Table of Content

10 November 2022, Volume 30 Issue 11

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Professional Forum

Nurturing care based on the perspective of brain science

CHI Xia

2022, 30(11):  1161-1163.  DOI: 10.11852/zgetbjzz2022-1999

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It has been widely recognized that the early stage of life is a critical period for brain development, which is of high plasticity. Evidence from brain science has demonstrated that nurturing care environment has an important influence on the structure and function of children's brains, as well as their psychological and behavioral development. During this critical stage, good health, adequate nutrition, responsive care, security and safety, and opportunities for early learning all together provide an early environment that children's brain development requires, and further promote the development of children's cognitive functions, including sensory, perceptual, sensorimotor, language, cognitive, emotional and social abilities, to fully make the rise of early developmental potential. Taken together, in an effort to promote children's health, it is of pivotal importance to widely carry out nurturing care under the guidance of brain science and also create an optimal caring environment to support early development and especially the development of the brain.

Original Articles

A prospective cohort study on the association between paternal exposure to cigarette smoke prior to pregnancy and children's intelligence at 6 years

SU Hui-jia, JI Hong-lei, CHEN Yao, CHEN Ya-fei, MIAO Mao-hua, YUAN Wei

2022, 30(11):  1164-1168.  DOI: 10.11852/zgetbjzz2022-0595

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Objective To explore the effect of paternal exposure to cigarette smoke prior to pregnancy on children's intelligence at 6 years old, so as to provide epidemiological evidence for prenatal and postnatal care services. Methods A total of 530 mother-child pairs were included in this study from the Shanghai-Minhang Birth Cohort Study (S-MBCS) established in 2012. Information on paternal exposure to cigarette smoke 3 months prior to pregnancy was obtained through a structured questionnaire at the first antenatal checkup. Intelligence of children at 6 years old was assessed using the Simplified Chinese Version of (the Wechsler Intelligence Scale for Children, Fourth Edition,WISC-Ⅳ). Multivariate linear regression model was used to analyze the effect of paternal cigarette smoke exposure prior to pregnancy on children's intelligence at 6 years old. Results After adjusting for covariates, paternal exposure to cigarette smoke prior to pregnancy was associated with a decrease of 2.83 points (95%CI:-5.51 to -0.16) of children's Full-Scale Intelligence Quotient (FSIQ). The effect of paternal smoking (OR=3.15, 95%CI:-6.32 to 0.03) was slightly stronger than that of paternal exposure to second-hand smoking (OR=2.62, 95%CI:-5.54 to 0.30). The effect of paternal smoking prior to pregnancy on children's FSIQ and Perceptual Reasoning Index (PRI) showed statistically significant dose-effect relationships (P_{for trend}<0.05). Children whose fathers smoked more than 5 cigarettes per day prior to pregnancy had a FSIQ decrease of 6.57 points (95%CI:-10.88 to -2.26) and a PRI decrease of 5.83 points (95%CI:-10.61 to -1.05). Besides, the sex and gestational weeks of children showed significant interactions with paternal exposure to cigarette smoke prior to pregnancy in the effects on children's intelligence (P_{for interaction}<0.05). The effects of paternal exposure to cigarette smoke prior to pregnancy on the intelligence of girls, or of children with less than 39 gestational weeks, were stronger. Conclusions Paternal exposure to cigarette smoke 3 months prior to pregnancy was associated with decreased children's intelligence at 6 years old. Our findings suggest that pre-pregnancy health guidance should strengthen the propaganda of husband's tobacco control before pregnancy, and both husband and wife should jointly assume the responsibility for prenatal and postnatal care.

Effect of transcranial magnetic stimulation combined with functional electrical stimulation on children with global developmental delay

HUANG Guo-shu, LIU Ying, HUANG Bing-yu, LIANG Miao-ying

2022, 30(11):  1169-1172.  DOI: 10.11852/zgetbjzz2022-0743

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Objective To analyze the effect of repetitive transcranial magnetic stimulation (rTMS) combined with functional electrical stimulation (FES) in children with global developmental delay (GDD). Methods A total of 54 children with GDD, who were treated in Nanning Maternal and Child Health Hospital from January 2020 to April 2022, were included in this study, and were divided into control group and experimental group. The control group received rehabilitation training and rTMS, while the experimental group received FES additionally. Development quotient (DQ) was assessed by Gesell Development Scale before and after intervention and statistical analysis was performed. Results There were no statistically significant difference in the general characteristics and DQ of the five dimensions by Gesell before intervention between the two groups(P＞0.05). After 6 months of intervention, DQ of the five dimensions by Gesell of children in the two groups were significantly improved compared with those before intervention (P＜0.05). DQ of speech ability dimension in the experimental group (51.11±18.84)was significantly higher than that in the control group (40.93±15.47) after intervention (t=2.171, P＜0.05). Significant effective rate (55.6% vs.14.8%) and effective rate (29.6% vs. 22.2%) of speech ability dimension in experimental group were significantly higher than those in control group after intervention (Z=3.963, P＜0.05). Conclusion The mode of rTMS combined with FES can significantly improve the language development of children with GDD, and reduce the long-term treatment cost of family and society.

