Table of Content

10 April 2023, Volume 31 Issue 4

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Expert Commentary

Early identification and early intervention of infants and toddlers with faltering growth

MAO Meng

2023, 31(4):  349-352.  DOI: 10.11852/zgetbjzz2023-0083

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Faltering growth in infants and toddlers is a common problem in clinical practice, and it can lead to a variety of short- and long-term health outcomes. Early life is a critical window for faltering growth identification and intervention, so a comprehensive understanding of how to identify and intervene faltering growth at early stage is of critical importance for achieving early appropriate catch-up growth and improving the lifetime health of infants and children.

Original Articles

Prospective cohort study on postnatal brain development and neurdevelopmental outcomes at the age of 18 to 24 months in small for gestational age infants

WANG Xiaoqing, LIU Jiuyue, YAO Guang

2023, 31(4):  353-358.  DOI: 10.11852/zgetbjzz2022-0729

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Objective To investigate the postnatal brain development and neurdevelopment at the age of 18 to 24 months in small gestational age (SGA) infants, in order to provide reference for follow-up and early intervention of SGA. Methods Neonates born in Puyang Maternal and Child Health Hospital from January 2019 to December 2020 and regularly followed up in the child health care clinic after discharge were selected as study subjects.According to gestational age and birth weight, neonates were divided into four groups: Premature SGA, premature appropriate gestational age (AGA), full-term SGA and full-term AGA.Cranial ultrasound was used to measure the corpus callosum length, corpus callosum-fastigium length, cerebellar vermis height, and cerebellar vermis anteroposterior diameter of the neonates within 24 to 48 hours.The neurdevelopment at the age of 18 to 24 months was assessed, and the effect of SGA on neurdevelopment was analyzed. Results There were statistically significant differences in vermis height between the four groups (F=5.214, P<0.05).The vermis height of premature SGA, premature AGA and full-term SGA infants were all lower than that of full-term AGA infants, which was higher inpreterm AGA and full-term SGA infants than preterm SGA infants.There were statistically significant differences in adaptability (F=10.152), gross motor(F=16.842), fine motor(F=5.256), language(F=12.387) and personal social development quotient(DQ) (F=7.963) between the four groups at 18 to 24 months of age (P<0.05).The language and personal social DQ of premature SGA infants was lower that of premature AGA infants, and the adaptation, gross motor, fine motor, language and personal social development were behind that of full-term AGA infants.However,full-term SGA laged behind full-term AGA in gross motor and language development.Compared with full-term AGA, premature SGA had an increasing risk of gross motor (OR=2.895, 95%CI:1.896 - 5.691, P<0.05) and language development retardation (OR=4.026, 95%CI:1.124 - 13.264, P<0.05), while full-term SGA had an increasing risk of gross motor development retardation(OR=1.259, 95%CI:1.084 - 2.169, P<0.05). Conclusions SGA may have abnormal brain development after birth, and the neurdevelopment at the age of 18 to 24 months lags behind AGA, and even full-term SGA are at a high risk of abnormal neurdevelopment.Therefore, clinical attention should be paid to the follow-up management and early intervention of SGA.

Status quo and related factors of Chinese phonological development in children aged 2 to 6 years

SONG Zhixiao, LIU Huijuan, GAO Nannan, QIAO Xiuyun, KE Jiamei, ZHANG Li, SUN Jin, LI Yan

2023, 31(4):  359-364.  DOI: 10.11852/zgetbjzz2022-0556

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Objective To assess the phonological development of children aged 2 to 6 years, and to analyze its influencing factors. Methods From July 2021 to February 2022, 198 children aged 2 to 6 years who took regular physical examination in Shandong Province Qianfosha Hospital were included in this study, and were divided into 8 groups by age with 0.5 years intervals. Language Development Assessment Scale for Children aged 2 - 6 Years was used to assess the pronunciation of the participants, and the influencing factors were analyzed. Results 1) The initials 'm', 'b', 't' and 'j' were level 1; the initials 'x', 'p', 'n', 'h', 'q', 'g' and 'd' were level 2; the initials 'k', ' f', 'l', 'ch', 'sh', 'zh', 'c', 'z' and 'r' were level 3; and the initials 's' was level 4. Levels 1 to 3 were all met, while level 4 was not. The finals were all up to standard. According to the age group, the initials were partially not up to the standard in children aged 2 - 4 years old, and were up to the standardin children aged 4 to 6 years, the finals reached to the standardin children aged 2.5 to 5.5 years. 2) Picky eating, late age of solid food intake, use of dialect for communication and long screen time were associated with higher rate of initials errors(P＜0.05). Picky eating, semi-liquid diet, primary school education, use of dialect for communication and long screen time on work day were associated with higher rate of finals error(P＜0.05). Conclusions There is a significant correlation between age and Chinese phonetics development. Phonics is learned by the age of 4. Dietary behavior, family language environment, main caregiver and screen time are related to phonetics development of children.

