Table of Content

10 August 2020, Volume 28 Issue 8

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Neurodevelopment of preterm infants

HAN Ying

2020, 28(8):  837-840.  DOI: 10.11852/zgetbjzz2020-1400

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The survival rate of premature infants has been significantly improved with the progress of medicine.However, the incidence of neurodevelopmental disorders in survival preterm infants is significantly higher than that in normal full-term newborns.This paper briefly summarizes the related risk factors, possible neurodevelopmental disorders and comprehensive management of preterm infants, in order to remind parents and clinicians to pay more attention to the developmental disorders and intervention of preterm infants.

Effect of the Abecedarian approach on intelligence and physical development of infants

CAO Hui, YAN Shuang-qin, CAI Zhi-ling, LI Ling, GU Chun-li, TANG Tian, ZHONG Yuan, WANG Su-mei

2020, 28(8):  841-844.  DOI: 10.11852/zgetbjzz2020-0229

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Objective To explore the effect of the Abecedarian (ABCD) approach on intelligence and physical development of infants, in order to provide scientific reference for facilitating the early development of children. Methods A total of 61 infants who was born from June 2017 to February 2019, took the first 42 days of physical examination in Maanshan Maternal and Child Health Hospital, and voluntarily participate in ABCD training, were enrolled as intervention group.And 61 infants at the same period were as control group.All infants were followed up to 9 months old.Data of body weight, length and head circumference were collected, and intellectual development was assessed using developmental screening test(DST) for child under six.Child health care management checklist was used to collect data on social demography and infant information.Chi-square, t-test and linear regression were used to analyze data. Results The scores of development quotient (DQ) and mental index (MI) in the intervention group were 99.25±12.13 and 102.98±10.10, respectively, which were 6.45 in DQ and 5.78 in MI significantly higher than the control group(t=3.100, 3.174, P<0.05).Linear regression analysis showed that the intervention was a determinant of infant intelligence development (DQ:B=0.263, 95%CI:1.96—10.51, P<0.05;MI: B=0.243, 95%CI:1.37—8.73, P<0.05).However, there was no significant difference on body weight, length and head circumference between the two groups at 9 months old (t=0.382, -0.254, -1.873, P>0.05). Conclusion Infant health care integrated with the abecedarian approach (ABCD) has a positive role in promoting the development of intelligence, which is suitable for further promotion and application.

Association of child linear growth and neurodevelopment among children under 3 years old in poverty-stricken areas

ZHAO Chun-xia, WANG Xiao-li, ZHANG Yun-jun

2020, 28(8):  845-848.  DOI: 10.11852/zgetbjzz2019-1879

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Objective To examine the association of linear growth and neurodevelopment among children under 3 years old in impoverished areas of Guizhou and Shanxi Province, in order to provide suggestions fro further intervention. Methods Data were obtained from the cross-sectional study conducted among children under 3 and their caregivers in six poverty-stricken counties from July to September in 2013.Non-parametric test and general linear regression analysis were performed to investigate the association of child linear growth and early neurodevelopment. Results The height-for-age Z-score(HAZ), the median standardized Age and Stages Questionnaire Z score (ASQ Z-score) using the Chinese national norms for children was -0.73±1.44 and -0.08(-1.30, 0.77), respectively.Among children aged 1 to 17 months, the ASQ Z-score for the healthy children group was 0.36 higher than the growth insufficiency group, 0.78 higher than the growth retardation group(P＜0.05).After controlling for children's sex, age, caregivers' age, sex, ethnicity, education, the primary caregivers, family income and household access to internet, the ASQ Z-score increased by 0.106s for every 1s increase in HAZ. Conclusions Child linear growth is positively correlated with early neurodevelopment.Linear growth deficit is an independent risk factor of child neurodevelopment in young children in resource-poor settings of rural China.In the routine growth monitoring and counselling services, the guidance and promotion of early development of children with growth deficits and stunting should be taken into account.

Influence of domestic dialect on language development of children

LIN Yuan-yuan, ZHANG Yi-wen, LIU Xue-man, LEE Wendy

2020, 28(8):  849-853.  DOI: 10.11852/zgetbjzz2020-0443

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Objective To explore the influence of domestic dialect on language development of children, thus to provide theoretical reference for discussing the reasons for developmental language disorder. Methods Totally 688 children aged 35.1—95.7 months in Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center from November 2015 to September 2019, were enrolled in this study.According to their language exposure in family, 151 children were selected as mandarin group and 537 children were in dialect group.Chi-square test and Mann-Whitney U test were run to examine the differences on language abilities between two groups. Results There were no significant differences on age, gender composition and the proportion of developmental language disorder between mandarin group and dialect group (P>0.05).Moreover, difference was not found on five dimensions of language abilities between children with and without developmental language disorder, including total language, receptive, expressive, semantic and syntax (P >0.05). Conclusions Domestic dialect has no adverse effect on children's language development.On the contrary, the quality and quantity of language exposure is more important for early language development.