Characteristics of speech fluency of school-age children with cerebral palsy in connected speech and its correlation with speech intelligibility

LIANG Wei-jian, GE Sheng-nan, WAN Qin, CHEN Fang-fang

2022, 30(11):  1173-1176.  DOI: 10.11852/zgetbjzz2022-0444

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Objective To explore the characteristics of speech fluency of school-age children with cerebral palsy in connected speech and its correlation with speech intelligibility, in order to provide theoretical basis for assessment and rehabilitation of speech fluency in children with cerebral palsy. Methods Totally 15 children with spastic cerebral palsy and 15 normal children with the same age were enrolled in this study from January to February 2021. The acoustic parameters related to speech fluency were analyzed by reading the speech-balanced reading materials, including speech rate, articulation rate, average pause duration, number of abnormal pauses, and number of repetitions. Speech intelligibility were judged by transcription. Spearman correlation analysis was carried out to analyze the correlation between the acoustic parameters related to speech fluency of children with cerebral palsy and their speech intelligibility. Results The speech rate, articulation rate, and speech intelligibility of children with cerebral palsy were significantly lower than those of the control group(t=-21.650,-15.440, -4.447, P＜0.05), while the average pause duration, the number of abnormal pause and the number of repetitions were significantly greater than those of the control group(t=19.639, 20.347, 3.767, P＜0.05). The speech rate (r=0.831), articulation rate (r=0.827), average duration of pauses (r=-0.849) were positively correlated with speech intelligibility, while the number of abnormal pauses (r=-0.783) and the number of repetitions (r=-0.672) of children with spastic cerebral palsy were negatively related to speech intelligibility (P<0.01). Conclusion Children with spastic cerebral palsy have lower speech intelligibility and abnormal speech fluency, which was reflected in the slower speech rate, the increasing number of abnormal pauses, average pause duration and the number of repetitions. Speech fluency in children with cerebral palsy is positively correlated with speech intelligibility, and the training of speech fluency should be reasonably added to the speech treatment of cerebral palsy.

Comparison of contingency discrimination training between 4- to 8-year-old children with autism spectrum disorder and normal children

SHEN Shi-hui, MA Chen-huan, WANG Yu, CHEN Jin-jin

2022, 30(11):  1177-1180.  DOI: 10.11852/zgetbjzz2022-0087

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Objective To compare the difference in contingency discrimination training between children with autism spectrum disorder (ASD) and normal children, in order to provide suggestions for the intervention of ASD children. Methods A total of 22 children diagnosed with ASD in the Department of Children's Health Care of Shanghai Children's Hospital and 24 normal children matched with age and intelligence quotient (IQ) were selected into this study from July 2020 to October 2021. Children in both groups took contingency discrimination training, and the difference was compared. Results The score of positive and negative contingency discrimination training under motivational manipulation between ASD children and normal children had no significant difference (Z=1.35,1.63, P＞0.05). ASD children scored significantly lower in positive and negative contingency discrimination training with external visualization signs than normal children (Z=2.83, 5.04, P＜0.05). And for ASD children, the score of positive contingency discrimination training with external visualization signs was significantly different with that of negative contingency discrimination training with external visualization signs (Z=3.17, P＜0.05). Conclusion ASD children have lower contingency discrimination training with external visualization signs than normal children. In addition, ASD children have lower negative contingency discrimination training with external visualization signs than positive contingency discrimination training with external visualization signs. Therefore, it is recommended that training related to contingency discrimination training with external visualization signs should be added to the rehabilitation training of ASD children.

Comparison of clinical application between Autism Diagnostic Observation Schedule Second Edition Module-1 and Children Autism Rating Scale in children with autism spectrum disorder