Behavioral and language characteristics of chidren with language development delay

LIU Huiyan, SONG Yanyan, ZHANG Shuqin, XIAO Wanqi

2023, 31(4):  365-368.  DOI: 10.11852/zgetbjzz2022-0682

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Objective To analyze the characteristics of children with language development delay at diffierent ages, so as to provide scientific basis for early clinical detection and intervention. Methods A study was conducted in children aged 1.5 to 6 years with questionnaire survey during January 2020 to January 2021.The S-S linguistic retardation assessment was adopted.Then the language development characteristics and influencing factors were analyzed. Results 1) The age of delayed speech visits was mainly between 1.5 and 3.5 years old, with an average of 2.6 years old, and significantly more boys than girls.Among children with delayed speech visits, 52.48% had an expressive vocabulary of less than 10 words, and 12.38% visited the hospital because they did not speak, the level of language comprehension was mainly at the symbolic stage of things, 80.20% had behavioral problems, 58.29% had dietary behavioral problems.And 62.87% were exposed to electronic screens for more than 1h/d, 50.99% parent-child interaction was less than 2h/d.2) The proportion oflanguage comprehension delay and operational task delaywere significantly different among different age groups (χ²=13.68, 17.62, P<0.01).The proportion of delayed language comprehension gradually increased with age, and the difference was most significant around 2 years old.The rate of operational task delay was higher in each age groups.3) Multivariate Logistic regression analysis showed that higher education level of the main caregiver was a protective factor for language comprehension (OR=0.81, 95%CI:0.67 - 0.97, P＜0.05), while behavioral problems increased the risk of operational task delay (OR=2.84, 95%CI:1.21 - 6.65, P＜0.05). Conclusions Language development delays mostly occur in children around 2.5 years of age and are prone to behavioral problems.After 2 years of age, in addition to language delays, children are more likely to have a combination of comprehension delays and operational delays, and behavioral problems increase the risk for operational delays.Therefore, early screening and targeted interventions are necessary, and scientific parenting and favorable behavior habits may help to children's early language development.

Translation and validation of the Paternal Involvement with Infants Scale

YIN Xiaohui, WANG Wei, ZHANG Jiaojiao, WANG Yang, XU Yahong

2023, 31(4):  369-373.  DOI: 10.11852/zgetbjzz2022-0926

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Objective To translate the Paternal Involvement with Infants Scale ( PIWIS) into Chinese version, and to test its reliability and validity. Methods The procedure of translation, back-translation and cross-cultural adaptation of PIWIS were carried out under Beaton's cross-cultural adjustment guideline.A total of 224 fathers of infants aged 0 to 12 months were surveyed, and the reliability and validity of the Chinese version of PIWIS were verified. Results The Chinese version's Cronbach's α was 0.940,the Cronbach's α for each subscale of warmth, control, frustration, indirect care, and active participation in the Chinese version of PIWIS were 0.934, 0.924, 0.753, 0.632 and 0.861, respectively.Repeated measures reliability of PIWIS was 0.876.Confirmatory factor analysis supported a 5-factor solution with good structural validity(χ² /df=2.676, RMSEA=0.086, CFI=0.841, TLI= 0.827).As a scalar scale, the PIWIS score was positively correlated with the score of Brief Coparenting Relationship Scale. Conclusion Chinese version of the PIWIS includes 33 items in 5 subscales, with acceptable reliability and validity.

Associated factors of screen exposure in infants

SHAN Ruijie, HAN Jing, QU Keli, YUE Lei, CUI Naixue

2023, 31(4):  374-378.  DOI: 10.11852/zgetbjzz2022-0829

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Objective To explore the correlation of infant and family-related factors with infant screen exposure, so as to provide a scientific basis for reducing infant screen exposure. Methods Infants who visited the Department of Child Healthcare of two tertiary hospitals for routine physical examination in Jinan from December 2020 to April 2022 were recruited using a convenient sampling method.Mothers completed questionnaires of infant screen exposure and questionnaires of associated factors, including infant age, sex and family nurturing environment.Univariate analysis was performed using t test and χ² test, and multivariate analysis was performed using Logistic regression analysis. Results A total of 362 infants were enrolled in this study, of whom 55.8% had screen exposure.Logistic regression analysis showed that infant age (OR=1.27, 95%CI:1.16 - 1.38), maternal education level (vocational college vs.bachelor's degree and above, OR=1.89, 95%CI:1.09 - 3.28; high school and below vs.bachelor's degree and above, OR=3.09, 95%CI:1.64 - 5.82), and maternal anxiety (OR=2.89, 95%CI: 1.11 - 7.52) were risk factors for screen exposure during infancy(P＜0.05). Conclusions Infant screen exposure is common.Low maternal education level and maternal anxiety are the risk factors of screen exposure among infants.It is recommended that screenings for at-risk infants, health education for mothers and other primary caregivers, popularization of the hazards of screen exposure in infancy and the availability of scientific parenting knowledge and skills should be implemented in child healthcare practice, so as to reduce the risk of screen exposure in infancy.