Study on domestic violent discipline and its influencing factors for children under 5 years old in some rural areas of China

HUANG Yue, CHEN Chun-yi, WANG Yin-ping, GAO Ya-qing, ZHOU Hong

2020, 28(8):  854-858.  DOI: 10.11852/zgetbjzz2020-0018

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Objective To describe the situation of domestic violent discipline experienced by children under 5 years old in rural China, and to explore its possible influencing factors. Methods Based on the baseline data of the 2016-2020 Integrated Maternal and Child Health Development Project sponsored by UNICEF, relevant data of the primary caregivers for children aged 12-59 months who participated in the survey were collected for analysis.The different types of domestic violent disciplines experienced by children last month were described in the form of the rate, and the Chi-squared test and binary Logistic regression model were used separately to conduct univariate analysis and multivariate analysis on the influencing factors of children suffering from different types of domestic violent disciplines. Results Among 4 567 caregivers, 3 317(72.6%) had used at least one type of violent discipline against children over the past month, and the prevalence of psychological aggression, physical punishment and severe physical punishment were 2 517(55.1%), 2 884(63.1%) and 521(11.4%), respectively.The clild, who was older or left behind, or whose primary caregiver was the mother or supported physical punishment, was more likely to experience domestic violent discipline(P＜0.05). Conclusions It is very common for children under 5 years old in rural China to experience domestic violent discipline.To ensure the comprehensive development of children in the future, targeted interventions should be conducted for these high-risk children.

Construction of a milestone index system of Chinese children's development based on experts consultation

PAN Hong-di, ZHANG Yue, FENG Yun-jie, TANG He, FENG Wei-wei, YUE Qing

2020, 28(8):  859-862.  DOI: 10.11852/zgetbjzz2020-0333

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Objective To screen the milestone evaluation indicators for Chinese children's development, and to build a screening scale suitable for Chinese children development.Method The main evaluation indicators of children's development milestone were selected by expert consultation method, and the primary evaluation system was established. Results A total of 17 experts participated in the consultation, the authority coefficient (Ca) of experts was above 0.8, and the average authority degree of experts was 0.89.Finally 327 indicators meeting the developmental milestones of children with mean value≥4 and coefficient of variation＜0.25 were preliminarily selected, involving five energy areas of gross motor, fine motor, cognitive, language, social interaction and emotion. Conclusions Experts consulted in this study are well representative, with a high degree of consistency in indicator selection.The evaluation index system of Chinese children's development milestones has been preliminarily established.

Analysis on the association of C5a and TNF-α with insulin resistance in obese children

HU Wei, YIN Chun-yan, WANG Qian-li, SHEN Zheng, XIAO Yan-feng

2020, 28(8):  863-865.  DOI: 10.11852/zgetbjzz2020-0382

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Objective To investigate the correlations of complement C5a and tumor necrosis factor alpha (TNF-α) with insulin resistance by observing changes in clinical indicators of obese children with or without insulin resistance. Methods Children aged 7-14 years were enrolled in this study from the pediatric endocrine clinic of the Second Affiliated Hospital of Xi'an Jiaotong University from September 2014 to September 2016.All participants were divided into obesity with insulin resistance group (n=60), obesity with non-insulin resistance group (n=46) and control group (n=40).Physical data, levels of blood lipid, fasting blood glucose (FBG), insulin, TNF-α and complement C5a were tested.And the correlation of HOMA-IR and clinical indicators were analyzed. Results Body mass index (BMI) and waist circumference were significantly higher in the obese group and the insulin resistance group compared with normal control group and non-insulin resistance group (P＜0.001).Tri-glyceride(TG), FBG and insulin levels were significantly higher in insulin resistance group than those in non-insulin resistance group(P＜0.001), and HDL-C level was lower in insulin resistance group(P＜0.001).However, there was no significant difference on the level of total cholesterol (TC) among three groups(P＞0.05).The levels of TNF-α and C5a in the obesity group were significantly higher than those in the normal control group(P＜0.001).Difference on TNF-α level between the two groups were not significant, while C5a level was significantly higher in obesity with insulin resistance group than that in obesity without insulin resistance group (P=0.456).Multivariate regression analysis showed that BMI, waist circumference, FBG, TNF-α and C5a levels were positively correlated with insulin resistance (β=0.413, 0.234, 0.268, 0.318, 0.400, P＜0.05). Conclusions The inflammatory indicators like TNF- and C5a levels are closely related to insulin resistance index.BMI, TG, FBG, TNF-α and C5a levels may be independent risk factors for insulin resistance.

Correlation between Clara cell secretory protein level of cordblood and bronchopulmonary dysplasia in preterm infants

LI Yu-hong, WAN Zhen-xia, LU Qing-hua, MAO Qing-qing, CHEN Qian, ZHANG Pei-pei, TANG Jing-hai, WANG Qing-ling, HUANG Lei