WU Man-hong, XU Ning, CHANG Yan-qun, WEN Jian, LOU Yu-yan, HUANG Shuang-miao

2022, 30(11):  1181-1184.  DOI: 10.11852/zgetbjzz2022-0613

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Objective To compare the diagnostic value between Autism Diagnostic Observation Schedule Second Edition(ADOS-2) Module-1 and Children Autism Rating Scale (CARS) for children with autism spectrum disorder (ASD), in order to provide reference for clinical application. Methods From January 2019 to March 2022, a total of 104 children who firstly visited and diagnosed in the Department of Neurological Rehabilitation, Guangdong Women and Children Hospital were enrolled in this study, including 60 ASD children (ASD group:30 cases of high function and 30 cases of low function,), 24 children with global developmental delay (GDD) and 20 normal children (non-ASD group). All children were assessed by ADOS-2 Module-1 and CARS. The consistency of diagnostic results between the two scales and the criteria of American Diagnostic and Statistical Manual of Mental Disorders-5(DSM-5) was evaluated, and the sensitivity and specificityof the two scales in the diagnosis of ASD were compared. Results 1) The consistency between ADOS-2 module 1 and DSM-5 was good (Kappa=0.862),as well as between ADOS-2 module 1 and CARS (Kappa=0.695).The consistency was medium between CARS and DSM-5 (Kappa=0.509), 2) The sensitivity of ADOS-2 module 1 was significantly better than that of CARS (χ²=13.333, P<0.001). There was no significant difference in the sensitivity and specificity between diagnosing children with IQ≥70 and children with IQ <70(P>0.05). The sensitivity of CARS in the diagnosis of children with IQ <70 was significantly better than that of children with IQ≥70 (χ²=7.500, P=0.006), but the specificity was not statistically significant (P>0.05). Conclusions ADOS-2 module-1 and CARS are both important tools to assist in the diagnosis of ASD, and ADOS-2 module-1 has higher sensitivity and specificity in the early diagnosis of ASD children. In clinical work, it is recommended to lower the diagnostic threshold of CARS for children with IQ ≥ 70 in order to improve the diagnostic sensitivity of CARS and reduce the rate of missed diagnosis.

Original Articles

Association of ADAM33 gene and its serum level with the risk of asthma in Zhuang children in Guangxi

YANG Li-juan, DENG Gao, DING Bo, YANG Li-min, LI Dong-ming, HUANG Yong-fang, LIN Na

2022, 30(11):  1185-1190.  DOI: 10.11852/zgetbjzz2022-0474

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Objective To investigate the association of the gene polymorphism of ADAM33 gene rs597980, rs44707, rs2853209, rs3918396 and rs511898 with asthma in children of Zhuang nationality in Guangxi, so as to provide a better solution for the individualized treatment of bronchial asthma in the Zhuang population. Methods From January 2021 to June 2021, 93 children diagnosed with asthma in the Department of Pediatrics of the Affiliated Hospital of Youjiang Medical University for Nationalities and 94 healthy children who took physical examination in the Children's Health Department during the same period were selected as the study subjects. Gene polymorphism of ADAM33 gene rs597980, rs44707, rs2853209, rs3918396 and rs511898 were analyzed, and the serum expression levels of ADAM33 in the two groups were detected. Results 1) Both groups were consistent with Hardy-Weinberg genetic equilibrium. 2) Genetic model showed that the asthmatic effect of TT genotype at rs511898 locus was 2.977 times (OR=2.977, P=0.023) as great as that of CC genotype and 2.615 times (OR=2.615, P=0.035) as great as that of CT+CC genotype. In additive model, the asthmatic effect of TT genotype was 2.834 times (OR=2.834, P=0.031) as great as that of CC genotype, and the asthmatic effect of T allele was 1.869 times (OR=1.869, P=0.005) as great as that of C allele. 3) There was a strong linkage disequilibrium between rs597980 and rs2853209 (D'=0.96, r² =0.60). 4) Haplotype analysis showed that the frequency of GGTCC and GGACC haplotypes in control group was significantly higher than that in asthma group(P< 0.05), and the frequency of GGTCT haplotypes in asthma group was significantly higher than that in control group(P<0.05). 5) There was significant difference in serum ADAM33 expression level between the two groups (t=13.379, P< 0.05). The serum levels of CC, CT and TT genotypes at rs511898 were significantly different between the two groups (t=8.002, 10.364, 3.748, P<0.05). Conclusion TT genotype and T allele at rs511898 of ADAM33 gene may be a risk factor for asthma progression in Zhuang children in Guangxi. Haplotype GGTCT may be a risk haplotype for asthma in Zhuang children in Guangxi. Increasing serum ADAM33 level may lead to the onset of asthma.

