significant differences between VPA and control rats on CB1R and FAAH protein expressions in hippocampus (t=3.033, 2.865, P＜0.05), however the difference on CB2R and NAPE-PLD was not found (t=1.034, 0.290, P＞0.05). The significant differences in mRNA expression levels of CB1R, CB2R, FAAH and NAPE-PLD were not found in the hippocampus between two groups (t=2.239, 0.747, 0.748, 0.012, P＞0.05). Conclusion The protein expression levels of NAEs-related receptor and metabolic enzyme in hippocampus of ASD model rats are up-regulated, suggesting that low NAEs signal may be associated with the pathogenesis of ASD.

Current status of research on hypertension in children and adolescents

QI Huan, ZHANG Qing-hua, CHEN Ting

2020, 28(4):  416-418.  DOI: 10.11852/zgetbjzz2019-0688

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With the development of social economy,the incidence of hypertension among children and adolescents has shown an ascendant trend around the world in recent years,which was yet easily ignored in daily life. The prevalence of hypertension in adults could be significantly decreased by the effective prevention and intervene for high blood pressure during childhood and adolescence. In order to further strengthen the public cognition of hypertension in children and adolescents,this review provides reference for further research on intervention of hypertension in children and adolescents by summarizing its definition,influencing factors and preventive measures of hypertension.

Research on the manual ability classification system in cerebral palsy assessment

YANG Qing, WANG Qiu, LI Na, YI Lei

2020, 28(4):  419-422.  DOI: 10.11852/zgetbjzz2019-0617

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The manual ability classification system (MACS) is one of the most commonly used methods to assess the grading of manual ability in children with cerebral palsy.It has been widely used at home and abroad in the assessment,treatment and management of children with cerebral palsy. This article reviews the researches on the application of MACS in children′s rehabilitation medicine to promote the wide use of MACS in the rehabilitation of children with cerebral palsy.

Progress in sleep research in children with attention deficit/hyperactivity disorder

CHEN Feng-feng, WANG Yu

2020, 28(4):  423-426.  DOI: 10.11852/zgetbjzz2019-0964

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Attention deficit/hyperactivity disorder (ADHD) is a common behavioral development disorder in children and adolescents,mainly characterized by inattention not matched with one′s age, hyperactivity and/or impulsivity.ADHD is easy to co-occur with other diseases, of which sleep problems have been paid increasing attention to in recent years.Children with both ADHD and sleep problems may cause more severe functional disorders, affecting mood, attention, behavior, and ultimately affecting school or work performance and quality of life.This article mainly reviews the common sleep problems of ADHD children,the pathological mechanism of ADHD comorbid sleep problems and the effects of medication on sleep in ADHD children so as to improve people′s understanding the relationship of the two.

Research status and progress of breastfeeding for very low birth weight and extremely low birth weight infants

DONG Liang, LI Zhan-kui, ZHANG Li

2020, 28(4):  427-430.  DOI: 10.11852/zgetbjzz2019-1732

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Very/extremely low birth weight infants account for more than half of all neonatal mortality.Compared with low birth weight infants(≥1 500 g), the incidence of related complications in very/extremely low birth weight infants is higher and the prognosis is relatively worse.Breastfeeding has been shown to help improve their clinical outcome.This review combs the research status and progress of breastfeeding in very/extremely low birth weight infants.

Research progress on the mechanism of gut microbiota participating in airway hyperresponsiveness of allergic asthma through short-chain fatty acids

HE Xue-jia, ZHU Wei-wei, BI Mei-rong

2020, 28(4):  431-434.  DOI: 10.11852/zgetbjzz2019-0803

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Bronchial asthma (asthma) is a chronic airway inflammatory disease characterized by reversible airflow obstruction and airway hyperresponsiveness.Short-chain fatty acids (SCFAs),as the products of indigestible carbohydrates such as dietary fiber and resistant starch produced by intestinal probiotics,are not only the important energy source for the body,but also important immune signal molecules.The increasing concentration of SCFAs in the blood plays a protective role in pulmonary allergic inflammation.A large number of studies have shown that the occurrence of asthma is closely related to the changes of intestinal flora.This paper summarizes the possible molecular mechanism of intestinal flora participating in asthma airway hyperresponsiveness through short-chain fatty acids from the three aspects of ERK1/2 signaling pathway,TGF-β1/Smads signaling pathway,and GPR41 and GPR43 expression,thereby providing a potential new target for the treatment of asthma.

