Table of Content

10 December 2021, Volume 29 Issue 12

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Original Articles

Correlation between visceral fat area and uric acid in school-age children

RAO Jia-huan, CHENG Hong, YAN Yin-kun, HOU Dong-qing, ZHAO Xiao-yuan, ZHU Zhong-xin, YU Zhao-cang, WANG Hong-jian, GAO Ai-yu, MI Jie

2021, 29(12):  1276-1280.  DOI: 10.11852/zgetbjzz2021-1689

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Objective To explore the correlation between visceral fat area (VFA) and uric acid level in school-age children, so as to provide reference for preventing hyperuricemia (HUA) of children. Methods Data were from school-based cardiovascular and bone health promotion program (SCVBH), and 10 609 children and adolescents aged 8 to 18 years were finally included for analysis. The correlation between VFA and cardiovascular metabolic parameters was analyzed by Spearman correlation analysis. The body type was divided into four groups according to obesity diagnosed by body mass index (BMI) and VFA. The association between different obesity types and HUA was analyzed by multivariate Logistic regression, and the potential confounding factors such as age, blood pressure, blood glucose and blood lipids were adjusted. Results VFA increased gradually with growth and development of children, and the gender difference was significant. VFA was positively correlated with uric acid level in boys and girls (r=0.399, 0.375, P＜0.001). The prevalence of HUA increased successively among the non-overweight, overweight and obesity group divided by BMI (28.9%, 43.5% and 52.1% for boys, 6.0%, 15.9% and 32.4% for girls, respectively). The prevalence of HUA in the obesity group evaluated by VFA was significantly higher than that in the non-overweight group (57.5% vs. 33.7% for boys, 31.6 % vs. 7.7 % for girls, P <0.001). After adjusting the confounding factors such as age, blood pressure, blood glucose and blood lipid, the ORs and 95%CIs of risk for HUA were 2.70 (95%CI: 1.36 - 5.35) in boyswith simple abdominal obesity.and 4.74 (95%CI:3.77 - 5.95) in girls with mixed obesity. Conclusions VFA is closely related to uric acid levels in children. Body composition analysis in health examination can early detect obesity in children, which is also of great significance for prevention and control of HUA in children.

Dietary intake and its association with body fat among children and adolescents aged 6 to 16 years in Beijing

HUANG Yi-wen, YAN Yin-kun, HOU Dong-qing, ZHU Zhong-xin, YU Zhao-cang, WANG Hong-jian, GAO Ai-yu, ZHAO Xiao-yuan, XIAO Pei, CHENG Hong, MI Jie

2021, 29(12):  1281-1285.  DOI: 10.11852/zgetbjzz2021-1682

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Objective To investigate current status of dietary intake of children and adolescents in Beijing, and to assess its association with body fat, so as to provide evidence for making scientific strategies for children's dietary management. Methods A total of 14 945 children and adolescents aged 6 to 16 years were selected from 30 schools in Miyun, Tongzhou, Fangshan and Dongcheng districts of Beijing by using a stratified cluster sampling method from November 2017 to January 2018, including 7 483 (50.1%) boys. The survey contents included questionnaire survey (general demographic characteristics, life behavior variables, socioeconomic variables, etc.) and Physical examination (height, weight measurement and body fat test). According to the 2010 American Heart Association Criteria, the status of dietary was categorized as poor, intermediate and ideal. Results The proportions of children and adolescents with ideal, intermediate and poor dietary status were 19.4%, 52.8% and 27.8%, respectively. Fat mass index and fat mass percentage decreased with poor to ideal dietary status after adjusting for confounding factors (β=-0.081, -0.286, P_trend<0.05). Conclusions The dietary status of children and adolescents aged 6 to 16 years in Beijing is not optimistic, and poor dietary status may affect fat accumulation among children. Therefore, targeted dietary guidance should be put forward at family, school and social levels to reduce the risk of obesity in children and adolescents.

Influence of family and motor coordination ability on children's learning quality

LIU Guo-yan, MA Si-si, ZHAN Wen-qi, FAN Yu-ting, LI Jie-xuan

2021, 29(12):  1286-1290.  DOI: 10.11852/zgetbjzz2021-1311

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Objective To discuss the influence of family and motor coordination ability on children's learning quality, in order to provide theoretical evidence for improving children's learing quality. Methods A total of 340 preschool children aged 5 to 6 years were randomly selected by a cluster sampling method from two kindergartens in Shenzhen.Children's School Maturity Level Diagnostic Scale, Children's Learning Quality Parental Evaluation Scale and Family Environment Scale (Chinese version) were used to evaluate children's motor coordination ability, learning quality and family situation. Results Learning quality score was higher in girls (t=2.07), children whose parents with higher educational level (F=9.15, 9.50), and children with better motor coordination ability (t=2.14, P<0.05).Family intimacy and organization scores were positively correlated with children's motor coordination ability(r=0.13, 0.12,P<0.05).Family intimacy, independence and success scores were positively related to the total score of children's learning quality(r=0.19, 0.17, 0.22,P<0.05).Family contradiction score was negatively correlated with the total score of children's learning quality(r =-0.14, P<0.05).Motor coordination ability had a partial mediating effect in the influence of family intimacy and organization on children's learning quality, with the percentage of 8.93% and 8.84%. Conclusions Cultivating good learning quality of children can start from creating a harmonious family atmosphere and improving their motor coordination ability.