2020, 28(8):  866-869.  DOI: 10.11852/zgetbjzz2020-0116

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Objective To investigate the relationship between Clara cell secretory protein (CCSP) and bronchopulmonary dysplasia (BPD) in premature infants, in order to provide reference for early prediction of BPD. Methods Totally 105 premature infants were enrolled in this study from the Neonatal Intensive Care Unit of Maternal and Child Health Care Hospital of Shandong Province from January to May in 2019.After discharge, the infants were divided into three groups according to the discharge diagnosis, including NRDS group (n=22), BPD group (n=20) and control group (n=63).The level of CCSP in cord blood serum was tested by enzyme-linked immunosorbent assay (ELISA).The level of CCSP in cord blood serum among three groups was compared, and the diagnostic efficacy of CCSP in BPD of premature infants as well as its correlation with gestational age and body weight were analyzed.Variance analysis, χ² test and correlation analysis were used for statistical analysis. Results Compared with the control group [(46.237±19.991) ng/ml] and the NRDS group [(33.132±10.132) ng/ml], the level of CCSP in cord blood of BPD group was (20.332 ± 8.066) ng/ml, which was significantly different(F=19.926, P<0.001).LSD test showed thatthe level of CCSP in control group and NRDS group was higher than that in BPD group(P<0.05).The CCSP level in cord blood of premature infants was positively correlated with gestational age and birth weight(r=0.533, 0.550, P<0.01).When the cutoff value of CCSP level was 31.560 ng/ml, the diagnostic efficiency was the highest, the Jordan index was 0.582, the sensitivity and specificity was 90.0% and 68.2%, respectively.And the area under ROC was 0.886 (95%CI: 0.814-0.957, P<0.01). Conclusion The low concentration of CCSP in cord blood of preterm infants may reflect early lung injury, which is related to the occurrence of BPD and can be used as a potential marker for the prediction of BPD.

Developmental outcome of premature infants

ZHANG Xiao-ni, YI Bin

2020, 28(8):  870-874.  DOI: 10.11852/zgetbjzz2020-0886

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With the improvement of neonatal intensive care and treatment in recent years, the survival rate of premature infants, especially ultra-premature infants, has been greatly increased, and sequelae has gradually become a prominent problem in early childhood development.Premature birth can cause damage to various organs and systems, affecting growth and development, motor, language, audiovisual, cognitive and behavioral development, even casuing neurodevelopmental impairment/defects.The developmental outcomes of premature infants are reviewed in this paper.

Association between zinc, magnesium, iron, vitamin D deficiencies and attention deficit hyperactivity disorder

ZHANG Lin, HU Bin, ZHANG Yu-ping, HE Li

2020, 28(8):  875-878.  DOI: 10.11852/zgetbjzz2019-1289

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Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder.The incidence of ADHD is increasing year by year.The etiology and pathogenesis are still unclear.Although there is limited evidence to support nutritional supplements in the treatment of ADHD, a large number of studies have shown that zinc, magnesium, iron and vitamin D levels in children with ADHD are significantly lower than those in healthy children.These nutrients play an important role in neurological function.Therefore, this article reviews the research progress of the relationship between zinc, magnesium, iron and vitamin D deficiency and ADHD, and encourages medical workers to take appropriate screening measures and preventive treatment by reviewing the dietary history of children.

Effect and mechanism of parents' postpartum depression on the social emotional competence development of infants

YU Teng-fei, LIANG Shan, CHENG Wen-hong

2020, 28(8):  879-882.  DOI: 10.11852/zgetbjzz2019-1191

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Social emotional competence is the basis for the development of mental health of infants.It is influenced by family factors and infants' own factors.Parental postpartum depression is an important risk factor for infants to develop social emotional competence.This paper summarizes the effects of postpartum depression on the social emotional competence of infants, and discusses the mechanism of how postpartum depression influence social emotional competence from the aspects of parenting style, marriage relationship and individual factors of infants.

Application of artificial intelligence in autism spectrum disorder rehabilitation

YOU Jia, LI You-jun, CHEN Yan-ni

2020, 28(8):  883-886.  DOI: 10.11852/zgetbjzz2019-1215

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Autism spectrum disorder (ASD) is a series of neurodevelopmental diseases with retarding social-emotional interaction, language and nonlinguistic communication, as well as fellowship with peers, resulting in inferior social development.Conventional diagnostic instruments such as Autism Diagnostic Observation Schedule-Revised (ADOS-R) and Autism Diagnostic Interview (ADI-R) have been used in screening, and methods of Applied Behavior Analysis (ABA), Treatment and Education of Autistic and Communication Handicapped Children (TEACCH), as well as Social Story have been applied in treatments.However, great challenges are still in front of the facts of early accurate diagnosis and workable intervene with ASD.Rapid development of artificial intelligence (AI) has led medicine into a smart age.With the application of AI in medicine, ASD have the potential to be identified timely and accurately, and get progress in treatment in the core symptoms.Meanwhile, AI also makes it possible to better resolve the issues of inadequate medical resources and large treatment costs.This article has reviewed recent literature on AI in ASD and unveiled the research results related to machine learning, virtue reality technology, robot--mediated intervention, and the ethics and prospect of AI in autism rehabilitation.

