Chinese Journal of Child Health Care

Report on early childhood development practices in China from a global health perspective

HUANG Yangmu, DANG Yuan

2024, 32(1): 1-6. DOI: 10.11852/zgetbjzz2023-1344

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As the health disparities among children indirectly reflect the unfair distribution of national child healthcare, education, and other infrastructure, early childhood health development is a globally significant public health concern. On a global scale, 193 countries have endorsed The 2030 Agenda for Sustainable Development and have explored various development strategies. The government placing children's interests and their rights at the core of their efforts to achieve theSustainable Development Goals(SDGs) is essential, China has made substantial progress in improving children's well-being over several decades of continuous effort and practice. However, challenges persist, including regional development imbalances, insufficient service capabilities in impoverished rural areas, and emerging issues like obesity, myopia, and mental health problems. China still needs to meet the growing health needs of children fully. From a global health perspective, this article systematically reviews the current status of global early childhood health development, outlines the significant milestones and best practices in China's early childhood development efforts, and also anticipates the focus and challenges in early childhood development in China based on global trends, hoping to contribute to further research in this field.

Association of sexual development characteristics and phases with the cognitive and behavioral development of adolescents aged 10 to 14 in rural areas of Shaanxi Province

WANG Liang, ZHU Yingze, QI Qi, ZHU Zhonghai, ZENG Lingxia

2024, 32(1): 10-15. DOI: 10.11852/zgetbjzz2023-0201

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Objective To analyze the association of sexual development characteristics and phases with the cognitive and behavioral development of adolescents aged 10 to 14 in rural areas of Shaanxi Province, in order to provide scientific reference for enhancing adolescent health. Methods The study population was selected from a birth cohort study's follow-up data for the adolescent phase. The Tanner quintile method was used to assess sexual development, the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ) was used to assess cognitive development, and the Youth Self-Rating Scale(YSR-2001) was used to assess behavioral development. Generalized linear models was used to examine the association of the stages of adolescent sexual development with their cognitive and behavioral development. Results A total of 1 887 adolescents were enrolled in this study, with 1 111 (58.9%) boys. The proportion of boys and girls who have started sexual development was 78.22% and 89.30%, respectively. The detection rate of behavioral problems in adolescents was 9.70%, with 11.80% in boys and 6.70% in girls, and the gender difference was significant (χ²=13.517, P＜0.001). Compared to adolescents in Tanner stage Ⅰ, adolescents in stage Ⅲ had a higher total cognitive score of 2.19 (95%CI: 0.15 - 4.23), and a higher total score of 3.84 (95%CI: 0.85 - 6.83,P<0.05) in stages Ⅳ-Ⅴ. The detection rate of total behavioral problems of children in Tanner stages Ⅳ-Ⅴ was 2.63 times(95%CI:1.27 - 5.46,P<0.05) higher than that in stage Ⅰ. In boys, the rate of detection of internalizing problems was 3.96 times(95%CI:1.60 - 9.81,P<0.01) higher than that in stage Ⅰ, and the detection rate of internalizing problems was 2.88 times(95%CI:1.19 - 7.01,P<0.05) higher than that in stage Ⅰ. Conclusions There is a significant correlation of sexual developmental phrase with cognitive and behavioral development among adolescents aged 10 - 14 years in rural Shaanxi Province. The detection rate of adolescent behavioral problems increases with the increase of sexual development level and cognitive level, and there are significant gender differences.

Effect of polygenic risk score in the sustainability of childhood obesity intervention