Research progress on sleep evaluation methods for children

FENG Wei-wei, ZHANG Tong

2020, 28(4):  435-437.  DOI: 10.11852/zgetbjzz2019-0443

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Childhood is a period of high occurrences of sleep problems.Therefore,early evaluation for children′s sleep is needed to enable early intervention and treatment.This review summarizes the evaluation process and evaluation tools on children′s sleep.

Bibliometric study on international research hotspots for pediatric obesity

ZHOU Shuang, LI Xiao-tong, LI Wei, WANG Hai-jun

2020, 28(4):  438-442.  DOI: 10.11852/zgetbjzz2019-0950

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Objective To analyze the international research hotspots of pediatric obesity through the bibliometric analysis,so as to provide reference for grasping the future research area on pediatric obesity. Methods Pediatric obesity was used as the mesh term in searching of published international literature related with pediatric obesity in PubMed database from 2013.Then topic words and sub-topic words of literature on pediatric obesity were retrieved by bibliographic items Co-occurrence matrix builder(BICOMB) and the matrix of the topic words and sub-topic words was generated.Bi-clustering analysis of the matrix was carried out using gCLUTO software,then visual mountain graph and tree diagram were generated further. Results A total of 6 546 literature was included in PubMed since 2013.The number of published literature increased from 2013 and reached a peak in 2016.Results of the cluster analysis showed that international research focus mainly concentrated on six clusters, including psychology, intervention, diagnosis and epidemiology, etiology and risk factors, physiopathology and complications, and health promotion and treatment of pediatric obesity.Intervention, diagnosis and epidemiology of pediatric obesity were the core hotspots in recent years, with the large number of literature and highly consistent research theme compared with other clusters. Conclusionss The number of literature on pediatric obesity has increased recently.International research hotspots include psychology, etiology and risk factors, diagnosis and epidemiology, treatment, intervention,physiopathology and complications of pediatric obesity.Intervention, diagnosis and epidemiology of pediatric obesity are the core hotspots in recent years.

Application of general movements combined with Dubowitz neurological examination in evaluating neurodevelopmental outcomes of premature asphyxiated infants

MA Yan-yan, SHEN Fei-fei, LI Hai-ying, SUO Gui-hai, WU You-jia

2020, 28(4):  443-446.  DOI: 10.11852/zgetbjzz2019-0656

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Objective To analyze the application value of general movements(GMs) combined with Dubowitz neurological examination in the evaluation of neurodevelopment in asphyxiated premature infants. Methods A total of 60 premature asphyxiated infants treated in the neonatal ward of the Affiliated Hospital of Nantong University from February 2017 to March 2018 were enrolled in the study,and were divided into brain injury group(n=28) and non-brain injury group(n=32)according to the consensus of experts on brain injury of premature infants in 2012. Dubowitz neurological examination was performed at least twice within 7 days after birth and 40 weeks after correcting gestational age. GMs screening and re-screening were performed in the pre-term stage,writhing movements stage and fidgety movements stage.Children′s Developmental Center of China(CDCC) was conducted at the corrected age of 3,6 and 12 months old.The early diagnostic value of GMs combined with Dubowitz neurological examination in brain injury of premature infants with asphyxia and its correlation with CDCC were analyzed. Results 1)The sensitivity and specificity of GMs combined with Dubowitz neurological examination in predicting brain injury in premature infants with asphyxia were 96.43% and 84.38%,respectively. 2)The positive rate of GMs combined with Dubowitz in screening for brain injury in premature infants was positively correlated with the CDCC(PDI、MDI) score at 3,6 and 12 months of gestational age (r=0.71,0.66;0.67,0.59;0.73,0.71),and the correlation was the strongest at 12 months. Conclusion GMs combined with Dubowitz neurological examination can be used as an effective means for early diagnosis of brain injury in premature infants with asphyxia.