Survey on early infant developmental coordination disorder in 46 073 cases in six cities of China

ZHANG Jia-jia, WANG Lei, CHEN Gui-xia, LIN Yao, HUA Jing

2021, 29(12):  1291-1294.  DOI: 10.11852/zgetbjzz2021-0080

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Objective To explore the influence of early-term birth (gestational age of 37 to 38 weeks) on developmental coordination disorder (DCD), so as to provide clues for targeting the population receiving intervention and prevention. Methods A total of 46 073 preschool children from 670 kindergartens in Shanghai, Maanshan, Taizhou, Haikou, Xiamen and Yangzhou were enrolled from April to December 2018.The ability of motor coordination was assessed using Little Developmental Coordination Disorder Questionnaire (Little DCDQ). Results The score of total motor coordination (67.30±8.90 vs.67.50±8.80), motor control (22.82±3.08 vs.22.89±3.04) and general coordination (21.95±3.26 vs.22.03±3.21) in early children were lower than those of completely full term children (t= 2.174, 2.201, 2.382, P<0.05).Multivariate analysis showed that after controlling for potential confounding factors such as sex, age and education level of parents, body mass index(BMI), the risk of DCD in girls with early-term birth was 1.157 times higher than that with full-term birth (OR=1.157,95%CI:1.001-1.340, P<0.05). Conclusions Early-term infants should be attached great importance in early assessment and intervention of DCD.Strengthening the healthcare in early-term children would be one of the key points to promote the quality of population and save the medical expenditure under the "two-child" policy.

Development and evaluation of the Chinese Toddler Sleep Assessment Scale

FENG Wei-wei, ZHANG Yue, WANG Hui-shan, PAN Xiao-ping, HUANG Xiao-na, XU Tao, ZHANG Tong, Provincial Working Group for Study on the Development of Chinese Infants and Todders Sleep Assessment Scales

2021, 29(12):  1295-1299.  DOI: 10.11852/zgetbjzz2021-0272

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Objective To develop Chinese Toddler Sleep Assessment Scale (TSAS) suitable for Chinese toddles aged 13 - 35 months, and to evaluate the reliability, validity and feasibility of the scale, so as to provide an appropriate tool for assessing the sleep of Chinese children. Methods An item pool was established.The items were preliminary selected and modified through brainstorming, Delphi and pre-test.A total of 551 children aged 12 - 35 months in six communities, six towns and two sleep clinics were investigated from July to November 2019 using random sampling.Item analysis, validity analysis, reliability analysis, feasibility and confirmatory factor analysis were used to evaluate the scale. Results The TSAS had 20 items, including 6 factors of sleep rhythm,bedtime arrangement,night wakings, daytime sleepiness,parasomnias breathingand sleep disordered with total variance explained of 55.55%.The item-level content validity of all items ranged from 0.83 to 1.00.The scale was positively correlated with the Brief Infant Sleep Questionnaires in terms of sleep latency, number of night wakings and sleep duration (r=0.41, 0.69, 0.42, P<0.001).Except for daytime sleepiness, community sample scored lower than clinical sample in terms of the total score and other 5 factors (P<0.05).The total Cronbach's α coefficient was 0.72.The total retest reliability was 0.84.The completion rate of the scale was 92.6%.The results of confirmatory factor analysis showed that the factor structure model of TSAS was reasonable and stable. Conclusions TSAS have good reliability and validity, which could distinguish the sleep of toddlers in the community and clinics, and could be used for early screening of toddlers' sleep problems.

Effect of early start denver model on toddlers with autism spectrum disorder

WANG Shi-huan, ZOU Xiao-bing, ZOU Yuan-yuan, ZHANG Hai-tao, CHEN Kai-yun

2021, 29(12):  1300-1303.  DOI: 10.11852/zgetbjzz2021-1382

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Objective To explore the effect of early start denver model (ESDM) on toddlers with autism spectrum disorder (ASD), in order to provide evidence for improving the prognosis of ASD. Methods A total of 60 ASD toddlers were recruited from June 2015 to June 2017 in Child Developmental & Behavioral Center, the Third Affiliated Hospital of Sun Yat-sen University,and were randomly divided into experimental group (n=30) and control group (n=30).Children in experimental group received ESDM intervention, while the control group was in the period of waiting for intervention.The ESDM intervention lasted one hour once a week for 24 weeks.Baseline system assessments were conducted before intervention, PEP-3 and Gesell Development Scale (GDS) were completed in both two groups after intervention. Results Before intervention, there were no statistically significant differences in age, gender, communication, social interaction, repetitive and stereotyped behavior, cognition, language and fine movements between the experimental group and control group (P >0.05).Compared with control group, language and personal-social scores in ESDM group were significantly improved (t=2.215, 2.379, P＜0.05).Furthermore, the raw score of cognition, language expression, language understanding, small muscles, imitation and non-language behavioral characteristics in ESDM group was significantly improved (t=2.336, 2.510, 2.416, 2.578, 2.017, 2.150, P<0.05).In addition, the score gaps of languagedevelopment quotient of GDS in the ESDM group were significantly higher than those in the control group before and after intervention (Z=2.105, P<0.05). Conclusions After ESDM intervention, the language and social communication, cognitive, verbal expression and comprehension, fine movements and imitation abilities of ASD toddlers are significantly improved. Additionally, non-verbal stereotypical behaviors significantly reduce in ASD toddlers.