CHEN Jing, SHAN Rui, XIAO Wucai, SONG Jieyun, LIU Zheng

2024, 32(1): 16-20. DOI: 10.11852/zgetbjzz2023-0027

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Objective To explore the relationship between polygenic risk score (PRS) and the sustainability of childhood obesity intervention, in order to provide scientific basis for future sustainable and personalized childhood obesity intervention based on genetic background. Methods A total of 148 children with overweight/obesity at baseline were selected as study subjects from a cluster randomized controlled trial (September 2018 to April 2021) regarding the effect of a childhood obesity intervention in Beijing, China. Saliva was collected to detect the whole genome sequencing. Four PRSs were built: weighted and unweighted PRS₆₉, weighted and unweighted PRS₆₇. The interactions between PRS and study arms on the sustainability of intervention effect (the changes in obesity-related indicators between the end of the intervention and the last follow-up) were analyzed. Results There were interactions between PRS and study arms on the rebound degree of waist circumference adjusted for body mass index (BMI), waist-to-hip ratio adjusted for BMI, and systolic blood pressure after the intervention. Compared with the control group, children in the intervention group carried each additional unit (standard deviation) of weighted PRS₆₉, the waist circumference adjusted for BMI rebounded more by 0.34 (95%CI: 0.05 - 0.63, P=0.020), and waist-to-hip ratio adjusted for BMI rebounded more by 0.29 (95%CI: 0.03 - 0.56, P=0.031) at the last follow-up survey. When children in the intervention group carried each additional unit (standard deviation) of weighted PRS₆₇ and unweighted PRS₆₇, systolic blood pressure at the last follow-up survey rebounded more by 3.58 (95%CI:0.50 - 6.66, P=0.023) and 3.75 (95%CI: 0.78 - 6.71, P=0.014), respectively. Conclusions The higher PRS (the more risk alleles) children with overweight/obesity carried, their waist circumference, waist-to-hip ratio and systolic blood pressure are more likely to rebound after the intervention. Findings from this study suggest that future studies should focus more on these high-risk children after the intervention to prevent and control obesity rebound.

Status quo of preterm infants' feeding difficulties at weaning and self-feeding transition stage and its influencing factors

CHEN Die, PENG Wentao, TANG Mengyan, LIU Xiaomei

2024, 32(1): 21-25. DOI: 10.11852/zgetbjzz2023-0329

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Objective To investigate the prevalence and influencing factors of feeding difficulties in preterm infants at weaning and self-feeding transition stage, so as to provide a scientific basis for the management of feeding preterm infants. Methods Preterm infants at corrected age of 6 - 24 months were recruited from the Department of Child Health of five maternal and child health hospital of Chengdu from April to May 2021, and were surveyed by using the Chinese Version of the Montreal Children Hospital Feeding Scale (MCF-FS) and the self-designed questionnaire on the influencing factors of feeding difficulties. Then the status quo of feeding difficulties and its influencing factors were analyzed. Results The prevalence rate of feeding difficulties in 231 preterm infants was 32%. Among them, the prevalence rate of mild, moderate and severe feeding difficulties was 15.2%, 7.8% and 9.1%, respectively. Binary Logistic stepwise regression analysis indicated that food allergy (OR=4.253,95%CI: 1.430 - 12.649), anxious mood of caregivers (OR=6.064,95%CI: 2.998 - 12.268), tease or chase during eating(OR=2.873,95%CI: 1.382 - 5.970), recreational activities at eating (OR=2.328,95%CI: 1.115 - 4.860), and forced feeding (OR=2.772, 95%CI: 1.239 - 6.198) were positively associated with feeding difficulty of preterm infants(P＜0.05). Conclusion Feeding difficulties in the weaning and self-feeding transition period of preterm infants are prevalent, so the guidance should focus on premature infants with food allergy, anxious caregivers and improper feeding behaviors, and appropriate interventions should be taken to promote scientific feeding.

Status quo of screen exposure and its determinants in 3- to 6-year-old children in Minhang district, Shanghai