Basic Experimental Articles

Effects of endocannabinoid system on autistic behavior in valproic acid-induced rats

PENG Zhen, LIU Yu, ZENG Yi-yuan, LUO Gui-bao, CHENG Li-xia, LI Yin-chu, ZHANG Yu-jue, ZOU Ming-yang

2022, 30(11):  1191-1197.  DOI: 10.11852/zgetbjzz2021-1865

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Objective To investigate the effect of altered 2-arachidonoylglycerol(2-AG) levels on autistic behaviors in VPA-induced rats(ASD model), so as to provide evidence for identifying the etiology of ASD. Methods The rats were divided into CON group, VPA group(ASD), acute JZL184 injection group [VPA+40 mg/kg JZL184 group(VPA+40AJ)], chronic JZL184 injection group [including VPA+1 mg/kg JZL184 group(VPA+1RJ), VPA+3 mg/kg JZL184 group(VPA+3RJ) and VPA+10 mg/kg JZL184 group(VPA+10RJ) ]. The ASD-like behavior of rats in each group was assessed. The levels of endocannabinoids(eCBs) in the hippocampus of rats were detected by liquid chromatography-mass spectrometry. Western blot was used to test the expression levels of related receptors and metabolic enzymes in eCB system. Results The levels of 2-AG and AEA in VPA group were significantly lower than those in CON group(P<0.05). After JZL184 intervention, the levels of 2-AG in VPA+3RJ group and VPA+10RJ group significantly increased(P<0.05). Compared with the CON group, the number of buried marbles, self-grooming time and spontaneous activities increased significantly in VPA group, and the sociability index and the social preference index decreased(P<0.05). After JZL184 intervention, the number of buried marbles, self-grooming time and spontaneous activities decreased, and the sociability index and the social preference index in VPA+40AJ group increased significantly, the self-grooming time of the rats in VPA+1RJ group decreased. After JZL184 intervention, the number of buried marbles, self-grooming time and spontaneous activities decreased, and the social preference index of the rats in VPA+3RJ group increased significantly. The number of buried marbles and self-grooming time decreased, and the social preference index of the rats in VPA+10RJ group increased significantly(P<0.05).The protein expressions of CB1R, DAGL, MAGL and FAAH in VPA group were significantly higher than those in CON group(P<0.05).After JZL184 intervention, the protein expressions of DAGL and MAGL of the rats in VPA+3RJ group were significantly down-regulated, and MAGL in VPA+10RJ group were also significantly down-regulated(P<0.05). Conclusions Low eCBs signal is associated with autistic behaviors in VPA-induced rats, and boosting 2-AG levels can improve repetitive and stereotypical behaviors, hyperactivity and social functions in ASD rats.

Review

Research progress in adverse neurodevelopmental outcomes of moderate or late preterm infants

ZHANG Yi-min, JIN He-yue, TAO Fang-biao, ZHU Yu-min

2022, 30(11):  1198-1202.  DOI: 10.11852/zgetbjzz2022-0037

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In recent years, the survival rate of premature infants has greatly increased with the continuous improvement of medical level. However, due to insufficient gestational age, premature infants have a higher risk of adverse neurodevelopmental outcomes than full-term infants. And neurodevelopmental problems have gradually become a prominent problem faced by the early development of premature infants. Approximately 80% of the total number of preterm infants is moderate or late preterm infants. However, the correlation between extremely preterm birth and neurodevelopmental disorders is currently well studied, while there are few studies on the correlation between moderate or late preterm birth and neurodevelopmental disorders. In this paper, the neurodevelopmental outcomes of moderate or late preterm infants are reviewed in order to provide evidence for early clinical evaluation. It is of great significance for early intervention by predicting the neurodevelopmental outcome of moderate or late preterm infants by using placenta-brain axis biomarkers.

Research progress on the influencing factors of neurodevelopment in preterm infants from socio-ecological perspective

CAO Mi, ZHANG Jun, ZHANG Dan, YANG Xin-yi

2022, 30(11):  1203-1207.  DOI: 10.11852/zgetbjzz2022-0158

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Neurodevelopmental impairment among preterm infants is a major and serious global public health problem, and its influencing factors are multiple and complex. Based on the social ecological theory, this paper reviews the individual, family and social influencing factors of preterm infant neurodevelopment from different ecological system levels, in order to provide a new perspective and path for optimizing the outcomes of preterm infants.

Influencing factors of developmental regression in children with autism spectrum disorder

ZHOU Ping, CHEN Li

2022, 30(11):  1208-1211.  DOI: 10.11852/zgetbjzz2021-0483

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Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized as heterogeneous clinical manifestations.Developmental regression, regarded as a specific subtype in ASD, is getting more and more attention.However, the influencing factors of regression are not clear.It is generally believed that it is a kind of developmental disorder caused by genetics, environment and their interaction.This review aims to summarize the influencing factors increasing risk of regressive autism from the perspective of environment and genetics, thereby providing references for the recognition and interventions in early childhood.