Dietary zinc intake and serum zinc level and their association with cardiovascular diseases risk factors in children and adolescents

ZHU Qian-rang, DAI Yue, ZHANG Jian, ZHANG Jing-xian, XIE Wei

2021, 29(12):  1304-1308.  DOI: 10.11852/zgetbjzz2021-0703

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Objective To estimate the level of dietary zinc intake and serum zinc among children and adolescents in Jiangsu province from 2016 to 2017, and to explore the association of dietary zinc intake or serum zinc concentrations with nutrition-related cardiovascular disease risk factors. Methods A total of 1 251 children and adolescents aged from 6 to 17 years were selected from 12 monitoring sites in Jiangsu Province from 2016 to 2017 by multi-stage stratified random sampling.Participants took physical examinations (height, weight, waist circumference), biochemical tests (serum zinc, fasting blood glucose and lipids) and dietary intake assessment (24-hour dietary recall for 3 consecutive days).Pearson χ² test, Kruskal-Wallis test and linear regression model were used to conduct statistical analysis. Results A total of 1 122 children and adolescents aged 6 to 17 years were included in this study.The amount of zinc intake in 39.39% of the participates was below average requirement, whereas it was 56.7% for the participates aged from 13 to 17 and 54.8% for rural participates.The proportion of participants whose serum zinc levels were lower than the reference value was low (0.5%).But there were differences in serum zinc levels among different genders and regions, among which male and urban participants had higher serum zinc levels.Linear regression showed that there was no linear association between dietary zinc intake and serum zinc levels, and there was a weak positive association between dietary zinc intake and high density lipoprotein (β=0.072, 95%CI:0.034 - 0.111, P<0.001) and a negative association between serum zinc and fasting blood glucose(β=-0.506,95%CI:-0.575 - 0.437, P<0.001). Conclusions Children and adolescents in Jiangsu Province are still at a high risk of insufficient dietary zinc intake.Adequate dietary zinc intake and high serum zinc level in children and adolescents are related to good metabolic status.

Review

New progress in the pathogenesis of neonatal necrotizing enterocolitis

LIU Na, LI Zhong-liang, ZHANG Chun-lei, LI Xue-feng, ZHANG Cheng-yuan, ZHANG Xue-bo

2021, 29(12):  1309-1312.  DOI: 10.11852/zgetbjzz2020-2064

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Necrotizing enterocolitis (NEC) is one of the diseases with high morbidity and mortality in neonates. Although the clinical diagnosis, treatment and nursing of newborns have improved, the unclear pathogenesis is still the main reason that limits the prognosis of NEC. In recent years, new progress has been made in the research of the pathogenesis of NEC, including the modulation of vascular endothelial growth factor, the signal transduction of Toll-like receptors, the discovery of potential biomarkers of NEC through metabolomics, probing for genetic predispositions to NEC susceptibility, determining mechanistic relations between anemia, intestinal flora imbalance and NEC. In-depth understanding of the pathogenesis of NEC will help to further improve the diagnosis and treatment of this disease. In this article, these new insights will be reviewed.

Research progress in gastrointestinal problems in children with cerebral palsy

LIU Xiao, ZHANG Li-hua, CHAO Yi-quan

2021, 29(12):  1313-1316.  DOI: 10.11852/zgetbjzz2020-1192

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Cerebral palsy (CP) is a symptom cluster of persistent central motor and posture developmental disorders, activity limitation syndrome, which is caused by non-progressive brain injury of developing fetuses and infants. Gastrointestinal problems are common in children with cerebral palsy, mainly including oropharyngeal swallowing disorders, gastroesophageal reflux disease and constipation. This review combs the main gastrointestinal problems in children with cerebral palsy in order to improve the understanding of parents and medical staff to the gastrointestinal problems in children with cerebral palsy.

Progress in current situation and intervention measures of neonatal birth defect

JIANG Wen-jing, CHEN Yu-qing, YANG Jia-hui, SHEN Yan, WU Kai-mei, LI Xian-hong

2021, 29(12):  1317-1320.  DOI: 10.11852/zgetbjzz2020-1521

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Neonatal birth defect is a major public health issue around the world. This review describes the epidemiological prevalence,the intervention measures,and the challenges of the neonatal birth defect,so as to provide references for developing more culturally adaptive measures in future for Chinese government and health care professionals.

Progress in the application of whole-body vibration on the rehabilitation of children with cerebral palsy

HAN Lin-xiu, GUO Jin

2021, 29(12):  1321-1324.  DOI: 10.11852/zgetbjzz2020-1672

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Whole-body vibration (WBV) training is a neuromuscular training method in which a vibration platform produces mechanical stimulations that are transmitted through the soles of the feet to the whole body,thereby causing changes in the patient's physiological function. Many studies have shown that WBV plays a positive role in the rehabilitation of children with cerebral palsy. This review will focus on the effect of WBV on the lower limbs^,function in cerebral palsy children.

Research progress of perinatal exposure and bronchial asthma in children

HU Long-ji, QU Shu-qiang

2021, 29(12):  1325-1328.  DOI: 10.11852/zgetbjzz2020-1861

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Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. The prevalence rate of bronchial asthma in Chinese children is increasing year by year, and the overall level of control is still not ideal in Chinese children. There is growing evidence that negative events occurring early in life, even in the perinatal period, significantly increase the risk of asthma and poor pulmonary function later in life. This article reviews the researches on the relationship between perinatal exposure and bronchial asthma in children.