CHEN Min, ZHANG Hongmei, KANG Shurong, LI Yun

2024, 32(1): 26-30. DOI: 10.11852/zgetbjzz2023-0004

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Objective To investigate the screen exposure status in 3- to 6-year-old children in Minhang district and to analyze its determinants, so as to provide a basis for scientific intervention of screen exposure in children. Methods A total of 1 035 children aged 3 to 6 years were selected from 30 classes in 10 kindergartens in Minhang district by multi-stage cluster sampling in October 2022. An online questionnaire survey was conducted by their parents. Screen exposure was difined as spending more than one hour on video products per day. Multivariate Logistic regression model was adopted to analyze the determinants of children screen exposure. Results Among 1 035 children, 730 experienced screen exposure (70.53%). The average time of daily screen exposure was (1.67±0.98)h. The daily screen exposure time of children aged 3, 4, 5 and 6 years at weekends was (1.77±1.13), (1.76±1.04), (1.98±1.10)h and(2.08±1.22)h, respectively, and the difference was statistically significant (F=3.98, P<0.01). Multivariate Logistic analysis showed that age group of 5 years old (OR=1.79, 95%CI:1.19 - 2.68), the caregivers using video products for 1 - 2hours/day (OR=2.61, 95%CI:1.90 - 3.60) and >2hours/day (OR=2.10, 95%CI:1.35 - 3.27) when accompanying children, parents supporting children using video products(OR=1.59, 95%CI:1.17 - 2.15), children using video products before bedtime(OR=1.94, 95%CI:1.32 - 2.86), and unsupervised use of video products for children(OR=1.94, 95%CI:1.36 - 2.77) were independent risk factors for children's screen exposure(P<0.05). Father's education level of bachelor(OR=0.61,95%CI:0.43 - 0.89), master and above(OR=0.49, 95%CI:0.34 - 0.73) was a protective factor for children's screen exposure(P<0.05). Conclusions Attention should be paid to the problem of screen exposure of 3 -to 6 - year-old children. Targeted efforts should be made to popularize the knowledge of the harm of early screen exposure to children among caregivers, caregivers are advocated for the rule formulation of screen behavior, scientifically regulate children's screen exposure behaviors, and increase parent-child communication, so as to reduce the adverse effects of screen exposure on children's health.

Cross-sectional study on the association between gut microbiota composition and blood pressure in children

FANG Guoqing, ZHANG Xin, ZHA Dayong, CHEN Shanshan, HONG Zhen, ZHANG Zheqing

2024, 32(1): 31-38. DOI: 10.11852/zgetbjzz2023-0047

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Objective To analyze the association between the composition of gut microbiota and blood pressure in children aged 6 - 9 years, in order to provide new ideas for childhood hypertension prevention and treatment. Methods A total of 411 children aged 6 - 9 years were recruited in Guangzhou from December 2015 to March 2017. The gut microbiota was characterized by 16S ribosomal RNA amplicon sequencing. The multivariate Methods with unbiased variable selection in R (MUVR) were performed to identify the significant OTUs. Spearman correlation as well as multiple linear regression were used to explore the relationship between gut microbiota and blood pressure in children. Results Significant difference in β diversity index was observed between children with normal blood pressure and those with abnormal blood pressure (R²_weighted=0.015,P_weighted=0.01;R²_unweighted=0.027,P_unweighted=0.001). After adjustment for covariates and controlling the false discovery rate (FDR), multiple linear regression analysis showed that blood pressure level in children decreased with the increasing abundance of OTU_3 (genus Blautia), OTU_131 (genus [Clostridium]_innocuum_group), OTU_1776 (genus Blautia), OTU_2159 (genus Prevotella) and OTU_91 (species Bifidobacterium_breve) (β:-0.18 --0.14; P_FDR<0.05. In contrast, blood pressure in children increased with theincreasing abundance of OTU_108(genus Sutterella), OTU_1(species Faecalibacterium_prausnitzii)、OTU_8(genus Roseburia), OTU_48 (genus Lachnoclostridium), OTU_81 (genus Coprococcus), OTU_401 (family Lachnospiraceae), OTU_1284 (family Lachnospiraceae) and OTU_2793 (family Lachnospiraceae)(β: 0.14 - 0.21; P_FDR<0.05. The influence of gut microbiota on systolic pressure and diastolic pressure may be mediated by the increase of body mass index (BMI). Conclusions Pediatric blood pressure level is associated with the composition of gut microbiota, while BMI partially plays a mediating role in the relationship. It is recommended to modulate the abundance of microbiota as genus Blautia, Sutterella and so on to prevent hypertension in children.