Characteristics of self-development in children with autism spectrum disorder and its implications for clinical rehabilitation

ZHANG Ya-ru, ZHANG Ting, SHAO Zhi

2022, 30(11):  1212-1215.  DOI: 10.11852/zgetbjzz2021-0440

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Self-awareness is the basis for the development of individuals' social interaction ability. Abnormal self-development is not only an important mechanism to explain the social interaction disorders in autistism spectrum disorder(ASD),but also one of the reasons for the occurrence of problematic behaviors. The paper reviews related researches on self-awareness of ASD children,expounds the influence of abnormal self-development on the core symptoms of ASD children,and summarizes the clinical empirical research on self-awareness training of ASD children,aiming to provide reference for the plan development of rehabilitation for ASD children. Further studies should emphasize self-development of ASD children,especially the psychological self-development,and focus on developing the methods to improve the self-cognition ability of ASD children,so as to promote their development of social interaction disorders and improve the core symptoms.

Research progress on intestinal microbes and their metabolites and autism spectrum disorder

LIU Huan, WANG Suo-ying, LI Yu-qin, SUN Zhi-ming

2022, 30(11):  1216-1220.  DOI: 10.11852/zgetbjzz2021-0627

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Currently, the underlying mechanisms of etiology and manifestations ofautism spectrum disorder (ASD) are still poorly understood.More and more studies have shown that changes in intestinal microbes and their metabolites (such as short-chain fatty acids, γ-aminobutyric acid, etc.) may be related to the pathogenesis of ASD.Therefore, this paper reviews the studies related to the changes and mechanisms of gut microbes and metabolites in ASD children, and analyzes the possible differences and associations of gut microbes and metabolites between ASD children and healthy children, in order to explore the influence of changes in intestinal microbes and their metabolites on children ASD, and to provide some new ideas for the diagnosis and treatment of ASD.

Research progress on the relationship between steroid hormones and autism spectrum disorder

HE Qing, XU Lei, XIE Jiang

2022, 30(11):  1221-1225.  DOI: 10.11852/zgetbjzz2021-0747

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Autism spectrum disorder(ASD) is a neuropsychiatric developmental disorder that begins in infancy and childhood. Steroid hormones may result in the onset of ASD by affecting neuropsychiatric development. This article reviews the relationship between common steroid hormones and ASD.

Meta Analysis

Meta-analysis on the effect of core stability training on the movement ability of children with spastic cerebral palsy

DENG Jing-hui, LONG Zheng-yin, LYU Zhi-gang, LU Yong-xue, MU Ke-rong, TANG Xue-yi

2022, 30(11):  1226-1230.  DOI: 10.11852/zgetbjzz2021-1908

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Objective To systematically evaluate the effect of core stability training on improving the motor ability of children with spastic cerebral palsy, in order to provide evidence for guiding the motor function rehabilitation training of children with spastic cerebral palsy. Methods Literature published from establishment to October 23rd, 2021 was retrieved from eight databases using boolean logical link keywords and free words, then was selected according to inclusion and exclusion criteria. Results A total of 17 articles with a sample of 1 085 children were included, of whom 542 were in the control group and 543 were in the experimental group. The walking ability (MD=4.58, 95%CI:3.73 - 5.43), fine motor ability (MD=1.96, 95%CI:0.47 - 3.45), balance ability (MD=6.03, 95%CI:3.87 - 8.20), functional independence (MD=6.35, 95%CI:5.49 - 7.25) and gross motor function (MD=3.37, 95%CI:1.40 - 5.34) of children in experimental group were significantly higher than those in control group. Conclusions Core stability training can effectively improve the motor abilities of children with spastic cerebral palsy and promote the development of movement and posture. However, due to the lack of homogenous literature and low quality of literature, it is still necessary to include a large sample, randomized double-blind trial to further evaluate the therapeutic effect of core stability training.

Meta-analysis of the effectiveness of aerobic exercise on cognition of children

ZHONG Xiao-ke, WANG Zhi-peng, JIANG Chang-hao

2022, 30(11):  1231-1236.  DOI: 10.11852/zgetbjzz2022-0051

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Objective To explore the relationship between aerobic exercise and cognition of children by Meta-analysis, so as to provide new orientation for researches on this field. Methods Randomized controlled trial studies on aerobic exercise and children's cognition published from January 2011 to December 2021 were retrieved by searching CNKI, Wanfang, VIP, PubMed and Web of Science databases. According to the inclusion and exclusion criteria of the literature, the quality of the literature was evaluated using the PEDro scale. Then literature with high quality was included. Revman5.4 and Stata12 software were used for Meta-analysis of the included literature. Random effect model or fixed effect model were selected according to heterogeneity test results.The SMD value and 95%CI were calculated and publication bias was assessed. Results A total of 2 052 subjects were included in 11 articles, including randomized controlled trials (n=10) and quasi-experimental designs (n=1). Aerobic exercise can significantly improve children's attention (SMD=0.97, 95%CI:0.34 - 1.61, Z=2.99, P=0.003), and inhibition control, the sub-component of executive function (SMD=0.59, 95%CI:0.07 - 1.10, Z=2.51, P=0.01). However, it had no significant influence on working memory and cognition flexibility (P＞0.05). Conclusion Aerobic exercise can significantly improve the cognitive function of children, but it has a selective influence on inhibition control, the sub-component of the execution function.