Research progress on the risk factors of neonatal sepsis

FENG Mei-yuan, FU Zhong-qiu

2021, 29(12):  1329-1332.  DOI: 10.11852/zgetbjzz2020-1902

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Neonatal sepsis can cause infection in all systems of the body, which is the main cause of neonatal infectious diseases and death. In recent years, different views have been put forward around the risk factors of neonatal sepsis. In addition to preterm birth and low birth weight, vitamin D deficiency is also considered as one of the risk factors for early and late onset sepsis. Premature rupture of membranes and chorionic amnitis, previously considered as risk factors for early sepsis, have also been disputed at present. This article reviews the progress of the above factors and the irrational use of antibiotics, invasive procedures and parenteral nutrition, which lead to late-onset sepsis, as well as other influencing factors, with the aim of providing measures for the prevention of neonatal sepsis.

Meta Analysis

Meta-analysis of the effect of pulmonary ureaplasma urealyticum infection on bronchopulmonary dysplasia

LI He-jia, HAO Ling, MIAO Jia-li, HUANG Jia-yu, MENG Jin-feng, REN Chang-jun

2021, 29(12):  1333-1338.  DOI: 10.11852/zgetbjzz2020-1298

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Objective To analyze the effect of pulmonary ureaplasma urealyticum (UU) infection on bronchopulmonary dysplasia (BPD), so as to provide evidence for preventing BPD in preterm infants. Methods Eight databases including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP and China Biomedical Database (CBM) were searched to collect the cohort study on the effect of pulmonary UU infection on BPD, and the source of samples were endotracheal. The retrieval time was from the establishment of the database to April 15th, 2020. Meta-analysis was carried out by using stata 15.1 software. Results A total of 21 cohort studies were included, 18 of which assessed outcomes at the 28th days after birth, 9 of which assessed outcomes at the 36th weeks of adjusted gestational age. Totally 3 039 subjects were included, 831 of whom were in UU infection group and 2 085 were in UU non-infection group. Random effect model indicated that UU infection did not increase the risk of BPD (assessment on the 28^th days after birth RR=1.69, 95%CI: 1.42 - 2.01; assessment on the adjusted gestational age of 36 weeks RR=1.20, 95%CI: 0.91 - 1.58). Conclusions Based on the existing research data, it can not be determined that UU infection is the influencing factor of BPD. A unified diagnostic standard of BPD and higher quality cohort studies are warranted to explore the relationship between UU infection and BPD.

Clinical Research

The influence of different feeding methods on clinical features and prognosis in term infants with necrotizing enterocolitis

LIU Shi-qi, HEI Ming-yan, WANG Hui-xin, DONG Shi-xiao, WENG Jing-wen, QI Yu-jie, JIANG Min

2021, 29(12):  1339-1342.  DOI: 10.11852/zgetbjzz2021-0489

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Objective To study the influence of different feeding methods on clinical features and prognosis of term infants with necrotizing enterocolitis (NEC), in order to provide scientific reference for the treatment of NEC. Methods Clinical data of term infants with NEC in Beijing Children's Hospital from January 2016 to December 2020 was retrospectively analyzed.According to the feeding methods before the onset of the disease, the patients were divided into breastfeeding group, mixed feeding group and formula feeding group.The general situations, onset diseases, hospitalization process and disease outcomes were compared among the three groups, and the risk factors of poor prognosis were analyzed. Results A total of 275 full-term infants with NEC were enrolled in the study, including 69(25.1%) cases in breastfeeding group, 118(42.9%) cases in mixed feeding group and 88(32.0%) cases in formula feeding group.The median age of the onset of disease was 6 days old in the formula feeding group, earlier than breastfeeding and mixed feeding groups (H＝41.415, P<0.001).The proportions of NEC Ⅲ stage, elevated CRP level (χ²＝32.273), thrombocytopenia (χ²＝15.158), peritonitis and sepsis (χ²＝15.329) in formula feeding group were higher than those of the other two groups(P<0.05).The proportions of patients with respiratory failure, electrolyte disorder and shock were higher than those of mixed feeding group (P<0.05).The mortality rates of formula feeding group were higher than that of other two groups (89.8% vs.94.2%, 98.3%, χ²=7.137,P=0.028).Logistic regression analysis showed that full-term NEC combined with shock(OR=9.598, 95%CI:1.507 - 61.112), metabolic acidosis(OR=6.632, 95%CI:1.693 - 25.974) and NECⅢ stage(OR=17.180, 95%CI:1.402 - 210.524) were risk factors for poor prognosis of NEC (P<0.05). Conclusions Reasonable breastfeeding can delay the occurrence of full-term NEC.The NEC condition of term infants with formula feeding is poorer, mainly with more complications and worse prognosis.