Review on Crigler-Najjar syndrome and uridine diphosphate glucuronosyl transferase 1A1 gene mutation

YAN Yue, LI Ya-rong

2020, 28(8):  887-889.  DOI: 10.11852/zgetbjzz2019-1420

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Crigler-Najjar Syndrome (CNS) is congenital, non-obstructive, non-hemolytic, hyperunbound bilirubinemia, which is characterized by a completed or near-total deficiency of uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) in liver cells.The preliminary diagnosis of CNS is mainly based on clinical manifestations and laboratory examination.After that, the diagnosis can be made by combining genetic testing, analysis of bile components and determination of UGT1A1 activity in liver tissues.CNS and UGT1A1 gene polymorphisms are of great significance in the metabolism of multiple drugs and the pathogenesis of multiple diseases.Even if the mechanism and specific effects of the genes are not qualitatively and quantitatively evaluated, clear diagnosis is of great significance for clinical guidance.This review summarizes the clinical diagnosis and treatment of CNS and the relationship between UGT1A1 gene mutations and CNS.

Bibliometric analysis of literature on neonatal hypoxic-ischemic brain damage

LYU Bai-yu, DING Guo-dong, KANG Juan

2020, 28(8):  890-894.  DOI: 10.11852/zgetbjzz2019-1652

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Objective To explore the research hotspots and development trends of neonatal hypoxic-ischemic brain damage (HIBD) at home and abroad, so as to provide reference and guidance for further research in the later stage. Methods Literature published till February 31st 2019 was searched from PubMed, Web of Science, FMRS, CNKI, WanFang and WeiPu database, and the basic methods of bibliometrics were used.Data were analyzed from the number of countries, subject distribution, journals and authors, institutions and funds, high frequency key words.A co-word matrix for high-frequency keywords was established and then cluster analysis was performed. Results 1)A total of 5 594 articles published in 1 246 journals were selected, including 205 journals with influential factors over 5. 2) The top three countries in terms of article volume on neonatal HIBD were the United States, China and Japan.3) The United States has formed a core group of authors in the field of neonatal HIBD, with high-quality journals, playing an irreplaceable role in this field.However, the core force of research on neonatal HIBD has not been formed in China.4) Eight of the top 10 research institutions in China were from advanced institutions, and the most research institutions were from Zhengzhou University, while the more in-depth researches were in Shanghai. Conclusions At present, China plays a leading role in the researches on neonatal HIBD.Multi-disciplinary, multi-level and multiregional large samples researches in this field are warranted in order to better promote clinical research.It is an urgent task to develop new drugs and targets for neonatal hypoxic-ischemic therapy, and the exploration of the role of autophagy in HIBD and related mechanisms may provide new ideas.

Construction and the improvement effect of a multidisciplinary follow-up clinic for high-risk preterm infants

HU Xiao-lin, CHEN Ling, LUO Xiao-ping, MENG Yu-shi, LIU Jin, GAO Jin-zhi, LIU Li-ying

2020, 28(8):  895-898.  DOI: 10.11852/zgetbjzz2020-0078

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Objective To investigate the effect of the quality improvement program on high-risk infants follow up (HRIF) clinic, in order to provide reference for improving the multidisciplinary follow-up system for high-risk preterm infants. Methods A total of 268 infants with gestational age<32 weeks or birth weight<1 500 g discharged from Tongji Hospital were recruited in a high-risk infant follow-up program from July 1st 2017 to July 31st 2018.Infants discharged in early period were defined as control group (n=185) and those discharged later were selected as intervention group (n=83).The control group was given conventional discharge guidance, while the intervention group received multidisciplinary HRIF.The follow-up rates of two groups at the corrected age of 1, 3, 6 months and Gesell score at the age of 6 months were compared. Results The follow-up rate of the intervention group and control group was not significantly different at the corrected age of 1 month(P>0.05), but the difference was significant at the age of 3 months and 6 months(χ²=5.307, 7.965, P<0.05).Infants in the intervention group had higher scores of cognitive and social functions assessed by Gesell scale at the corrected aged of six months (t=2.719, 3.661, P<0.05).Infants, who took regular follow-up at the corrected age of 1, 3, 6 months, had higher score in gross motor development and cognitive function than those without regular follow-up (F=8.486, 7.056, P<0.05). Conclusion The follow-up quality improvement program for high-risk infants increases the follow-up rate and indirectly facilitate the neurodevelopment of premature infants.

Effects of temperament and family environment on adaptation behavior in preschool children

QI Jing, LONG Lei, LIANG Jing, LI Hong-juan, GAO Hong, WANG Zhao-hui

2020, 28(8):  899-903.  DOI: 10.11852/zgetbjzz2020-0269

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Objective To study the characteristics of preschool children's adaptive behavior development, and to explore the influence of temperament and family environment on adaptive behavior, in order to provide basis for promoting the children's adaptive behavior. Methods A random cluster sampling method was used to select 304 parents of 4- to 6-year-old children from 3 kindergartens in Xi'an in October 2019.Parents were asked to fill out the questionnaire.ANOVA, correlation analysis and regression analysis were used to explore the influence of temperament and family environment on adaptation behavior in preschool children. Results 1)There were significant differences on independent factors, cognitive function factors, social/self-control factors and adaptive quotient (ADQ) in preschool children of different age groups(F=15.49, 6.31, 18.17, 20.91, P<0.05), and adaptive behavior developed with age.2) Rhythm, adaptability, response intensity, persistence, response domain, intimacy were significantly correlated with ADQ (r=-0.18, -0.17, 0.15, -0.13, 0.18, 0.28, P＜0.05).Rhythm, adaptability, intimacy and contradiction were significantly related to independent factors (r=-0.16, -0.18, 0.26, -0.13, P<0.05).Rhythm, persistence, intimacy and knowledge were significantly related to cognitive function factors (r=-0.14, -0.17, 0.18, 0.11, P<0.05).Response intensity, attention dispersal, response domain, intimacy and organization were significantly related to social factors (r=0.19, 0.13, 0.21, 0.21, 0.13, P<0.05).3) Family intimacy (β=0.28), temperamental rhythm (β=-0.15) and response threshold (β=0.14) could jointly predict adaptive behavior (F=14.75, P＜0.001). Conclusions The development of adaptive behaviors in preschool children is influenced by age, temperament, and family environment.Therefore, creating a suitable family environment according to the characteristics of children's temperament, could promote the all-round development of preschool children's adaptive behavior.