Clinical Research

Association between family parenting style and children's sleep

XUE Xu-sheng, JIA Tian, YANG Lin

2022, 30(11):  1237-1240.  DOI: 10.11852/zgetbjzz2022-0554

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Objective To analyze the relationship between family parenting style and children's sleep, and to determine the beneficial parenting style for children's sleep, so as to provide reference for improving children's sleep quality. Methods A total of 214 children aged 6 - 12 who underwent physical examination in the Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine from September to to December 2021 were collected as the study subjects. Egna Minnen Betrffende Uppfostran for Children (EMBU-C) and Children's Sleep Habits Questionnaire (CSHQ) were used to evaluate the parenting style and children's sleep status, then the association between the two was analyzed. Results There were statistically significant differences in CSHQ total score in different age (t=6.45, P＜0.001), co-sleeping (F=11.82, P＜0.001) and screen time groups (F=5.13, P=0.007). Significant correlations were found between parental EMBU-C and multiple dimensions of CSHQ (P<0.05). Multivariate linear regression analysis indicated that CSHQ total score of children significantly decreased from co-sleeping with caregivers to sleeping alone in a separate room (β=-1.81). Maternal emotional warm in each dimension of parental EMBU-C was negatively related to CSHQ total score of children (β=-0.50). However, screen time of children was positively correlated with CSHQ total score (β=1.89). The three factors together explained 18% of the variance (ΔR²=0.18). Conclusions Children's sleep status is related to age and family parenting style. Co-sleeping and excessive screen time in family parenting environment can reduce children's sleep quality, while maternal emotional warmth has a certain significance in improving children's sleep.

Risk factors of epilepsy in children with cerebral palsy

NIU Guo-hui, XIE Jia-yang, ZHU Deng-na, WANG Jun, LIU Hong-xing, WANG Xin, LI Ting-ting

2022, 30(11):  1241-1245.  DOI: 10.11852/zgetbjzz2022-0646

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Objective To analyze the association of high risk factors and clinical characteristics of cerebral palsy with epilepsy in children, and to explore the risk factors of epilepsy in children with cerebral palsy. Methods Data of children with cerebral palsy hospitalized in the Third Affiliated Hospital of Zhengzhou University from January 2019 to February 2022 were collected retrospectively, and the children were divided into two groups:cerebral palsy with epilepsy group and non-epilepsy group. The difference of high risk factors and clinical characteristics between the two groups was analyzed by χ² test, and multivariate Logistic regression was used to analyze the risk factors of common epilepsy. Results A total of 630 children with cerebral palsy were included, including 421 boys and 209 girls. There were 155 children with epilepsy in the cerebral palsy group and 475(24.6%) children in the non-epilepsy group. The prevalence rate of intrauterine distress, asphyxia, multiple births and congenital malformation in the cerebral palsy group were higher than those in the non-epilepsy group(χ²=4.788, 9.368, 5.255, 12.111, P＜0.05). There were significant differences in cerebral palsy classification, Magnetic Resonance Imaging Classification System(MRICS) and Gross Motor Function Classification System (GMFCS) between the two groups(χ²=213.686, 14.640, 481.531, P＜0.05). Spastic quadriplegia (OR=14.090, 95%CI:1.950 - 101.183), history of congenital malformation (OR=1.891, 95%CI:1.155 - 3.095) and history of asphyxia (OR=1.527, 95%CI:1.034 - 2.255) may be the risk factors of epilepsy in children with cerebral palsy (P<0.05). Conclusion Epilepsy in children with cerebral palsy is severe and had high prevalence rate, identifying risk factors can provide basis for targeted clinical treatment.