Nomograph model for predicting the risk of dyslipidemia with anthropometric indices in obese adolescents aged 13 - 16 years

LIAO Jing, ZHU Lin

2023, 31(4):  379-384.  DOI: 10.11852/zgetbjzz2022-1080

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Objective To establish a nomograph model for predicting the risk of dyslipidemia in obese adolescents by using existing anthropometric indicators, so as to provide methodological reference for early screening of dyslipidemia in obese adolescents. Methods A total of 421 obese adolescents aged 13 to 16 were recruited from 2020 to 2021 to measure anthropometric indices (height, weight, chest, waist, hip, thigh and calf circumference) and 13 anthropometric indices were calculated, including body mass index(BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index(CI), abdominal volume index (AVI), body adiposity index (BAI), cl-nica universidad de Navarra-body adiposity estimator (CUN-BAE), a body shape index (ABSI), body roundness index (BRI), triponderal mass index(TMI), waist divided by height 0.5(WHT.5R), relative fat mass (RFM) and BMI multiply by the square root of WC(BMIWC).Blood lipids of children were tested, using the "Reference Standards for Dyslipidemia in Children and Adolescents Aged 6 to 18 in China" to diagnose dyslipidemia.LASSO regression was used to screen the characteristic variables of dyslipidemia in obese adolescents, and a nomograph model with multi-indices was established.Hosmer-lemeshow goodness of fit test and bootstrap method (1 000 times) were used for model verification.The prediction ability of nomograph model was evaluated by the receiver operating characteristic(ROC) curve. Results The chest circumference, thigh circumference and ABSI were screened by LASSO regression to establish the nomograph model of obese boys.The Hosmer-lemeshow goodness of fit P value was 0.575, the mean absolute error of the calibration curve was 0.023, and the ROC-AUC was 0.62.BMI, TMI and ABSI were selected to establish the nomogram model of obese girls.The corresponding Hosmer-lemeshow goodness of fit P value was 0.422, the mean absolute error of the calibration curve was 0.023, and the ROC-AUC was 0.70. Conclusion The nomogram model of multi-indices combination established by LASSO regression can be used to predict dyslipidemia in obese adolescents.

Quality of life and associated factors among preschool overweight and obese children

LIU Weiwei, LOU Haiqin, FU Lu, DAI Qianqian

2023, 31(4):  385-389.  DOI: 10.11852/zgetbjzz2022-0890

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Objective To investigate the quality of life (QOL) of preschool overweight and obese children aged 5 - 6, and to analyze the associated factors of QOL using the structural equation model. Methods Using the multi-stage cluster sampling method, a total of 2 256 children aged 5 - 6 were surveyed from January to March 2021.Height and weight were measured to assess overweight and obesity.The survey was conducted using the Paediatric QOL Inventory 4.0, Family Social Capital Scale and Family Cultural Capital Scale. Results Totally 294(13.03%) children were detected with overweight and 241(10.68%) children were detected with obesity.The QOL of preschool children with overweight and obesity was significantly lower than that of normal children in Nantong City.The results of the structure equation model showed that the family social capital had a direct (β=0.160, P<0.05) and indirect (β=0.159, P<0.05) positive influence on the QOL of preschool children with overweight and obesity.Family cultural capital directly influenced the QOL (β=0.264, P<0.05).The type of obesity(β=-0.104), parental marital relationship(β=0.143), and only-child or not (β=0.094) directly affected the QOL of preschool overweight and obese children(P<0.05). Conclusions The QOL of overweight and obese children in Nantong is relatively low.Among them, non-only child and children with moderate to severe obesity need more extensive attention from society.Improving family social capital, family cultural capital and parental marital relationship can effectively improve the QOL of overweight and obese children.

Review

Research progress in the neurodevelopment of preterm infants with bronchopulmonary dysplasia

XIA Zhenglong, SONG Yanyan

2023, 31(4):  390-394.  DOI: 10.11852/zgetbjzz2022-0496

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Bronchopulmonary dysplasia (BPD) is an inflammatory disease caused by dysplasia of the lungs, and is closely related to long-term neurological dysplasia. Premature infants with BPD have developmental impairments in motor, cognitive, neurosensory and behavioral areas, but the mechanism by which BPD causes neurodevelopmental dysplasia in preterm infants remains unclear. This article reviews the effect of BPD on the neurodevelopment of preterm infants and its potential mechanism, including hyperoxia exposure, inflammation, glucocorticoids and nutrition, in order to provide reference for the new respiratory support technology and related neurodevelopment treatment of BPD.