Study on the effectiveness of perfusion index in neonatal hemodynamic monitoring

LIU Xue-qin, HE Yu-juan, ZHANG Wei-xing, SHEN Jie, LIU Yu-xia, ZHAO Bao-jun, TANG Cheng-he

2021, 29(12):  1343-1346.  DOI: 10.11852/zgetbjzz2020-1898

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Objective To explore the effectiveness of perfusion index (PI) in monitoring neonatal circulation,so as to find out a sensitive and easy way for circulation monitoring of neonates. Methods Newborns admitted to the Neonatal Intensive Care Unit (NICU) of Xinxiang Central Hospital from October 2018 to July 2019 were selected,and the neonatal critical illness score (NCIS) was performed after admission. The score >90 was non-critical,the score between 70 and 90 was critical,and the score<70 was extremely critical. Fifty-four children who were in critical or extremely critical condition and underwent invasive blood pressure monitoring with the consent and signature of their families were selected and included in the study. Mean arterial pressure (MAP) was recorded,and PI,blood lactic acid,heart rate,SPO₂ and left ventricular ejection fraction (EF) were monitored simultaneously. Results 1)There was a moderate positive correlation between PI and MAP (r=0.724,P=0.01) and a moderate negative correlation between PI and blood lactic acid (r=-0.688,P<0.01). The correlation between PI and heart rate,SPO₂,left ventricular ejection fraction (EF) was not significant. ROC curve showed that when the cut-off point of PI was 0.67,the sensitivity and specificity of PI for predicting MAP were 87.8% and 76.9%,with the AUC of 0.872 (P<0.01). When the cut-off point of PI was 1.35,the sensitivity and specificity of PI for predicting blood lactic acid were 100.0% and 77.3%,with the AUC of 0.931(P<0.01). Conclusions PI is a sensitive index for monitoring neonatal circulation.

Changes of serum cystatin C and humoral immune function indexes in asthma children and their correlation with mycoplasma pneumoniae infection

HU Chun-xia, KONG Ling-jun, MIAO Xin-xia, WU Jian-gang

2021, 29(12):  1347-1350.  DOI: 10.11852/zgetbjzz2020-2128

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Objective To explore the changes of serum cystatin C (CysC) and humoral immune function indexes in asthma children and their correlation with Mycoplasma pneumoniae (MP) infection, in order to provide reference for the treatment of asthma. Methods A total of 95 asthma children treated in Suzhou Ninth People's Hospital and Wujiang District Children's Hospital from September 2017 to June 2020 were enrolled into study group, meanwhile 63 children who took physical examination were selected as control group. Serum levels of CysC, humoral immune function indexes [immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM)] and MP infection rate were compared between the study group and control group. According to the severity of asthma, chidlren were divided into severe group and mild group. Serum CysC level, humoral immune function indexes and MP infection rate were compared. The correlation between MP infection and CysC level, humoral immune function indexes was analyzed. The evaluation value of each index and their combination for asthma severity was analyzed. The lung function indexes of all subjects were detected. According to MP infection, they were divided into MP infection group and non-infection group. The lung function indexes were compared between the two groups and control group. Results The levels of CysC and IgM, and MP infection rate in study group were higher than those in control group(t=9.942,2.880, χ²=10.914, P<0.05), while levels of IgA and IgG in study group were significantly lower than those in control group (t=10.289, 7.968, P<0.05). CysC and IgM levels were positively correlated with MP infection(r=0.170, 0.183, P<0.05), while IgG level was negatively related to MP infection (r＝-0.254, P<0.05). The levels of CysC and IgM, and MP infection rate in severe group were higher than those in mild group (t=3.695, 2.090, χ² =18.459, P<0.05), while levels of IgA and IgG in severe group were significantly lower than those in mild group (t=3.016, 3.192, P<0.05). The diagnostic value of serum CysC level combined with humoral immune function indexes and MP infection for predicting asthma severity was significantly higher than that of single index detection (Z=2.018, 2.899, 2.068, 3.094, 2.799, P<0.05). The forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and FEV₁/FVC in MP infection group were lower than those in non-infection group (t=2.437, 2.597, 2.261, P<0.05). Conclusions The serum CysC level and humoral immune function are abnormal in asthma children. The combined detection of serum CysC level, humoral immune function indexes and MP infection is of diagnostic value for asthma severity.

Association between formula addition during hospitalization of room-in new borns and their feeding patterns at 6 months of age

JIANG Xin, JIANG Hui

2021, 29(12):  1351-1354.  DOI: 10.11852/zgetbjzz2021-0302

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Objective To investigate the effect of complementary formula on feeding patterns at 6 months of age, in order to provide scientific reference for standardizing the management of adding formula during hospitalization. Methods A prospective cohort study was conducted. Methods A prospective cohort study was conducted.The demographic data of 372 mothers and infants in Shanghai First Maternity and Infant Hospital from January to March 2020 were collected as the baseline, and formula addition was as the exposure factor during hospitalization.The feeding patterns of infants at discharge, 42 days postpartum, 3 months of age and 6 months of age were used as outcome indicators.Meanwhile, the formula complementary during hospitalization was considered as an independent variable, and the breastfeeding outcome of 6 months postpartum infants was used as a dependent variable.Logistic regression was used to analyze the association between formula complementary during hospitalization and postpartum feeding patterns. Results A total of 131 infants had formula added during hospitalization.Logistic regression analysis showed that the formula complementary during hospitalization increased the risk factor for exclusive breastfeeding failure at 6 months postpartum(OR=2.110, 95%CI:1.194-3.729,P＜0.05). Conclusions The situation of formula addition during hospitalization is not optimistic, which will affect the exclusive breastfeeding rate of 6-month-old infants after delivery.Obstetric medical staff should attach great importance to it, strictly implement the indications of milk addition, and scientifically supervise and manage the formula complementary during hospitalization.