Changes and significance of cardiovascular metabolic indicators in children with asthma at different control levels

LI Wan-ying, SONG Chun-lan, SHAN Zhao-qian, XIONG Lei-lei, ZHANG Zhi-ying

2022, 30(11):  1246-1249.  DOI: 10.11852/zgetbjzz2022-0668

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Objective To analyze the changes of cardiovascular metabolic indicators such as blood lipids and serum uric acid in asthmatic children with different control levels, in order to determine the relationship between asthma control levels and cardiovascular metabolic risk factors. Methods A total of 88 asthmatic children who visited Zhengzhou Children's Hospital from October 2018 to December 2019 were selected as the case group, and were divided into well-controlled group and poorly-controlled group according to the asthma control level. Meanwhile, 30 healthy children were selected as the control group. The blood lipids, serum uric acid (sUA) and body mass index (BMI) levels of the asthmatic children were detected, and the lung function of the children in the case group was tested. Results There was no significant difference in the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and sUA between the case group and the control group (P>0.05). The level of high-density lipoprotein cholesterol (HDL-C) in the case group was significantly lower than that in the control group (t=-2.213,P＜0.05). The HDL-C level in the well-controlled group was significantly higher than that in the poorly-controlled group (t=2.692, P＜0.05), and the sUA level was significantly lower than that in the poorly-controlled group(t=-2.430, P＜0.05). The FEV1% pred level in the well-controlled group was significantly higher than that in the poorly-controlled group (t=9.741, P＜0.05). The FEV1% pred level of asthmatic children in the poorly controlled group was positively correlated with HDL-C level (r=0.457, P＜0.01), and negatively correlated with sUA level (r=-0.671,P＜0.01). Conclusion The control level of asthma in children is related to the levels of HDL-C and sUA, and the decrease of HDL-C and the increase of sUA may be the risk factors for poor control of asthma and poor lung function in children.

A case-control study on the influencing factors of congenital heart disease in children in Jilin

ZHU Ying-jie, WAN Li-xin, ZHANG Wen-yan, SONG Ping

2022, 30(11):  1250-1253.  DOI: 10.11852/zgetbjzz2022-0273

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Objective To identify the non-genetic influencing factors of children with congenital heart disease (CHD) in Jilin, so as to provide reference for making targeted strategies to reduce the risk of CHD among children in Northeastern China. Methods Children with CHD identified in the birth defects reporting system of Jilin Province from 2019 to 2020 and their mothers who met the inclusion criteria and were willing to cooperate were selected as the case group. Meanwhile, healthy children with the same sex, age and region and their mothers were selected into the control group by 1∶2 case-control matching. Multivariate Logistic regression model was used to analyze the influencing factors of CHD in children. Results There were no significant differences between case group and control group in terms of gender and age distribution(P>0.05). Multivariate analysis showed that premature (OR=6.224), father drinking alcohol within 3 months before pregnancy (OR=2.476), maternal BMI ≥25 kg/m² before pregnancy(OR=8.372) were the risk factors for CHD in children, while multivitamin use during pregnancy(OR=0.342) was a protective factor of CHD in children. Conclusions Premature birth, father's alcohol consumption within 3 months before pregnancy and mother's pre-pregnancy BMI ≥25 kg/m² are risk factors for the development of CHD in children in Jilin. Therefore, the focus should be on cardiac function in preterm infants, strengthening education on health care for couples preparing for pregnancy, encouraging them to quit smoking and drinking, control weight, so as to take an active role in pregnancy care.

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Clinical features of language delay in children

WANG Shao-wen, CHEN Jing-jing, YAO Yu-jia, WEI Xiu-li, YE Bei, FANG Shuan-feng

2022, 30(11):  1254-1257.  DOI: 10.11852/zgetbjzz2022-0322

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Objective To investigate the clinical features of language delay in children, in order to provide reference for the early detection and intervention. Methods From June 2019 to April 2020, a total of 151 children with language delay in the Department of Child Health care, Henan Children's Hospital were enrolled in this study. Children's intelligence was assessed by Gesell Development Scale. The ratios of developmental language delay and global developmental delay in children aged 1- years, 2- years and 3 - 4 years were analyzed. The differences of developmental quotients (DQs) in each area among the three age groups were compared, which were also compared between children younger and older than 3 years old. Results 1) The proportion of global developmental delay in children with language retardation as the main complaint increased gradually with the increase of age, which was 45.5%,61.2% and 95.5% in children in 1-,2-, 3 - 4 age group, respectively. 2) With the increase of age, the DQs of adaptability, gross motor, fine motor, language and social interaction area decreased gradually (F=26.175, 17.341, 18.516, 6.747, 4.180, P<0.05). There was a significantly sequential downward trend in adaptability, gross motor, fine motor, and language area from group 1- years to 2- years then to 3 - 4 years old(P<0.05). In social interaction area, there was only significant difference between children aged 1- years and 3 - 4 years (F=2.835, P=0.005). 3) The DQ values of children over 3 years old were significantly lower than those under 3 years old (F =5.521, 4.710, 4.933, 2.919, 2.670, P<0.01). Conclusions With the increase of age, the vast majority of children with language delay are not simple language problems, but more likely to be global developmental delay. Early screening, early diagnosis and early intervention are very important in the critical period of language development in children before the age of 3.