Effect of early intervention program on physical and neuropsychological development in premature small for gestational age infants

ZHENG La-jie, LIU Xian-peng, HUANG Huan-huan, SU Wei-dong, HUANG Yu-dan, LI Qiu-yue

2020, 28(8):  904-908.  DOI: 10.11852/zgetbjzz2020-0114

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Objective To study the effect of early intervention on physical and neuropsychological development of preterm small for gestational age infants(SGA)during hospitalization and after discharge in Neonatal Intensive Care Unit(NICU), in order to provide reference for the intervention of preterm high-risk infants. Methods Preterm SGAs hospitalized in NICU from October 2016 to February 2019 were enrolled in observation group (n=103), who received early intervention during hospitalization and after discharge.And those hospitalized in this hospital but did not took early intervention measures were selected as control group (n=89).Physical development indexes of the two groups were recorded.The 20 items of neuromotor assessment at 0-1 year old(INMA) and the Bailey Infant Development scale(BISDⅡ)were used for assessment at the critical age, and the results were compared between the two groups. Results At the corrected age of 6 and 12 months, there was no significant difference on body weight and length.However, there was significant difference on head circumference between observation group and control group at the corrected age of 12 months (t=-2.260, P=0.032).At the age of 18 months, there were significant differences on body weight, body length and head circumference between the two groups (t=-2.652, -3.381, -2.627, P<0.05).The catch-up growth rates of body weight and head circumference in observation group were significantly higher than those in control group at the corrected age of 6 months (χ²=3.891, 4.444, P＜0.05).And the catch-up growth rate of body length in observation group was also higher than that in control group (χ²=4.516, P=0.034).INMA results indicated that abnormal rate of observation group was lower than that of control group (χ²=4.401, 4.786, P<0.05).Moreover, the psychomotor development index (PDI) and the mental development index (MDI) in observation group were significantly higher than those in control group at the corrected age of 12 months and 18 months(t=2.645, 3.492, 2.427, 2.437, P＜0.05). Conclusion Early intervention for premature SGAs can promote their physical and neuropsychological development, facilitate early catch-up growth, reduce neurological sequelae, thereby achieving the development of healthy growth tracks of this kind of high-risk children.

Relationship between blood lipid and HbA1c level in children with first-onset type 1 diabetes mellitus

CHANG Jie, GU Fang, WANG Jie-ying, LI Rong-min, LEI Shu-qin, LI Zhen

2020, 28(8):  909-911.  DOI: 10.11852/zgetbjzz2019-1530

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Objective To observe the blood lipid levels in children with first-onset type 1 diabetes mellitus (T1DM), and to analyze its correlation with the level of glycosylated hemoglobin (HbA1c) in children. Methods Clinical data of 168 children with T1DM admitted to Baoding Children's Hospital from January 2018 to June 2019 were retrospectively analyzed, and 100 healthy children in the same period were selected as control group.Differences on blood lipids such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were compared between the two groups.Pearson analysis and multiple linear regression method were used to analyze the correlation between serum lipid level and HbA1c level in children with T1DM. Results The levels of TC, TG and LDL-C in T1DM group were significantly higher than those in control group (t=4.691, 7.705, 4.119, P＜0.001), while HDL-C level in T1DM group was significantly lower(t=3.845, P＜0.05).The level of HbA1c in dyslipidemia group was significantly higher than that in normal blood lipid group[(13.09±2.71)% mmol/L vs.(11.78±2.56)% mmol/L, t=3.209, P<0.05].Pearson correlation analysis showed that HbA1c level was positively related to TC, TG and LDL-C levels(r=0.547, 0.514, 0.438, P＜0.05), while significant correlation between HDL-C and HbA1c level was not found (r=0.109, P>0.05).Multiple linear regression analysis showed that TC and TG levels were closely related to HbA1c level (β=0.008, 0.045, P<0.05). Conclusion The proportion of dyslipidemia is higher in children with T1DM.Higher level of HbA1c indicates higher risk for dyslipidemia, which should be given more consideration in clinic practice.