Correlation of serum 25-(OH)D₃, albumin, ferritin with STAMP score and their predictive value for clinical outcome of preschool children with malnutrition

SONG Jie, HUANG Linjuan, GUO Bidan

2024, 32(1): 39-44. DOI: 10.11852/zgetbjzz2023-0193

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Objective To investigate the correlation of serum 25-hydroxyvitamin D₃ [25-(OH)D₃], albumin (ALB) and ferritin (SF) withScreening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) score in preschool children with malnutrition, and to analyze the predictive value of these factors on clinical outcomes, so as to provide reference for improving clinical outcomes. Methods Totally 90 preschoolers with malnutrition in Fuzhou Children's Hospital from August 2021 to August 2022 were selected as the observation group, and 60 healthy preschool children during the same period were selected as the control group. Nutritional guidance was provided to the preschoolers for a consecutive 3-month period, followed by monitoring and recording the incidence of malnutrition and iron deficiency anemia within 3 months after treatment. Results The levels of serum 25-(OH)D₃, ALB and SF were lower in the observation group compared to the control group, while the STAMP score was higher in the observation group (t=9.700, 6.047, 4.771, 26.976, P<0.05). The levels of serum 25-(OH)D₃, ALB and SF in preschool children with malnutrition showed a negative correlation with the STAMP score (r=-0.813, -0.792, -0.829, P < 0.05). After 3 months of treatment, the levels of serum 25-(OH)D₃, ALB and SF, as well as the difference between pre- and post-treatment levels, were lower in children with adverse clinical outcomes compared to those with good clinical outcomes (t=3.622, 2.189, 2.163, 8.704, 4.354, 5.296, P< 0.05). When the difference in serum 25-(OH)D₃, ALB and SF before and after treatment was small, preschool children with malnutrition had a higher risk of adverse clinical outcomes [25-(OH)D₃:OR=7.250, 95%CI: 3.008 - 17.476; ALB: OR=9.167, 95%CI: 2.954 - 28.444; SF: OR=5.730,95%CI: 2.364 - 13.890]. The combined predictive value of serum 25-(OH)D₃, ALB and SF before and after treatment had an AUC value of 0.927, higher than that of any single index. The decision curve analysis (DCA) showed that the combined prediction scheme of these factors had a clinical net benefit in predicting the clinical outcome of preschool children with malnutrition. Conclusions Low serum levels of 25-(OH)D₃, ALB and SF are indicative of a higher risk of adverse clinical outcomes. Utilizing the combined prediction of these factors before and after treatment shows high accuracy in predicting clinical outcomes.

Obesity status of Kazakh children and adolescents in Xinjiang agricultural and pastoral areas and its correlation with lifestyle

LIU Jingzhi, LI Qinxiu, HU Yanyan, AINUER·Mamat

2024, 32(1): 45-48. DOI: 10.11852/zgetbjzz2023-0368

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Objective To understand the obesity status of Kazakh children and adolescents in the agricultural and pastoral areas of Xinjiang and its association with lifestyle, so as to provide reference and help for maintaining good body shape and health intervention for Kazakh children and adolescents in agricultural and pastoral areas. Methods From April to June 2022, 6 242 Kazakh children and adolescents aged 10 - 20 years were tested for obesity and surveyed by lifestyle questionnaires using stratified whole-group sampling in the farming and herding areas of Yili Kazakh Autonomous Prefecture and Altay Region, Xinjiang. χ² test and Logistic regression analysis were used to analyze data. Results The obesity detection rate of Kazakh children and adolescents in Xinjiang farming and herding areas was 18.71%, with higher rates in boys (22.24%) compared to girls (15.12%), and the difference was statistically significant (χ²=52.04, P<0.01). Significant differences were observed in the obesity rates based on grade level, fruit consumption frequency, screen time of television, feeling hopeful for the future, fatigue, loneliness, and sadness (χ²=24.29, 4.61, 694.51, 7.15, 10.33, 6.51, 8.07, P＜0.01). Logistic regression analysis showed that female students (OR=0.63, 95%CI: 0.56 - 0.69) and students who felt hopeful about the future (OR=0.96, 95%CI: 0.94 - 0.99) were protective factors against obesity (P<0.05); while high school and lower grades (senior high school OR=1.38, 95%CI: 1.24 - 1.57; junior high school OR=1.82, 95%CI: 1.58 - 2.06; primary school OR=2.67, 95%CI: 2.33 - 2.99), fruit consumption ≥1time/d (OR=1.07, 95%CI: 1.03 - 1.16), watching TV ≥2h/d (OR=1.07, 95%CI: 1.02 - 1.17), frequent feeling of fatigue (OR=1.07, 95%CI: 1.03 - 1.12), loneliness (OR=1.08, 95%CI: 1.02~1.19) and sadness (OR= 1.09, 95%CI: 1.04 - 1.14) of students were risk factors for the development of obesity (P<0.05). Conclusions The obesity rate of Kazakh children and adolescents in the agricultural and pastoral areas of Xinjiang is high and closely associated with lifestyle. Therefore, it is crucial to improve unhealthy lifestyles in order to reduce obesity and promote the physical and mental well-being of this population.