Study on Shanghai urban toddlers′ social-emotional development and related influencing factors

ZHANG Yuan-yuan, JIN Xing-ming, BIAN Xiao-yan, WANG Sha-sha, FANG Yong-shuang, CHEN Jin-jin

2020, 28(4):  447-450.  DOI: 10.11852/zgetbjzz2019-1431

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Objectives To know about the status of toddler social-emotional development in urban areas of Shanghai,and to explore related influencing factors,so as to provide evidence for early screening and intervention. Methods A stratified cluster random sampling method was used to select children aged 1 to 3 from March to September 2017 in Shanghai urban areas as research objects.All toddlers′ social-emotional development status and related impact factors were investigated by Chinese Version of Urban Infant Toddler Social and Emotional Assessment (CITSEA),urban 1 to 3-year-old Children Family Nurturing Environment Scale and self-designed sociodemographic questionnaire. Results The detection rate of social-emotional development problems in urban areas of Shanghai was 24.44% (231/945).Boys demonstrated higher externalizing problem rate (11.0% vs.7.1%,χ²=4.493,P＜0.05),and 12 to 18-month-old toddlers demonstrated higher competence problem rate (15.9%) than other age groups(3.6% to 6.9%)(χ²=24.840,P<0.05).Univariate analysis revealed that parents′ age,occupation and educational level,maternal nurturing time,the only child,traumatic event,family rearing environment affected toddler′s social-emotional development(P<0.05).Logistic regression analysis showed that the only child,parents′ age,parents′ age,maternal occupation,maternal nurturing time and family nurturing environment significantly affected toddler′s social-emotional development(P<0.05). Conclusionss Many social factors including family nurturing environment lead to high problem rate of toddler′s social-emotional development.Public awareness should be raised and early screening and intervention are anticipated to promote integrated early child development.

Single-center survey on the status of vitamin A,D and E levels of neonates in hospital

QIAO Lu-sha, DING Xue-xing, BI Ling-yun

2020, 28(4):  451-455.  DOI: 10.11852/zgetbjzz2019-0448

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Objective To investigate the levels of vitamin A,D and E of neonates in hospital and the related influencing factors in Anyang,so as to provide scientific evidence for the prevention of vitamin A,D and E deficiency. Methods A total of 329 neonates treated in the Pediatrics Department of the People′s Hospital of Anyang City were enrolled in this study from May 2017 to February 2019.High performance liquid chromatography(HPLC) and liquid chromatography tandem mass spectrometry (MS/MS) were used to test the levels of vitamin A,D,E of neonates.The influencing factors for the levels of vitamin A,D,E were analyzed. Results 1) The levels of vitamin A,D,E in newborns were (0.17±0.09) mg/L,(14.21±12.05)ng/ml and (6.50±3.80)mg/L,respectively.2) Significant differences were found on vitamin A level between preterm infants and full-term infants,vitamin D level between boys and girls,vitamin E level between high-risk and non-high-risk infants (P<0.05).But there were no significant differences on vitamin A、D、E levels among children in different weight groups (P>0.05).3) Vitamin A subclinical deficiency,vitamin D and vitamin E deficiency accounted for a higher proportion.4) There were significant differences on vitamin D levels among neonates born in different seasons and in neonates between vitamin D supplementation ≥400 U/d and ＜ 400 U/d at the end of three months of pregnancy (P<0.05). Conclusionss Most neonates in hospital in Anyang area have vitamin A,D and E deficiency.Preterm and high-risk infants may be related to neonatal vitamin A and E levels,respectively.Different sex,seasons and vitamin D supplementation dose at the end of pregnancy are correlated with vitamin D level in neonates.