Study on the correlation between vitamin D deficiency and hypoxic ischemic encephalopathy in premature infants

LIU Yi-rong, ZENG Chun-ying, ZHANG Wen-jing, LIU Dong, CAI Yue-ju

2021, 29(12):  1355-1358.  DOI: 10.11852/zgetbjzz2020-2062

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Objective To investigate the correlation between vitamin D level at birth and hypoxic ischemic encephalopathy (HIE) in premature infants, so as to provide reference for its prevention. Methods From June 2018 to June 2020, 25 premature infants diagnosed with HIE (HIE group) and 138 children without HIE (non-HIE group) were selected as study objects from Pediatrics of Boluo County Maternal and Child Health Care Family Planning Service Center. 25-(OH)D level of umbilical artery blood at birth and maternal 25-(OH)D level were compared between the two groups. The risk factors for HIE were analyzed by Logistic regression. Results Compared with the non-HIE group, HIE group had a higher incidence of intrauterine distress(χ²=46.875), a lower Apgar score at 1min(t=10.854) and a longer mechanical ventilation time(t=7.166), and the differences were statistically significant(P＜0.01). The level of 25-(OH)D of cord blood at birth and maternal 25-(OH)D level in the HIE group were significantly lower than those in the non-HIE group(t=2.346, 2.092, P＜0.05). And the proportion of vitamin D deficiency or insufficiency at birth was significantly higher than that in the non-HIE group (64% vs. 39.9%, χ²=5.019,P＜0.05). Maternal 25-(OH)D level in the two groups was positively correlated with the 25-(OH)D level of premature infants at birth (HIE group r=0.825, non-HIE group r=0.682, P＜0.05). Logistic regression analysis showed that the risk factors for HIE included intrauterine distress (OR=1.137, 95%CI:1.105-1.209), 1min Apgar score＜5(OR=1.170, 95%CI:1.085-1.443), long mechanical ventilation time(OR=1.431, 95%CI: 1.275-1.610) and low 25-(OH)D level(Mother OR=1.234,95%CI:1.010-1.511;Preterm OR=1.505,95%CI:1.191-1.899). Conclusions The proportion of premature infants with deficiency or insufficient vitamin D at birth is 50.9% (83/163). Low vitamin D level at birth and low maternal vitamin D level are high risk factors for premature infants with HIE, and vitamin D supplementation during pregnancy and after birth should be paid attention to.

Clinical study on long-term prognosis of premature infants with bronchopulmonary dysplasia

LI Rui, JIN Rong, LI Li-li, SHAO Guang-hua, LIU Dong-yun

2021, 29(12):  1359-1362.  DOI: 10.11852/zgetbjzz2021-0185

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Objective To analyze the long-term development, respiratory diseases and dynamic changes of tidal pulmonary function in preterm infants with different degrees of bronchopulmonary dysplasia (BPD), in order to provide theoretical basis for early intervention and treatment for the long-term adverse prognosis of BPD children. Methods A total of 80 premature infants with BPD admitted to the Department of Neonatology, Affiliated Hospital of Qingdao University from January 2017 to June 2019 were selected into observation group.According to the BPD classification, infants were divided into grade Ⅰ BPD group (n=45) andⅡ and Ⅲ BPD group (n=35).Meanwhile,50 non BPD children with the same gestational age and weight in the same period were selected as the control group.The incidence of respiratory tract infection and other diseases were compared, and the lung function parameters of the three groups were compared before 1 year old. Results There were significant differences in weight, height and head circumference between the three groups at 1 month and 6 months (corrected age of 1 month old: F=7.616, 10.942, 24.381; corrected age of 6 months old: F=3.795, 9.569, 4.481, P<0.05).There were significant differences in the number of lower respiratory tract infections, wheezing times and hospitalization times at corrected age of 6 months old among the three groups (F=17.750, 19.212, 7.384, P<0.05).In terms of the long function, there were significant differences in respiratory rate (RR), inspiratory/expiratory ratio (Ti/TE), time to peak (tPF%tE) and volume to peak (VPF%VE) among the three groups (corrected age of 1 month old: F=7.861, 9.909, 7.021, 6.825; corrected age of 6 months old: F=9.399, 6.545, 7.287, 5.538; corrected age of 1 year old: F=6.962, 8.099, 4.752, 8.549,P＜0.05).Among them, the tPF%tE and VPF%VE of BPD group were lower than those of non-BPD group at corrected age of 1 month old (P< 0.05).Only the tPF%tE and VPF%VE of BPD group were lower than those of non-BPD group at corrected age of 6 months and 1 year old (P< 0.05). Conclusions Children with BPD are more likely to have growth retardation, high respiratory prevalence and high tidal lung obstruction.