Retrospective analysis of the diagnosis age with 121 cases with autism spectrum disorder in Xuhui District, Shanghai

ZHOU Zhao-e, ZHU Guo-wei, LYU Yu-jing

2022, 30(11):  1258-1261.  DOI: 10.11852/zgetbjzz2022-0123

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Objective To summarize and analyze the treatment time and diagnosis months of children with autism spectrum disorder (ASD) registered and diagnosed in Xuhui District since the early autism screening in communities(primary health care institutions) was carried out from 2012 to 2020, so as to provide basis for identifying ASD children earlier and faster. Methods Children aged 18 to 24 months with positive results in routine screening, and children who were suspected with social interaction problems and with abnormal results of the age screening scale or Denver Ⅱ during the physical examination of 18 to 24 months with negative screening and non 18 - 24 month old children in Xuhui District Maternal and child health care center and 13 community health service centers, were referred through the green channel to the developmental behavior specialist clinic of the Child Healthcare Department of the Pediatric Hospital Affiliated to Fudan University for diagnosis. Children diagnosed with ASD were enrolled in this study, and were divided into three different reasons for consultation: Diagnosis in 18 to 24 months old with a positive screening result, diagnosis beyond 18 to 24 months old with a positive screening result, diagnosis in 18 to 24 months old with a false negative screening result. One way ANOVA was used for inter-group comparison and LSD method was used to compare the two groups when the difference was statistically significant. Results Among 121 children diagnosed with ASD, 82 cases aged 18 to 24 months with a positive screening result were diagnosed, 18 cases aged beyond 18 to 24 months with a positive screening result were diagnosed, 21 cases aged 18 to 24 months with a false negative screening result were diagnosed, with an average age of (26.34±9.08) months. The age of diagnosis was significantly different among the three groups (F=21.22, P<0.001). There was no significant difference in the age of diagnosis for the four reasons for consultation among doctor referrals and parental self-referrals in children aged 18 to 24 months with a false negative screening result, referrals for systematic medical examinations and referrals for school and nursery admissions for children beyond 18 to 24 months with a positive screening result (F=1.746, P=0.176). Conclusions The age of diagnosis is generally earlier for children managed by the child health care system and routinely screened in Xuhui District. Diagnosis is confirmed earlier for children aged 18 to 24 months with a positive screening result.

Difference in air pollutant concentration between suburbs and urban areas and its correlation with the severity of asthma in children

FU Yan-yan, LIU Wei, XU Li-yuan

2022, 30(11):  1262-1266.  DOI: 10.11852/zgetbjzz2022-0203

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Objective To explore the difference in air pollutant concentration between suburbs and urban areas and its correlation with the severity of asthma in children, in order to provide theoretical reference for the prevention and treatment of asthma. Methods A total of 211 children with asthma treated from January 2017 to December 2019 were enrolled in this study, and were evaluated for pulmonary function and asthma score. Meanwhile, 23.71 km² urban area of Shenyang, Liaoning Province and 22.86 km² suburban areas were selected to detect the concentration of air pollutants. The correlation of the air pollutants concentration in suburbs and urban area with the prevalence of asthma was analyzed. Results The total concentration of PM₁₀ [(0.139±0.032)mg/m³ vs. (0.048±0.012)mg/m³], API (65.455±8.741 vs. 56.955±8.774) and PM₂ [(0.036±0.010)mg/m³ vs. (0.036±0.010)mg/m³] in urban air pollutants was significantly higher than those in suburban air pollutants (t=24.256, 6.827, 17.575, P＜0.001). The incidence of asthma in urban area was higher than that in suburban area (χ²=26.626,P＜0.001). There was no statistical difference in FEV1 and PEF between children in suburbs and urban area(P>0.05), but significant difference was found in asthma score (t=18.863,P＜0.001). Pearson correlation analysis showed that the asthma scores of urban and suburban patients were significantly correlated with the concentration of NO₂, SO₂, PM₁₀, PM_2.5 and API (r_{urban area}=0.197, 0.318, 0.252, 0.451, 0.167, P<0.05; r_{suburban area}=0.281, 0.241, 0.428, 0.395, 0.487, P<0.05). Spearman correlation analysis showed that the severity of asthma in suburbs and urban area was positively related to NO₂, SO₂, PM₁₀, PM₂₅, API, asthma score, PM2.5, FEV1 and PEF (r_{urban area} =0.458, 0.398, 0.478, 0.498, 0.356, 0.524, 0.511, 0.528, P<0.05; r_{suburban area}=0.457, 0.419, 0.589, 0.524, 0.398, 0.425, 0.424, 0.407, P<0.05). Conclusion There are differences in air pollutants concentration between suburbs and urban area, which is positively correlated with the severity of asthma children. The more polluted the area, the more severe the asthma in children.