Clinical observation of pharmacogenetic testing to guide individualized treatment of asthma in children

LIU Yan-lin, TANG Su-ping, LAN Di-shi, DONG Li, LIN Jie-qi, CHEN Shen, CHEN Lan, YE Wen-jing

2020, 28(8):  912-916.  DOI: 10.11852/zgetbjzz2020-0079

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Objective To observe and evaluate the clinical efficacy of individualized treatment of childhood asthma under the guidance of pharmacogenetic testing. Methods Children with acute exacerbation of mild-moderate allergic asthma were enrolled in this study from Department of Allergy of Fuzhou Children's Hospital from January to April in 2019.According to the results of pharmacogenetic testing, children were divided into inhaled glucocorticoid experimental group and leukotriene modulator experimental group, with 20 cases in each group.Corresponding individual asthma treatment was carried out in two groups.The indicators were compared with the control group without genetic testing after follow-up for six months, including fractional exhaled nitric oxide(FeNO), children asthma control test(C-ACT) score, pulmonary function FEV₁%, PEF, FEF25%, FEF50%, FEF75%, the number of respiratory infections and the number of children's missing days of school. Results 1) The inhaled glucocorticoid treatment experimental group was significantly better than the control group in C-ACT score and pulmonary function FEV₁%, PEF, FEF25% indicators(P<0.05).FeNO and pulmonary function FEF50%, FEF75% in the experimental group were not significantly different from those in the control group (P>0.05).2)The leukotriene modulator treatment experimental group had a significantly better C-ACT score and pulmonary function FEV 1%, and the PEF index was significantly better than the control group(P<0.05).FeNO and lung function FEF25%, FEF50%, FEF75% in the experimental group were not statistically different from those in the control group (P>0.05).3) During the follow-up for 6 months, the number of infections and missing days of school in the inhaled glucocorticoid treatment experimental group were significantly lower than those in control group (t=4.461, 7.259, P<0.05), but the differences were not significant between the leukotriene modulator treatment experimental group and the control group(P>0.05). Conclusions Pharmacogenetic testing is the direction to achieve individualized treatment of asthma.Currently there are limited clinical data in China, so large sample studies are warranted to provide more reliable clinical data.

Comparative study on bioelectrical impedance analysis and body mass indexin nutrition assessment of children with duchenne muscular dystrophy

ZHAO Xiao-peng, XIE Ying, HU Huan-yu, ZHAO Li-hua, CHEN Yin-hong, LI Zeng-ning

2020, 28(8):  917-920.  DOI: 10.11852/zgetbjzz2019-1513

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Objective To analyze the body composition of children with duchenne muscular dystrophy (DMD) by bioelectrical impedance analysis (BIA), and to compare the consistency of body mass index (BMI) with the percentage of body fat (PBF) when assessing the overweight of DMD children. Methods A total of 39 male DMD children were enrolled in case group from August 2015 to February 2017 in Neuromuscular Department of the Third Hospital of Hebei Medical University, and 46 healthy boys were randomly selected as control group during the same period.BIA was used to test body composition in two groups. Results There was no significant difference on fat content and BMI between the two groups (P＞0.05).The height, weight, body water, protein, inorganic salt, muscle mass and basal metabolic rate (BMR) of DMD children were significantly lower than those in control group (P<0.05).However, the PBF of DMD children was higher than that of the control group (P<0.05).There was positive correlation between PBF and age in DMD children (r=0.546, P<0.05).BMI was poorly consistent with PBF in determining the overweight of children with DMD (Kappa=0.352, P<0.05). Conclusions Compared with healthy children with the same age and gender, the nutritional status of DMD children is poor.BIA can more accurately assess the nutritional status of patients than using BMI.

Effect of INSURE strategy in combination with budesonide on the incidence of bronchopulmonary dysplasiaduring the treatment of respiratory distress syndrome in very low birth weight

ZHANG Hui, MA Yuan-pei, WU Hui, PIAO Mei-hua, HAN Tong-yan

2020, 28(8):  921-924.  DOI: 10.11852/zgetbjzz2019-1452

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Objective To analyze the effect of INSURE strategy in combination with budesonide on the incidence of bronchopulmonary dysplasia(BPD) during the treatment of respiratory distress syndrome in very low birth weight, in order to provide scientific basis for clinical treatment to reduce the incidence of BPD. Methods 1) A total of 83 neonates diagnosed with RDS admitted to Peking University Third Hospital within 1 h after birth from January 2014 to December 2018, whose gestational age was less than 32 weeks and birth weight was from 1 000 to 1 500 g, were selected in this study, and were divided into the modified group with 35 cases (intubation-surfactant and budesonide-extubation) and conventional group with 48 cases (intratracheal administration of surfactant and mechanical ventilation).2) A clinical questionnaire was designed to collect general information, incidences of BPD and other complications, outcomes and so on. Results 1) PO₂ in the modified group was higher than that in the conventional group at 6 h after administration, and both ventilator and total oxygen use time were significantly shorter than those in the conventional group (t=2.571, 3.633, 3.484, P＜0.05).2) The incidence of BPD and patent ductus arteriosus in the modified group was significantly lower than those in the conventional group (χ²=3.886, 3.920, P＜0.05).But there were no statistically significant differences on the incidence of other complications and survival rate between the two groups(P＞0.05). Conclusions INSURE strategy in combination with budesonide can improve oxygenation in early stage, shorten ventilator and total oxygen use time, significantly reduce the incidence of BPD, and also reduce the incidence of patent ductus arteriosus, which does not increase the risk of other diseases and death in the short term.Therefore, further researches are warranted so as to promote its application on clinical practice.