Survey of pubertal development among 6- to 16-year-old children in Shenzhen

WANG Li, SU Zhe, WANG Qiang, LIU Jian, ZHOU Li, WANG Chang

2020, 28(4):  456-459.  DOI: 10.11852/zgetbjzz2019-0423

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Objective To conduct a cross-sectional study on pubertal development of students aged 6 to 16 years in Shenzhen,in order to provide basic data for children health care and health education. Methods Two primary schools and two middle schools were randomly selected from three districts of Shenzhen,and finally 10 674 children aged 6 to 16 years were enrolled in this study.Data of secondary sexual development(testicular and pubic hair development in boys, breast and pubic hair development in girls) were obtained by the status quo method, and the age of menarche was inquired.Probit regression model was used for statistical analysis, and the results were expressed by median age and the corresponding 95% confidence interval. Results The age of onset of Tanner stages 2 for testicular and pubic hair for boys were 10.1(10.0-10.2) years old and 12.2 (11.9-12.6) years old, respectively.The age of onset of breast development and pubic hair for girls was 8.5(7.4-9.4) years old and 10.6 (10.5-10.7) years old, respectively.The age of menarche for girls was 12.1(11.8-12.4) years old.Compared with the data of study in urban Chinese children in 2005, the onset age of puberty was 0.4 years earlier for boys and 0.7 years earlier for girls, and the age of menarche was 0.1 years earlier for girls. Conclusions The onset age of puberty and the age of menarche in students aged 6 to 16 years in Shenzhen are similar to the results of the pubertal study in 2005.

Analysis on causes and influencing factors on the untreated rate of two-week illness of left-behind children in rural areas in Chengdu

LU Rui-ge, JIANG Feng-bi, YUAN Xin-qi, ZHOU Jia-ji, XIONG Fu

2020, 28(4):  460-463.  DOI: 10.11852/zgetbjzz2019-0623

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Objective To analyze the causes and influencing factors related of two-week absence of medical treatment for left-behind children in rural areas of Chengdu,in order to provide scientific evidence for making health services policies. Methods Totally 468 left-behind children and their guardians were randomly selected from six towns of Chengdu city from January to December in 2015. The general situation of left-behind children,the general condition of the caregiver and the two-week prevalence rate,and the two-week non-diagnosis rate were investigated by questionnaire survey. Results In this survey,150 left-behind children reported had been sick within two weeks,the two-week prevalence rate was 32.05%. Among them,19 patients were not treated,and the rate of undiagnosed patients in the two weeks was 12.67%.There were significant differences in the untreated rate of two-week illness of left-behind children in Chengdu with different gender,whether they had only one child,the different gender,age and education level of the guardian,the payment method of medical expenses,and the monthly family income(P<0.05). Logistic regression analysis showed that left-behind girls (OR=1.408,95%CI:1.260~1.733),guardians aged 60 years and over (OR=1.533,95%CI:1.396~1.837) were independent risk factors for untreated of two-week illness of left-behind children in rural areas in Chengdu. Only child (OR=0.502,95% CI:0.220~0.813),female guardian (OR=0.644,95%CI:0.302~0.785),guardian′s education level above primary school (OR=0.675, 95% CI:0.309~0.858),the family monthly income of 3 000 yuan or more (OR=0.607,95%CI:0.330~0.891) were the independent protective factors(P＜0.05). Conclusionss In Chengdu rural schools,the untreated rate of two-week illness of left-behind children is generally at a low level,which is mainly affected by the gender of left-behind children,whether they are only children,the gender of guardians,the age of guardians,the cultural level of guardians and the monthly income of families. Health educations should be promoted among left-behind children and guardians.

Research on the risk factors of ventricular hemorrhage complication on very low birth weight infants and extremely low birth weight infants

KE Chuang-hong, YANG Tian-jiao, HONG Mei-ting, MO Xiao-huan

2020, 28(4):  464-466.  DOI: 10.11852/zgetbjzz2019-0999

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Objective To research the risk factors of ventricular hemorrhage in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI),in order to provide the basis for clinical treatment. Methods Clinical data of 185 inpatients with VLBWI and ELBWI from division of Neonatology,the Affiliated Hospital of Guangdong Medical University from July 2016 to July 2018 were collected.And factors which may cause ventricular hemorrhage were determined by single factor analysis and multivariate Logistic regression analysis. Results Logistic regression analysis showed that hypoglycemia (OR=8.772,95%CI:2.880―26.720,P＜0.01),low hematocrit(OR=0.211,95%CI:0.072―0.618,P=0.005),sepsis (OR=6.427,95%CI:2.306-17.911,P＜0.01) and mechanical ventilation (OR=2.984,95%CI:1.013-8.785,P=0.047) were independent risk factors for ventricular hemorrhage. Conclusionss Very low birth weight infants and extremely low birth weight infant are at a higher risk for intraventricular hemorrhage.Active prevention of hypoglycemia,low hemoglobin congestion,infection and reasonable mechanical ventilation can help reduce the occurrence of intraventricular hemorrhage in very low birth weight infants and extremely low birth weight infants.