Research progress in the prediction model of bronchopulmonary dysplasia in preterm infants

LI Jinglan, SUN Wenqiang, ZHU Xueping

2023, 31(4):  395-398.  DOI: 10.11852/zgetbjzz2022-0522

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease characterized by simple pulmonary alveoli and pulmonary vascular retardation, accompanied by pulmonary fibrosis, cystic degeneration and atelectasis. There is no effective treatment for BPD, and once it occurs, it is irreversible and seriously affects the survival rate and prognosis of children in the near and long term. Therefore, early detection, prevention, and treatment are important to assess and improve the prognosis of children. At present, research has been done on the high risk factors of BPD at home and abroad, and a variety of early warning models of BPD have been established. This article reviews the latest research progress of BPD early warning model in preterm infants, in order to provide theoretical basis for early clinical intervention and prevention of the occurrence and development of BPD.

Research progress in the impact of microplastics on newborn's health

ZHANG Xueyi, ZHANG Yayu, LI Jia

2023, 31(4):  399-403.  DOI: 10.11852/zgetbjzz2022-0429

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Plastics are now widely used around the world and can degrade into microplastics under natural conditions. Microplastics are widely found in air, water and soil, and enter into organisms through respiratory and digestive tracts, damaging health by physical accumulation and chemical means. In recent years, research on the harm that microplastics do on human health has been increasing and has become a research hotspot. As research continues, microplastics have been found to be strongly associated with the health of newborns and may be one of the factors influencing the quality of survival of newborns. However, there are few reports on the effects of microplastics on neonatal health, so this paper intends to review the exposure pathways and hazards of microplastics by collecting existing studies.

Progress in neurodevelopmental assessment of premature infants

WANG Na, LI Xiaoying

2023, 31(4):  404-407.  DOI: 10.11852/zgetbjzz2022-0574

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With the development of medical science, more methods are used for the early detection of neurodevelopmental impairment in premature infants in order to improve their neurodevelopmental outcomes, such as the examination in brain structure, metabolism, neurological function and the application of neurobehavioral assessment scales. In recent years, cranial ultrasound and cranial MRI are widely used in clinic, amplitude-integrated EEG, brainstem auditory evoked potentials,whole-body motor assessment and the Alberta Infant Movement Scale and Neonatal Behavioral Neurological Assessment(NBNA) score have been used more often in clinical practice, resting-state functional magnetic resonance imaging, Dubowitz Neurological Assessment Method and Hammersmith Neurological Assessment Method have been gradually used in premature infants. In this paper, the characteristics and clinical application of these assessment methods are discussed.

Research progress in the parenting stress of children with attention-deficit hyperactivity disorder

YI Wenxia, CHEN Li

2023, 31(4):  408-411.  DOI: 10.11852/zgetbjzz2022-0541

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Attention-deficit hyperactivity disorder (ADHD) is one of common chronic neurodevelopmental disorder in childhood, which is characterized by inattention, hyperactivity, impulsivity incompatible with the development level, and it has a significant impact on children's academic performance, interpersonal communication, social functioning, as well as the family quality of life and social development. Parents of ADHD children experience more parenting stress than parents of typically developed children during parenting and parent-child interaction. This review combs the assessment and situation of parenting stress of parents of ADHD children, in order to raise the attention of clinician and society to current situation of parenting stress of ADHD children.

Research progress in the correlation between attention-deficit hyperactivity disorder and obesity in children

LIU Ruizhuo, CHEN Li

2023, 31(4):  412-415.  DOI: 10.11852/zgetbjzz2022-0557

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Attention deficit/hyperactivity disorder(ADHD) is a common neurodevelopmental disorder in childhood, and has become an increasingly serious public health problem along with obesity. In recent years, a large number of studies have shown a broad correlation between ADHD and obesity. This article aims to comprehensively review the relationship between ADHD and obesity in children, so as to promote the understanding and standardized management of ADHD children comorbid with obesity, and to propose the direction of further research.

Meta Analysis

Meta-analysis of the relationship between serum vitamin D level and risk of pediatric fractures

YE Xixia, ZHU Zhixin, CHEN Mingming, ZHANG Yaqin, ZHOU Jing, CAO Wenting

2023, 31(4):  416-421.  DOI: 10.11852/zgetbjzz2022-0240

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Objective To systematically evaluate the correlation between serum vitamin D level and the fracture risk in children and adolescents, so as to provide theoretical basis for early prevention of fractures in children. Methods PubMed, Embase, CNKI,VIP and Wangfang Database were searched to retrieve the observational studies on the association between serum vitamin D level and the fracture risk from the establishment of the database to December 31st 2021. Simultaneously, references of related literature were searched. The quality of the literature was evaluated by NOS standard application. Review Manager 5.4 software was used to perform Meta-analysis, the MD value of the combined effect size and its 95% confidence interval(CI) were estimated. Results A total of 18 English articles were included, with 2 614 cases in the fracture group and 4 519 in the control group. Meta-analysis showed that serum Vit D level in the fracture group was significantly lower than that in the control group(MD=-3.54, 95%CI:-5.45 - -1.63, P<0.05). Subgroup analysis showed that the serum Vit D level of Asian children in the fracture group was significantly lower than that in the control group(MD=-5.15, 95%CI:-9.40 - -0.91, P<0.05). Conclusion Lower serum vitamin D level in children with fracture is associated with an increased risk of fracture in children.