Research advance in the changes of bone mineral density during puberty

CHENG Ke, LAN Li

2024, 32(1): 49-53. DOI: 10.11852/zgetbjzz2023-0084

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Bone mineral density is an important indicator of bone nutrition. The bone mineral density of children gradually increases with age, and the accumulation of bone mineral density in adolescence increases significantly, which is the most sensitive period to affect the peak bone mass. Sex hormone promotes bone formation and bone mineral density acquisition, and the peak secretion of growth hormone and insulin-like growth factor-1 increases bone mineral density accumulation. Children with precocious puberty develop earlier, and the length of puberty is shortened, resulting in changes in bone mass accumulation. GnRHa(gonadotrophin releasing hormone analogue) treatment of precocious puberty also affects bone metabolism. The level of 25-(OH)D₃ in children varies with age in a U-shaped curve, which is the lowest in adolescence. Changes in body composition such as bone mass in adolescence have a long-term impact on bone health and even adult physique.

Research progress in the correlation between maternal depression and childhood obesity

ZHOU Hongju, GUAN Ji, LUO Jing, JU Xuemei, YU Jiaxin

2024, 32(1): 54-58. DOI: 10.11852/zgetbjzz2023-0207

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Maternal depression can cause physical and mental harm to herself. This condition can lead to poor physical development in early offspring (newborns). However, the effect of maternal depression on the long-term physical development of offspring remains controversial. Studies have shown that offspring exposed to maternal depression in developed countries are at an increased risk of obesity. In view of the high incidence of maternal depression and childhood obesity in China, this article reviews the correlation between maternal depression and offspring obesity, aiming to provide insights for relevant research in China and offer references for the prevention and intervention of maternal depression and childhood obesity.

Research progress in the relationship between vitamin D deficiency and central precocious puberty in children

LIU Xiaoqi, WANG Kundi, WANG Jun, LI Zecheng

2024, 32(1): 59-63. DOI: 10.11852/zgetbjzz2023-0209

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Central precocious puberty (CPP) is an endocrine disease of children due to the early onset of hypothalamic-pituitary-gonadal axis function. This leads to increased secretion of gonadotropin release impulse, causing the development of internal and external genitalia and the presentation of secondary sex characteristics. Studies have found that the onset of CPP in children may be related to vitamin D deficiency. Vitamin D, affected by sunlight duration, acts on neurons and neurotransmitters in the hypothalamic-pituitary-gonadal axis, promotes obesity and affects the expression level of insulin-like growth factor-1, which are four factors involved in the occurrence and development of CPP. The overall effect of vitamin D combined with gonadotropin-releasing hormone analogues on CPP is significant. This article reviews the correlation between vitamin D deficiency and CPP, as well as the possible mechanism of action, in order to provide some theoretical basis for researchers.

Research advance in the influencing factors of pubertal timing

YANG Fei, MA Wei

2024, 32(1): 64-67. DOI: 10.11852/zgetbjzz2023-0251

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Adolescence is a critical period for sexual maturation and physical growth, and the time of the first appearance of events during puberty initiation is called puberty timing. Recent studies have shown that abnormal changes in the pubertal timing are mainly influenced by genetic, environmental, nutritional, ethnic, and early-life factors. This review focuses on the current research progress of factors influencing puberty onset phase and related disease, in order to provide theoretical basis for prevention of clinical related diseases.

Research progress in food neophobia in children

FU Xiao, TANG Mengyan, LIU Xiaomei

2024, 32(1): 68-72. DOI: 10.11852/zgetbjzz2023-0513

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Food neophobia is one of the distinctive feeding disorders in children. It affects children's physical growth and neurological development, resulting in negative impacts on their eating behaviors and habits. This review elucidates the concept and origin of food neophobia, and summarizes the prevalence, associated factors and effective interventions according to previous literature, in order to provide suggestions and guidance for the prevention and early intervention of children with food neophobia.