Clinical analysis of eight neonates with Prader-Willi syndrome

ZHANG Juan-li, YAN Qin-qin, CAI Yu-xiang, DU Xiang-yang, WANG Chun-yang, CHEN Min

2020, 28(4):  467-470.  DOI: 10.11852/zgetbjzz2019-0868

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Objective To study the perinatal clinical features of Prader-Willi syndrome (PWS),in order to promote the early diagnosis and intervention of PWS. Method Clinical data of 8 neonates diagnosed with PWS in the Neonatal Department of Xi′an Children′s Hospital from January 2016 to July 2018 were collected for analysis. Results Eight neonates were full term,of whom 4 cases were smaller than gestational age (SGA),and six cases were delivered by cesarean section. Six patients got 6-9 in terms of 1 min Apgar score and no cases were found with severe postnatal asphyxia. The main clinical phenotypes in the neonatal period included central hypotonia,feeding difficulties,skin hypopigmentation and weak crying in 8 cases. There were 7 cases with special facial features and 6 cases with external genital dysplasia (5 cases were male with small penis,and 2 of them with cryptorchidism,one female case with labia majora dysplasia). And 5 cases comorbided with small hands and feet,slender fingers,adduction of thumb,flat ulnar margin,2 patients had abnormal thyroid function (one patient with increased TSH level and decreased T4 level,while another one patient with normal level of TSH and decreased T4 level). Conclusions Although cesarean section,SGA,low Apgar score,and no postpartum weight gain are not specific to PWS,it is suggested that genetic testing should be conducted as early as possible and thyroid function should be tested regularly when combined with central hypotonia,persistent feeding difficulties,dysplasia of external genitalia,and decreased skin pigmentation.

Analysis of influential factors associated with myopia of pupils aged 8-9 years in Haidian district, Beijing

ZHAO Jing, ZHAO Jian-guo, LI Chang-fu, MA Cui, FANG Xin-lin, LI Qi, WU Xi, WANG Kai

2020, 28(4):  471-474.  DOI: 10.11852/zgetbjzz2019-0505

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Objective To investigate prevalence of myopia and its influential factors among pupils aged 8-9 years in Haidian district, Beijing, in order to provide basis for prevention and control of myopla. Methods At the end of December in 2016, 2 241 pupils aged 8-9 years from 11 primary school were recruited by using cluster sampling method.The participants were asked to fill in questionnaires with the help of parents, visual examination and physical examination were taken as well. Results The prevalence of myopia among pupils aged 8-9 years in Haidian district was 58.3%(1 206/2 241).The prevalence rates of myopia among boys and girls were 52.3% and 55.4%,respectively.Multi-factor Logistic regression analysis showed that higher frequency of keeping correct reading/writing postures(OR=0.879,95% CI:0.798-0.968,P=0.009)was a protective factor of pupil′s myopia, while longer time of taking extracurricular classes(OR=1.408,95% CI:1.142-1.736,P=0.001)、Father′s myopia(OR=1.464,95% CI:1.204-1.78,P<0.001)、mother′s myopia(OR=1.667,95% CI:1.365-2.035,P<0.001)were risk factors. Conclusionss The situation of the myopia prevention among pupils aged 8-9 years in Haidian District is serious.The targeted interventions should be implemented to address this issue.

Clinical screening combined with ultrasound in diagnosis of developmental dysplasia of the hip and analysis of early intervention results

ZHANG Cai-hong

2020, 28(4):  475-478.  DOI: 10.11852/zgetbjzz2019-0566

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Objective To investigate the significance of clinical screening of hip joint and ultrasound examination of hip joint in the diagnosis of developmental dysplasia of the hip (DDH) and the effect of early intervention. Methods Infants under 6 months with positive hip screening results who took first physical examination in Pediatric Healthcare Clinic of Qilu Hospital (Qingdao) were enrolled in this study from July 2016 to June 2018. Children with positive ultrasound examination of type Ⅱa were given early intervention, and the positive rate of ultrasound as well as the effect of early intervention were analyzed. Results There were 1 485 infants with positive clinical screening result of the hip, including 623 males and 862 females. Ultrasound examination of the hip was positive in 174 cases, including 50 males (8.02%) and 124 females (14.39%). And 122 children with Type Ⅱa results were intervened by holding legs and padding wide diapers, of whom 117 cases (95.94%) recovered to normal status and 5 cases were referred to Pediatric Orthopaedics Department. Conclusions DDH can be detected early by clinical hip screening and ultrasound examination. Early intervention is simple, painless and has a high recovery rate.