Clinical Research

Association of pregnancy age and maternal feeding behavior with motor development among high-risk infants

WANG Hui, WANG Lijuan, TONG Lian, WANG Jun, ZHANG Yaping, ZHANG Qing

2023, 31(4):  422-426.  DOI: 10.11852/zgetbjzz2022-0491

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Objective To assess the association between maternal pregnancy age and feeding behavior with motor development among high-risk infants, in order to promote its application in the early intervention of high-risk infants. Methods A total of 227 high-risk infants who were born from March 2020 to February 2021 were investigated to get the information of health condition related risk factors, feeding patterns and complementary food addition condition were investigated and analyzed with Logistic regression analysis method. Results The rate of exclusive breastfeeding was 44.1% in high-risk infants within six months, and 74.9% began supplementary feeding when the high-risk infants were 4 to 6 months old. The detection rate of abnormalities in gross motor was 25.1%. There was significant difference in the effect of supplementary feeding patterns, fetal abnormalities during pregnancy and rescue history of perinatal asphyxia on gross motor development in male high-risk infants(χ² =5.77,4.45,5.70, P＜0.05). Not adding supplements during 4 to 6 months old (OR=3.90, 95%CI:1.27 - 12.03, P=0.018) and maternal pregnancy age＜16 years old or ＞35 years old (OR=14.72, 95%CI:1.71 - 127.00, P=0.014) were risk factors for abnormalities in the early development of gross motor of male high-risk infants. Conclusions High-risk boys who are not given complementary foods 4 to 6 months after birth and whose maternal pregnancy age was <16 years old or >35 years old will be at an increased risk for gross motor developmental problems. Education of women at childbearing age is supposed to be strengthened, and further studies on adding complementary foods are warranted, thereby promoting early intervention effect.

Correlation of hypersensitive C-reactive protein and metabolic syndrome in children and adolescents

WU Qiaoling, XU Jian, ZHAO Zhengyan, PENG Yongmei, GONG Chundan

2023, 31(4):  427-432.  DOI: 10.11852/zgetbjzz2022-0469

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Objective To investigate the relationship between serum hypersensitive C-reactive protein (hs-CRP) level andphysical and serum laboratory metabolic indicators in children and adolescents with metabolic syndrome (MetS). Methods The physical examination and metabolic indicators of 543 children and adolescents aged 10 - 15 years were retrieved from the national"11th Five-Year" Science and Technology Support Plan project Research on early identification and intervention technology of metabolic syndrome. The physical and metabolic indexes of children with different levels of hs-CRP were compared, and the association between hs-CRP and MetS related indexes was analyzed. Results Subjects with higher hs-CRP had significantly higher levels of triglyceride (TG), C-peptide, carotid intima media thickness (IMT), diastolic blood pressure and the prevalence of non-alcoholic fatty liver disease (NAFLD) (t=-3.150,-3.537,-3.662,-2.439,χ²=7.521,P<0.05), while significantly lower levels of fasting blood-glucose (FBG), glycosylated hemoglobin A1C ratio (HbA1C%) and the prevalence of hyperglycemia (t=3.859,4.060,χ²=8.268,P<0.05). hs-CRP level was positively correlated with TG, C-peptide, IMT and diastolic blood pressure (r=0.112, 0.223, 0.174, 0.140, P<0.05), and was negatively correlated with high density lipoprotein cholesterol (HDL-C) and FBG (r=-0.098, -0.234, P<0.001). After adjusting for gender and age, children with abdominal obesity (OR=1.215, 95%CI:1.002 - 1.472) and NAFLD (OR=1.741, 95%CI:1.332 - 2.275) had significantly higher hs-CRP levels, whereas children with hyperglycemia had significantly lower hs-CRP levels (OR=0.187, 95%CI:0.038 - 0.929). hs-CRP was still significantly lower in children with hyperglycemia after adjusting for gender, age, abdominal obesity and NAFLD (OR=0.178, 95%CI:0.034 - 0.924). Conclusions hs-CRP is an important early monitoring indicator for MetS in children and adolescents, and it is significantly correlated with abdominal obesity, glycolipid metabolism disorder, increased diastolic blood pressure and NAFLD. The association between hs-CRP and abdominal obesity is stronger than that of body mass index and C peptide is more important in predicting abnormal glucose metabolism than FBG in the early stage of MetS.