Correlation between vitamin A deficiency and recurrent respiratory tract infection in children

HUANG Na, CHENG Xiao-jun, LIU Ying, LI Xue-ning, ZHU Xing-hua, HE Jia, LIU Ying

2020, 28(8):  925-927.  DOI: 10.11852/zgetbjzz2019-1321

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Objective To analyze the relationship between serum vitamin A level and recurrent respiratory tract infection (RRTI) in children, so as to provide reference for the prediction of vitamin A as a risk of RRTI and the adjuvant treatment of RRTI. Methods A total of 120 children with RRTI admitted to the second pediatrics department of the Fourth Affiliated Hospital of China Medical University were selected as observation group from August 2017 to August 2018.And the other 120 children with respiratory infection admitted to the hospital in the same period were selected as the control group.The levels of vitamin A and immunoglobulin (IgA, IgG, IgM) in two groups were analyzed and compared.And the relationship between vitamin A and immunoglobulin was analyzed.Children with RRTI were followed up for one year, exogenous vitamin A supplementation was recorded after discharge, and the number of RRTI was observed. Results The serum vitamin A level of the observation group was lower than that of control group, and the detection rate of subclinical vitamin A deficiency in the observation group was higher than that of control group (t=2.632, χ²=7.366, P<0.05).The IgG level in the vitamin A deficiency group was significantly lower than that in children with normal vitamin A level (F=5.036, P＜0.05).Pearson analysis showed that vitamin A level was positively correlated with IgG level (r=0.172, P<0.05).There was no significant difference on the number of respiratory infections between the groups with vitamin A supplementation and without vitamin A supplementation before treatment (P>0.05).After treatment, the number of respiratory infection in both groups was significantly reduced (t=9.291, 2.036, P<0.05), and it was less in the group with vitamin A supplementation than group without vitamin A supplementation (t=2.448, P＜0.05). Conclusion RRTI is associated with vitamin A deficiency, and vitamin A supplementation can be helpful to reduce respiratory infection.

Value of Graf ultrasound in the diagnosis of developmental hip dysplasia in infants aged 0 to 6 months

XU Ying, ZHU Xiao-gai

2020, 28(8):  928-930.  DOI: 10.11852/zgetbjzz2020-0026

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Objective To investigate the diagnostic value of Graf ultrasound in the development of developmental hip dysplasia (DDH) in infants aged 0-6 months, in order to provide reference for clinical screening for DDH. Methods A total of 1 393 infants with suspected DDH admitted to the neonatal ward of Jinchang First People's Hospital from July 2014 to October 2019 were examined by Graf ultrasound, and clinical and X-ray examinations were performed as the "gold standard" to determine DDH.Graf ultrasound diagnosis results, diagnostic accuracy, specificity, and sensitivity were analyzed, and the differences on α and β angles between normal hip abnormal and DDH were compared. Results 1) Among 1 393 infants who underwent Graf ultrasound examination, the detection rate of DDH was 5.60%.The proportion of DDH in female infants was significantly higher than that of male infants, and the proportion of breech delivery in infants with DDH was significantly higher than that of non-breech delivery (P <0.05).Among the 2 786 hip joints examined, the hip joint abnormality rate was 4.74%.Moreover, α angle of the abnormal hip joint was significantly smaller than that of the normal hip joint, β angle was significantly larger than that of the normal hip joint (P <0.05).2) The accuracy of Graf ultrasound in the diagnosis of developmental hip dysplasia was 100%, the specificity was 99.87%, and the sensitivity was 100%.3) Totally 96 of 278 type Ⅱa hip joints were converted to type Ⅰ, 4 of 10 type Ⅱb hip joints were converted to type Ⅰ, and 132 abnormal hip joints were treated with plaster fixation or Pavlik sling Later all turned to normal hip joints during follow-up. Conclusion Graf ultrasound is of good diagnostic value for DDH in infants and young children aged 0~6 months, and it is worthy of clinical application.

Early hematological characteristics analysis of children with influenza A and B

LOU Dan-dan, XU Er-di, XIAO Yan-feng

2020, 28(8):  931-935.  DOI: 10.11852/zgetbjzz2020-0067

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Objective To analyze the epidemiological characteristics of the children with influenza, and to explore the value of blood routine test in early diagnosis of influenza, so as to provide evidence for clinical diagnosis and treatment. Methods All the influenza-like cases from the Pediatric Emergency Department of the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled in this study from December 2018 to April 2019.The antigen of influenza virus was detected according to the influenza virus antigen detection kit (colloidal gold method) in nasal or throat swabs and the blood cell count and morphological by peripheral venous blood.And the epidemic characteristics and the characteristics of different cell types in blood routines were analyzed and compared among children with the influenza A, B and acute upper respiratory infection at different ages. Results Totally 442 influenza-like cases were enrolled in this study, and were divide into influenza A group(n=187), influenza B group (n=60) and acute upper respiratory infection group(n=195).There were no significant differences on general data among the three groups.Children with influenza A and B most had high fever, while upper respiratory tract infections had moderate fever.The levels of white blood cell counts, platelet count, neutrophil count and lymphocyte count in children with acute upper respiratory tract infection were significantly higher than those in children with influenza A and/or B at the same age.The percentage of monocytes in children under 6 years old and with upper respiratory tract infection was lower than that of children with influenza A.For children aged 6 to 14 years, the percentage of monocytes in children with upper respiratory tract infection was significantly lower than that in children with influenza A and/or B at the same age.Furthermore, the higher the temperature, the higher the percentage of monocytes would be in children under 3 years old. Conclusions Children with influenza usually has a higher fever temperature than those with common upper respiratory infections.Differential blood cell counts can partially help distinguish influenza from common upper respiratory infections.