Analysis of the relationship between neonatal community acquired pneumonia and serum 25-hydroxyvitamin D and lymphocyte subsets

WANG Ting-ting, ZHOU Jian, CHEN Hong-fang, ZHOU Jing-qian, FANG Jin-ping, LYU Jun-ying

2020, 28(4):  479-481.  DOI: 10.11852/zgetbjzz2019-0747

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Objective To analysis the serum 25-hydroxyvitamin D level and lymphocyte subsets in neonates with community acquired pneumonia,and to provide evidence for clinical treament. Methods A total of 68 full-term neonates diagnosed with community acquired pneumonia in the First People′s Hospital of Yongkang City from November 2018 to January 2019 were randomly selected as the observation group,and 68 healthy full-term neonates born in the same period of our hospital as the control group.Serum 25-hydroxyvitamin D level was detected by BIO-RAD 680 ELISA and lymphocyte subsets were detected by Facs Canto2 flow cytometry of BD company. Results Compared with the control group,the serum 25-hydroxyvitamin D level in the observation group was significantly lower than that in the control group (t=6.815,P＜0.01).The positive rate of CD3+ and CD4+ cells and the ratio of CD4+/CD8+ in the observation group were significantly lower than those in the control group (t=2.912,2.947,3.115,P＜0.01); the positive rate of CD19+ cells in the observation group was significantly higher than that in the control group (t=5.565, P＜0.01).The positive rates of CD3+ and CD4 + cells,CD4+/CD8+ in the 25-hydroxyvitamin D deficiency group were significantly lower than those in the normal group (t=3.084,4.234,3.021,P＜0.01); but the positive rates of CD19+ cells in the deficient group was significantly higher than that in the normal group (t=3.515, P＜0.01). Conclusionss The incidence of 25-hydroxyvitamin D deficiency in neonates with community-acquired pneumonia is higher.The level of cellular immunity in neonates with community-acquired pneumonia is lower,which may be related to the low level of 25-vitamin D.

Evaluation of rehabilitation effect of Learning Style Profile on children with autism spectrum disorder

MA Chen-huan, WANG Sha-sha, LI Meng-fan, LIU Feng, WEI Nian-jin, CHEN Feng-feng, CHEN Ling-yan, WANG Yu

2020, 28(4):  482-485.  DOI: 10.11852/zgetbjzz2019-0890

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Objective To explore the rehabilitation effect of the Learning Style Profile(LSP) on children with autism spectrum disorder(ASD),in order to promote its application in China. Methods A total of 55 ASD children aged 36-72 months were admitted from June 2018 to June 2019,trained with LSP for 6 months and evaluated to assess rehabilitation effect by 0 to 6-year-old Children′s Neuropsychological Development Scale,Childhood Autism Rating Scale(CARS) and Strengths and Difficulties Questionnaire(SDQ) before and after intervention. Results According to the results of 0 to 6-year-old Children′s Neuropsychological Development Scale,developmental quotient(DQ) of language expression, social behavior and adaptive behavior area were significantly improved after intervention (t=7.99,7.10,6.29,P＜0.01), while DQ of large motor and fine motor area were improved without significant difference(t=1.28,1.76,P>0.05).Meanwhile,the score of CARS scale was significantly decreased after intervention(t=6.36,P＜0.01).According to the results of SDQ scale,hyperactivity attention deficit score,peer relationship score and difficulty score were significantly decreased,pro-social behavior score was significantly improved(t=5.98,6.96,7.74,6.78,P＜0.01).Emotional symptom score and conduct problems score were decreased without significant difference(t=0.24,0.92,P>0.05). Conclusionss LSP can effectively improve the social skills and reduce the severity of symptoms in children with ASD.So LSP can be more widely used in the treatment of ASD children in China.