Correlation of dietary patterns with overweight and obesity among elementary and secondary school students in Urumqi City, China

CAI Wenping, GUO Niya

2023, 31(4):  433-437.  DOI: 10.11852/zgetbjzz2022-0648

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Objective To investigate the dietary patterns of elementary and secondary students in Urumqi city, and to analyze its correlation with overweight and obesity. Methods From March 2020 and December 2021, a total of 674 students from eight primary and secondary schools in the new urban area, Tianshan district, Shaeback district and the Hydromologue district of Urumqi city were recruited in this study by stratified cluster sampling. General characteristics and dietary data of the participants were collected by questionnaires. Dietary frequency and factor analysis were used to extract dietary patterns. Three-dimensional modeling body composition analyzer was used to measure the body composition data of the students. Then the BMI-Z value was calculated and overweight and obesity were assessed. Multivariate Logistic regression model was used to analyze the association of dietary patterns with overweight and obesity. Results Three dietary patterns of students from Urumqi city were extracted in this study:The sweet processed group (which was associated with a high intake of beverages, ice cream, hamburgers, biscuits, etc.), The health conscious group (which was based on milk, vegetables, fruits, cereals, etc.) and the staple meat group (which was based on foods related to beef, pork, lamb, etc.). After stratified by age, the BMI, body fat, basal metabolic rate and percentage body fat of 7- to 11-year-old students in the health conscious group were significantly lower compared with the 12- to 17-year-old students in sweet processed group (P<0.05). Compared with sweet processed group and staple meat group, 12- to 17-year-old students in the healthy conscious group had lower muscle mass, basal metabolic rate and body fat percentage (P<0.05). Logistic regression model analysis showed that after adjustment for confounders, higher scores in the health awareness group were associated with a lower risk of developing overweight and obesity among students (OR=0.59, 95%CI:0.39 - 0.92). Conclusion Dietary patterns are correlated with overweight and obesity among primary and secondary school students in Urumqi City, and changing dietary patterns is beneficial for healthy growth of students.

Influence of feeding factors on necrotizing enterocolitis in preterm neonates

REN Li, HEI Mingyan, QI Yujie, JIN Fei, WENG Jingwen, DONG Shixiao, SHEN Yanhua, JIANG Min

2023, 31(4):  438-441.  DOI: 10.11852/zgetbjzz2022-0453

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Objective To explore the influence of feeding factors on the development of necrotizing enterocolitis (NEC) in preterm infants with gestational age less than 37 weeks, so as to provide reference for clinical management of NEC. Methods Preterm infants hospitalized in Neonatal Center of Beijing Children's Hospital from June 2019 to June 2021 were enrolled in this study. Infants with NEC were selected into the case group, meanwhile non-NEC infants matched by 1∶2 were selected as controls. The differences in feeding patterns (breast, mixed, formula feeding) and feeding factors (the onset time to enteral feeding after birth, fasting duration and parenteral feeding duration, etc.) were compared between the two groups of preterm infants, and the effects of these factors on the development of NEC were analyzed using univariate and multivariate Logistic analysis. Results There were 47 cases in the experimental group (30 cases in stage Ⅱ and 17 cases in stage Ⅲ), and 94 cases in the control group. There were no statistically significant differences in the general characteristics between the two groups (P＞0.05).Univariate analysis showed significant differences in the type of enteral feeding (χ²＝ 24.871), duration of fasting (Z＝-10.062), duration of parenteral feeding (Z＝-2.217) and the onset time to enteral feeding after birth (Z＝-15.772) in the two groups of preterm infants (P<0.01). Multifactorial Logistic regression analysis showed that breastfeeding was a protective factor for the development of NEC in preterm infants (P<0.01), prolonged fasting time (OR＝ 8.109, 95%CI:5.477 - 12.007), delayed enteral feeding after birth (OR＝ 17.710, 95%CI:11.748 - 26.699) were risk factors for the development of NEC in preterm infants (P<0.001). Conclusions Formula feeding and prolonged parenteral feeding are associated with the increased risk of NEC. Breastfeeding and enteral feeding early after birth may reduce the incidence of NEC in premature infants.

Application of the Gesell Developmental Diagnostic Scale in language-related developmental diseases