Analysis of the safety monitoring of national immunization program vaccines for children in Anshan City during 2015-2018

ZHONG Wei-wei, ZHANG Lu

2020, 28(8):  936-938.  DOI: 10.11852/zgetbjzz2020-0238

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Objective To analyze the characteristics of suspected adverse event following immunization (AEFI) in Anshan City during 2015-2018, so as to evaluate the safety of national immunization program vaccines. Methods The AEFI case data of Anshan City during 2015-2018, collected by the AEFI information management system were analyzed by descriptive epidemiological method. Results A total of 863 AEFI cases caused by immunization program vaccines for children were reported in Anshan during 2015-2018, with 199 cases in 2015, 231 cases in 2016, 170 cases in 2017 and 263 cases in 2018.The overall reported incidence was 42.53/10⁵.Among all the reported cases, 796(92.24%) cases were common adverse reactions, 39(4.52%) cases were rare adverse reactions, 26(3.01%) cases were coincidental events, and 1(0.12%) case was psychogenic reaction, 1(0.12%) case was undetermined.A total of 649(75.20%) cases occurred among children under one year old.The vaccine with the highest reported number and incidence of AEFI was the DTaP vaccine, reported by 336 cases (93.19/10⁵). Conclusion AEFI monitoring in Anshan is of high sensitivity, and national immunization program vaccines for children are highly safe.

Effect of nursery care on the incidence of acute upper respiratory tract infection and the change of pharyngeal pathogens in children

LUO Chun-chou, CAI Hui-zhen, ZHANG Bao-zhong, LIN Xiu-mei, YANG Hui-lian, CHEN Xian-gui, LIN Ying

2020, 28(8):  943-946.  DOI: 10.11852/zgetbjzz2020-0019

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Objective To understand the influence of nursery care on the incidence of acute upper respiratory tract infection (AURI) and the change of pharyngeal pathogens in children, so as to provide reference for the development of effective AURI prevention measures and treatment strategies. Methods Ninety-one healthy preschoolers enrolled in a public kindergarten for the first time in this city were examined for pharyngeal swab pathogens before the first physical examination and after the first time of AURI in the kindergarten.And the influence of collective life on the change of pharyngeal pathogens was analyzed. Results There was no significant difference on the number of bacterial species isolated from pharynx swabs before and after AURI occurrence in 91 children, and the total proportion of bacteria (≥2+) after getting AURI was higher than the baseline (42.28% vs.33.77%, P=0.036).One case (1.1%) was positive for Mycoplasma, while chlamydia and 7 respiratory viruses were not detected before nursery care.However, 25 cases (27.47%) were positive for viruses and Mycoplasma after AURI, and the difference was statistically significant (χ²=37.111, P<0.001).Further analysis indicated that 51.65% were bacterial infections, 27.47% were non-bacterial infections, of which 5.50% were mixed infections.There was a tendency of concentrated distribution of common pathogens in the occurrence time of AURI. Conclusions There are mixed colonization of bacteria exists in the pharynx of healthy preschoolers, and the colonization of viruses, mycoplasma and Chlamydia is extremely rare.Collective life in kindergartens may induce the occurrence and transmission of AURI among children.So it is very important to strengthen child health care and disease prevention in kindergartens.

Effect of family rehabilitation Wechat program on children with functional dysarthria

CHEN Li, DAI Yan-qiong, TANG Liang, CAO Si-qi

2020, 28(8):  947-949.  DOI: 10.11852/zgetbjzz2019-1372

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Objective To explore the effect of family rehabilitation Wechat program on children with functional articulation disorder (FAD), in order to provide scientific reference for clinical treatment. Methods Totally 36 FAD children treated in rehabilitation department of Shanghai Children's Hospital from January 2018 to July 2019 were enrolled in this study, and were randomly divided into routine family rehabilitation group and Wechat small program group, with 18 cases in each group.And the intervention last for 8 weeks.Before and after treatment, the articulation disorders were assessed by the method developed by China Rehabilitation Research Center. Results Before treatment, there was no significant difference on error sounds between the conventional home rehabilitation group and the Wechat Mini Program group (t=0.72, P=0.48).After 8 weeks of treatment, the error sounds of the two groups of children significantly improved (t=10.73, 15.74P<0.01).Moreover, the error syllables were significantly reduced in the family WeChat mini-program group compared with the conventional home rehabilitation group (t=0.37, P<0.05). Conclusion Family rehabilitation Wechat program can better improve the mispronunciation of children with functional dysarthria.