Application of the Test of Infant Motor Performance for infants in Kunming area

LI Hai-wei, ZHAO Lin, LU Ai-jie, ZHANG Yu-ping, SHI Hong-li

2021, 29(12):  1363-1367.  DOI: 10.11852/zgetbjzz2020-2126

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Objective To assess the motor development of 168 infants in Kunming by using Test of Infant Motor Performance(TIMP), and to compare the original score of TIMP in this study with the constant modulus data in the United States, so as to provide certain reference for the localization of TIMP. Methods TIMP was performed in 168 full-term infants and premature infants with corrected gestational age of 34 - 57⁺⁶ weeks in Kunming, the original scores and general conditions of infants were recorded. Results 1)With the increase of fetal age, TIMP scores increased gradually, and the scores in each group were significantly lower than the American normal standard for the same age group (t＝-3.763,-4.181,-3.554,-3.423,-2.489,-3.463,-4.579,-2.612,-2.359,-3.249,-3.038,-4.248,P<0.05). 2) The TIMP score of full-term infants was higher than that of premature infants (t=-2.615, P＜0.05). TIMP score of infants with birth weight ≥2 500 g was higher than that of infants with birth weight between 1 500 and 2 499 g (t=-2.593, P＜0.05).There were significant differences in TIMP scores among infants with corrected ages <40 weeks, 40 - 44 weeks, 45 - 48 weeks, 49 - 52 weeks, and ≥53 weeks (F=168.226, P<0.001). 3) Gestational age at birth (full-term or premature) and the corrected gestational age at TIMP test were influential factors for TIMP score (t=2.550, 11.539,P<0.05). Conclusions TIMP assessment scores can reflect the athletic performance of infants at different corrected gestational ages. However, test scores of each group are significantly lower than the American normal standard of the same age group. Therefore, it is necessary to establish Chinese norm for providing local data reference, and to provide early assessment and intervention for preterm infants and low birth weight infants.

Experience Exchange

Analysis of the home environmental risk factors associated with language development delay in toddlers

ZHOU Ying, WANG Chen

2021, 29(12):  1368-1371.  DOI: 10.11852/zgetbjzz2021-0015

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Objective To explore the influencing factors in family associated with language development delay (LDD) of toddlers, in order to provide evidence for early intervention of LDD. Methods A total of 55 children aged 16 to 30 months and diagnosed with LDD in Peking Union Hospital from July 28th, 2020 to January 27th, 2021 were enrolled in this study.Meanwhile, 71 typical developed children who took physical examination in this hospital were selected as control group.Children's language development was identified by Chinese Communicative Development Inventory-Putonghua version (CCDI-P).The correlations of language development with educational level of parents and main caregivers, family environment, birth status were analyzed. Results There was no difference on domestic dialect between the two groups (P>0.05).Compared with control group, LDD group had less toddlers from only-child family, less parents or main caregiver with bachelor or higher educational degree, more introverted caregivers, more grandfather or nanny as the main caregiver, longer screen time and earlier exposure to screen, more proportion of parental company <2 h/d, screen time ≥2 h/d and being exposed to screen <12 months old(P<0.05).Logistic regression analysis revealed that the onset age for screen ≤12 months old(OR=9.562, 95%CI:3.106-29.437), screen time≥2 h/d(OR=3.222,95%CI:1.169-8.884) and grandfather or nanny as the main caregivers (OR=7.034,95%CI:1.930-25.634) were the risk factors for LDD of toddlers(P<0.05). Conclusions Besides being exposed to screen too early or too long, grandfather or nanny as the main caregiver is the home environmental risk factor associated with language development delay in toddlers.So it is supposed to avoid early screen exposure, to reduce the screen time, and to encourage parents to take care of their children personally.

Predictive value of serum Toll-like receptor 4 for recurrence risk in children with severe asthma within one year after treatment

TANG Jing, LI Tao, MENG Lin

2021, 29(12):  1372-1375.  DOI: 10.11852/zgetbjzz2020-1961

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Objective To investigate the predictive value of serum Toll-like receptor 4 (TLR4) for recurrence risk in children with severe asthma within one year after treatment, in order to provide new ideas for preventing the recurrence of asthma. Methods A total of 80 cases of severe asthma children underwent treatment in Chengde Central Hospital from September 2018 to September 2019 were selected into severe asthma group, meanwhile 100 healthy children who took physical examination during the same period were selected as control group. Serum TLR4 level was compared between severe asthma group and control group. The enrolled children were divided into relapse group (n=38) and non-relapse group (n=42) according to the recurrence of asthma within 1 year after treatment. The difference of serum TLR4 level in the early stage after admission was compared between the two groups. The predictive value of serum TLR4 level on the recurrence of asthma was analyzed using the Receiver Operating Characteristic (ROC) curve. Logistic multivariate regression model was used to analyze the risk factors of recurrence in children with severe asthma within 1 year after treatment. Results Serum TLR4 level of children with severe asthma at admission was significantly higher than that of normal control group (t=15.882, P＜0.01). ROC curve showed that critical value of serum TRL4 level in hospitalized children with severe asthma predicted recurrence within 1 year after treatment was 20.33 pg/mL, AUC was 0.860(95%CI:0.782-0.938), the corresponding sensitivity and specificity were 76.19% and 73.68%, respectively. There were statistically significant differences in the onset age, TLR4 level after one week treatment and allergic rhinitis between the relapse group and non-relapse group (t=4.825, 6.001,χ²=6.128, P＜0.05). Logistic regression analysis showed that onset age <6 years old(OR=1.711,95%CI:1.403-2.205), allergic rhinitis(OR=1.894, 95%CI: 1.654-2.420), serum TLR4 level >20.33 pg/mL after one week treatment(OR=2.401,95%CI:1.834-2.781) were independent risk factors for recurrence within 1 year after treatment of severe asthma(P＜0.05). Conclusions Abnormal increasing of serum TLR4 level in children with severe asthma at the early stage of admission is an independent risk factor for asthma recurrence within 1 year after treatment, which has early predictive value for recurrence.