WANG Shaowen, ZHANG Yixia, CHEN Jingjing, WEI Xiuli, YE Bei, FANG Shuanfeng

2023, 31(4):  442-445.  DOI: 10.11852/zgetbjzz2022-1356

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Objective To analyze the developmental characteristics and differences among autism spectrum disorder (ASD), developmental language disorder (DLD) and global developmental delay (GDD) by using Gesell Developmental Diagnostic Scale (GDDS), so as to provide scientific basis for early screening and differential diagnosis. Methods Clinical data of 178 children, involving 29 ASD children, 45 DLD children and 104 GDD children in the Department of Child Health care, Henan Children's Hospital from September 2021 to April 2022 were retrospectively analyzed. The developmental quotients (DQs) of the five dimensions of GDDS (gross motor, fine motor, language, adaptive behavior, personal-social behavior) of children in each group were analyzed and compared. The differences in the language development and nonverbal development levels (the average of gross motor, fine motor, adaptive behavior and personal-social behavior development) between the two groups were analyzed. Results 1) There were significant differences in the nonverbal development levels among ASD, DLD and GDD groups (H=―95.90, 38.25, ―57.65, P＜0.05), and also in the language functional area (H=―99.99, 30.89, ―69.11, P＜0.05). 2) There were significant differences in the DQs of language, personal-social behavior and gross motor development among ASD, DLD and GDD children (H=82.438, 51.156; 160.045, 65.098; 322.038, 210.908, P＜0.001). There were no significant differences among the DQs of fine motor, adaptive and gross motor in ASD and DLD groups (P>0.05). But there was a significant difference between the DQs of fine motor, adaptive and gross motor functional area in GDD groups (H=119.975, 63.621, P＜0.05). There was no significant difference between the DQs of language and personal-social dimension in ASD children(P＞0.05), but in the DLD group the difference was significant (H=-94.946, P＜0.001). Conclusions Children with ASD, DLD and GDD all have unbalanced development, with significant differences in GDDS dimensions in the different disease categories.The level of language development and nonverbal development of ASD children significantly lag behind GDD and DLD children. GDDS can be used to assess speech-related developmental disorders, and is helpful to facilitate the early identification and differential diagnosis of these disorders.

Investigation and analysis of influencing factors of self-management behavior in school-age children with bronchial asthma

MAI Guohua

2023, 31(4):  446-450.  DOI: 10.11852/zgetbjzz2022-0351

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Objective To investigate the self-management behavior of school-age children with bronchial asthma, and to analyze its influencing factors, so as to provide scientific reference for the prevention and intervention of bronchial asthma in children. Methods A total of 132 school-age children with bronchial asthma treated in Pingdingshan Maternal and Child Health Hospital from January 2020 to May 2021 were selected as the study subjects. The self-management behavior of asthmatic children was investigated by questionnaire, and the influencing factors of self-management behavior of school-age children with bronchial asthma were determined by multivariate Logistic regression analysis. Results The total score of self-management behavior of 132 school-age children with bronchial asthma was(119.76±19.32) points. The average score of daily life management behavior, disease medical management behavior and social psychological management behavior was(23.13±3.51) points,(62.88±10.27) points and(33.75±5.54) points, respectively. The scores of daily life, disease medicine, social psychology and total score of self-management behavior in children aged 11 to 14 years, with a course of more than 4 years and guardian's education level of college or above were higher than those in children aged 7 to 10 years, with a course of less than 2 years or 2 - 4 years and guardian's education level of junior middle school/below and senior high school/technical secondary school(daily life: t=4.838, F=8.928, 8.764; disease medicine:t=3.507, F=9.205, 6.514; social psychology: t=3.901, F=12.028, 9.635; total score of self-management behavior: t=3.865, F=9.939, 7.791, P<0.01). The scores of disease medicine and total score of self-management behavior of children with family history were higher than those without family history(t=2.876, 2.088, P<0.05). There were significant differences in the scores of disease medicine, social psychology and total score of self-management behavior in children with different education methods(F=3.469, 73.525, 8.410, P<0.05 or <0.01). Multivariate Logistic regression analysis showed that 11 to 14 years old(OR=0.297,95%CI:0.139 - 0.541), family history(OR=0.600,95%CI:0.327 - 0.852) and persuasion education(OR=0.484,95%CI:0.206 - 713) were protective factors for the better self-management behavior of school-age children with bronchial asthma(P＜0.05), but the disease course of 2 to 4 years(OR=1.837, 95%CI:1.237 - 2.549) and less than 2 years(OR=2.881,95%CI:2.175 - 3.624), guardian education degree of senior school or secondary specialized school(OR=1.782,95%CI:1.266 - 2.582)and junior high school or below(OR=3.019,95%CI:2.352 - 3.607), beating and scolding parenting style(OR=1.322, 95%CI:1.017 - 1.823) were risk factors(P＜0.05). Conclusions The self-management behavior of school-age children with bronchial asthma still needs to be improved, which is affected by the children's age, course of disease, guardian's education level, family history and parenting style. Self-management education should be considered and conducted from multiple perspectives to improve the self-management ability of children with bronchial asthma.

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Retrospective study on the neuropsychological development of preterm multiple births and singleton births

CHEN Feng, ZHANG Yu

2023, 31(4):  451-456.  DOI: 10.11852/zgetbjzz2022-0707

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Objective To analyze the neurobehavioral development of preterm multiple births and singleton births, so as to provide reference for post discharge management and early intervention of preterm infants. Methods A total of 535 preterm infants who were followed up in the Department of Child Healthcare of Wenzhou People's Hospital from January 2017 to December 2021 were selected as the study subjects, and were divided into multiple births and singleton births groups according to the number of pregnant fetuses. Infants were assessed regularly by Gesell Developmental Scale and their general data were recorded. Neuropsychological development of infants in the two groups was compared and the influencing factors were analyzed. Results 1) At 12 months of corrected age, there were statistically significant differences in developmental quotient(DQ) values of adaptability between preterm multiple births and singleton births (t＝2.773, P<0.05). 2) For preterm multiples, there were statistically significant differences in DQ values of adaptability, gross motor movement and language between 6 months of corrected age and 12 months of corrected age (t＝-2.038, -4.833, 5.198, P<0.05). 3) For preterm singletons, there were statistically significant differences in DQ values of adaptability, gross motor movement, fine motor and language between 6 months of corrected age and 12 months of corrected age (t＝-6.547, -6.251, -4.441, 4.738, P<0.05). 4) After controlling for confounding factors, Logistic regression analysis showed that multiple birth was a risk factor for abnormal development of adaptability (OR=5.066,P=0.010), low birth weight was a risk factor for abnormal development of gross motor movement (OR=15.186,P=0.003), low gestational age was a risk factor for abnormal development of fine movement (OR=2.225,P=0.005), low gestational age(OR=2.675,P<0.001) and male (OR=3.844,P=0.026) were risk factors for abnormal development of social interaction. Conclusions Preterm multiple births and singleton births are prone to developmental delays in language and social interaction, and preterm multiple births are also at risk for adaptive developmental disorders. Therefore, follow-up monitoring should be strengthened and scientific intervention guidance should be given based on the factors affecting the development of premature infants.

Analysis of physical growth and body composition in 3-year-old preterm infants

WANG Jing, XIANG Sijia, LU Ying, YANG Lei, HU Xiaosha, QIAN Jun, CHI Xia, ZHANG Min

2023, 31(4):  457-460.  DOI: 10.11852/zgetbjzz2022-0585

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Objective To analyze the physical growth and body composition in 3-year-old preterm infants, in order to provide guidance for clinical nutrition support and promoting the growth development of children. Methods Premature infants born from June 2018 to April 2019 and undergoing regular physical examination at the Children's Health Care Department of the Women's Hospital of Nanjing Medical University were randomly selected as the study group, while 3-year-old full-term infants who took physical examination at the same period were selected as the control group. The physical growth index and body composition index of children were measured to compare difference in the growth and body composition of preterm and full-term infants during this period. Results 1) Compared with the controls, the weight and height of premature infants were significantly lower(t=-2.36, -3.26, P＜0.05). 2) The detection rates of emaciation, overweight and obesity were not significantly different between preterm and full-term infants(χ²=5.01, P＞0.05). 3) Compared with the controls, the total body water, protein, inorganic salt and fat-free mass of premature infants were significantly lower(t=-2.70, -2.15, -2.33, -2.79, P＜0.05), but no significant difference was found in the total amount of body fat between the two groups (P>0.05). 4) BMI of premature infants were significantly lower than that of controls (t=-2.05,P=0.03), but fat mass index and body fat percentage had no difference between the two groups (P>0.05). Conclusions At 3 years of age, preterm infants still lag behind full-term infants in terms of physical growth and differ from full-term infants in terms of body composition, with weight gain in preterm infants being more prominent in terms of body fat gain. Therefore, physical measurements need to be combined with body composition monitoring when assessing the growth of preterm infants to better promote healthy growth.

Clinical manifestations and related factors of feeding intolerance in premature infants

ZHENG Shuiying, LUO Yanyun

2023, 31(4):  461-464.  DOI: 10.11852/zgetbjzz2021-0321

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Objective To analyze the clinical manifestations and related factors of feeding intolerance in premature infants (<34 weeks gestation), in order to provide reference for the prevention and treatment feeding intolerance. Methods A total of 107 premature infants <34 weeks gestation in Tonglu Maternity and Child Health Care Hospital from February 2018 to August 2020 were selected in this study. The basic data, clinical manifestations and feeding tolerance of maternal and premature infants were investigated by self-made questionnaire and medical records. The related influencing factors of feeding intolerance of premature infants <34 weeks gestation were analyzed by univariate and multivariate Logistic regression analysis. Results In this study, 36.45% of very preterm infants had feeding intolerance. Univariate analysis showed that lower birth weight, abnormal umbilical cord, multiple births, late start of feeding, late enteral feeding up to 110kCal/kg, late enteral feeding up to 150kCal/kg and late evacuation of faeces were the risk factors of feeding intolerance in premature infants (P<0.05). Multivariate Logistic regression analysis showed that higher birth weight was an independent protective factor for feeding intolerance in premature infants (OR=0.003, 95%CI:0.000 - 0.789, P<0.05), while late start of feeding(OR=1.213, 95%CI:1.011 - 1.456), late enteral feeding up to 110kCal/kg(OR=1.525, 95%CI:1.186 - 1.960), late enteral feeding up to 150kCal/kg(OR=1.230, 95%CI:1.097 - 1.378) and late evacuation of faeces (OR=1.505, 95%CI:1.027 - 2.207) were independent risk factors for feeding intolerance in premature infants (P<0.05). Conclusion It is necessary to pay close attention to the premature infants with lower birth weight, late start of feeding, late enteral feeding up to 110kCal/kg, late enteral feeding up to 150kCal/kg and late defecation, and take timely and effective interventions for the above factors.