Health services and health status of children under 7 years old in Xinjiang Production and Construction Corps from the year 2014—2019

WANG Yue, WANG Xu-ran, JING Wen, ZHANG Hui, XIANG Yang

2021, 29(12):  1376-1379.  DOI: 10.11852/zgetbjzz2020-2216

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Objective To analyze the health services and health status of household register children under 7 years old in Xinjiang Production and Construction Corps from 2014 to 2019, in order to provide theoretical basis for formulating child care management measures. Method Data on Annual Report on Maternal and Child Health in Xinjiang Production and Construction Corps from 2014 to 2019 were retrieved to make statistical descriptions and deduces. Results A total of 81 838 live births were registered in the Xinjiang Production and Construction Corps from 2014 to 2019, and the male-female ratio was 1.08 to 1.The number of children under the age of 7, 5 and 3 years was 704 480, 517 053 and 311 964, respectively.The mortality of children under 5 years old, infants and neonates showed a downward trend year by year(χ²=27.47, 13.32, 11.74, P＜0.01). The breastfeeding rate and exclusive breastfeeding rate(χ²=13.57, 442.29, P＜0.001), as well as the proportions of newborns visit, health administration of children under 7 years old, systematic administration of children under 3 years old showed an increasing trend year by year(χ²=415.88, 2 481.97, 3 393.64, P＜0.001). In terms of the nutritional evaluation, the detection rates of low body weight, growth retardation, overweight and obesity in children younger than 5 years old were decreasing year by year(χ²=22.68, 24.55, 132.82, 29.66, P＜0.001), while the anemia prevalence rate was on the rise, and that of moderate and severe anemia was on the decline (χ²=94.93, 66.13,P＜0.001). Conclusions Health care services for children in Xinjiang Production and Construction Corps have been gradually improved, and the overall health status of children has been gradually improved. However, attention still should be paid to the anemia among children. In order to further improve children's health level, it is necessary to formulate the local personalized health care policy for children.

Analysis of factors associated with the quality of general movements in preterm infants with gestational age less than 34 weeks

HUANG Lei, JIAO Xiao-yan, NAN Nan, YUE Li, JIN Bei-yi, HE Li

2021, 29(12):  1380-1383.  DOI: 10.11852/zgetbjzz2021-0381

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Objective To analyze the perinatal factors influencing the quality of general movements (GMs) in preterm infants with gestational age less than 34 weeks, in order to provide theoretical basis for clinical intervention. Methods Preterm infants with gestational age less than 34 weeks were collected, who were born inGansu Provincial Maternity and Child-Care Hospitalduring January 2017 to October 2019 and followed up in the Children's Health Care Department.There were 554 cases in stage of writhing movements and 318 cases in stage of fidget movements.The high-risk factors for the quality of GMs were analyzed by t test, χ² test and multivariate Logistic regression. Results Multivariate Logistic regression analysis showed that in the stage of writhing movements, the factors significantly associated with abnormal GMs results were low birth weight (OR=7.653, 95%CI:2.547 - 22.995), apnea (OR=2.556, 95%CI:1.254 - 5.209), congenital heart disease (OR=4.394,95%CI:1.507 - 12.809).In the stage of fidget movements, neonatal asphyxia (OR=3.802, 95%CI:1.338 - 10.806)and respiratory distress (OR=4.507,95%CI:1.563 - 12.998) were risk factors for abnormal GMs results. Conclusions Low birth weight, apnea, congenital heart disease, neonatal asphyxia, and respiratory distress are high-risk factors for abnormal GMs in preterm infants with gestational age less than 34 weeks.Early screening and intervention should be performed to preterm infants with high risk factors.

Appropriate Technology

Analysis of the efficacy of rehabilitation training combined with parental participation on functional dysarthria

YUAN Guang-hui, CHEN Huan, YUAN Yuan, YI Yu-long, LUO Sheng-nan

2021, 29(12):  1384-1386.  DOI: 10.11852/zgetbjzz2020-1860

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Objective To analyze the efficacy of rehabilitation training combined with parental participation on the articulation of children, so as to lay a scientific foundation for the clinical treatment of functional dysarthria. Methods A total of 67 children with functional dysarthria in the department of rehabilitation, Zhuzhou Central Hospital, from September 2018 to January 2020 were enrolled in this study. According to the random number table method, children were randomly divided into parental participation group (n=33) and conventional group (n=34).Both groups were given regular articulation training, while parents were involved during the entire treatment process in the parental participation group and trained once a week with daily WeChat check-in for a total of 12 weeks. Results After 12 weeks of treatment, the articulation level was significantly improved than that before treatment both in parental participation group and regular group (t=22.38, 25.50, P<0.01). Moreover, the articulation level of the parental participation group was significantly higher than that of the conventional group (t=5.10, P<0.01). The average days of home exercise and the total effective rate of the parental participation group were significantly higher than those of the conventional group(t=16.08, χ²=19.90, P＜0.01). Conclusions Rehabilitation training combined with parental participation is more effective for children with functional dysarthria.