Conceptual analysis of health literacy in children and adolescents with unintentional injury

TANG Ping, SUN Jingmin, LU Qunfeng, TANG Wenjuan, JI Jianlin

2024, 32(1): 73-78. DOI: 10.11852/zgetbjzz2023-0216

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Objective To clarify the concept of health literacy among children and adolescents with accidental injuries through literature review and analysis. Methods A systematic search was conducted across multiple databases, including China National Knowledge Infrastructure, Wanfang database, VIP database, China Biomedical literature database, PubMed, CINAHL, and PscyINFO database. The literature was analyzed using Rodgers' evolutionary concept analysis method. Results A total of 56 articles were included. The health literacy of children and adolescents with accidental injuries comprised three conceptual attributes:cognition, emotion and behavior. The influencing factors included children's demographic factors, family and school related factors and social related factors. The result can be beneficial to reduce the occurrence of injury events, save family economic expenditure and alleviate the burden on social medical resources. However, there is currently a lack of specific measurement tools for assessing health literacy in this population, as the existing evaluation items are drawn from general health literacy scales. Conclusions The concept of health literacy among children and adolescents with accidental injuries is multifaceted and evolving. Future research should focus on exploring the characteristics of health literacy among children and adolescents of different ages and regions from their own perspectives. Additionally, efforts should be made to refine the concept and develop specialized measurement tools to facilitate further studies in this area.

Body mass index and body fat rate evaluation of girls aged 6 - 8 years

YANG Wencong, ZHAI Shuang

2024, 32(1): 79-83. DOI: 10.11852/zgetbjzz2023-0233

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Objective To analyze the measurement of body mass index (BMI) and body fat percentage in girls aged 6 to 8 years,in order to provide a scientific basis for the prevention and treatment of childhood obesity. Methods The medical examination data of 968 girls with bone age of 6 - 8 years who underwent obesity screening in General Hospital of Northern Quarter Command from January 2022 to July 2022 were retrospectively analyzed. BMI, body fat percentage, nutritional indicators, and obesity rate of girls with bone age of 6 - 8 years were analyzed.Multivariate Logistic regression analysis was used to identify the risk factors for obesity in girls with bone age of 6 - 8 years old. Results BMI, body fat percentage and visceral fat grade of girls aged 6 - 8 years followed an increasing trend with age: 6 years old < 7 years old < 8 years old (F=10.196, 68.327, 66.584, P<0.001). The average BMI of girls aged 6 - 8 years and the average body fat percentage of girls aged 7 - 8 years old were higher than the normal range. Additionally, the average value of 25-hydroxy vitamin D[25-(OH)D] in girls aged 6 - 8 years was lower than the normal range. The overweight rates of girls aged 6,7 and 8 years were 19.50%, 18.21%, and 15.95%, respectively, and the obesity rates were 9.75%, 12.35%, and 15.95%, respectively. Furthermore, the Logistic multivariate regression analysis revealed that birth weight ≥ 4.0kg (OR=1.962,95%CI: 1.292 - 2.979), eating frequency of high-fat and high-calorie > 3times/week (OR=1.432, 95%CI: 1.172 - 1.749),frequency of sweet food >3times/week (OR=2.670, 95%CI:1.170 - 6.093), eating speed < 15min/meal (OR=1.366, 95%CI:1.108 - 1.685), outdoor activity frequency <30min/day (OR=2.083, 95%CI:1.162 - 3.736), and parents lack of knowledge or with limited understanding of nutrition (OR=1.721, 95%CI:1.129 - 2.623) were independent risk factors for obesity in girls aged 6 - 8 years old (P<0.05). Conclusion The obesity rate of girls with bone age of 6 - 8 years old is high and should be addressed through a scientific diet, reasonable exercise, and educating parents to improve their knowledge of nutrition.

Effects of different fortified feeding methods on the nutrient metabolism and growth rate of very low birth weight preterm infants

NING Yue, LUO Liyan, DUAN Jiang, XIE Yunbo, QI Zhiye, ZHANG Caiying, YANG Li, ZHONG Qinghua

2024, 32(1): 84-88. DOI: 10.11852/zgetbjzz2023-0038

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Objective To analyze the effects of different fortified feeding Methods on nutritional metabolism and growth rate of preterm very low birth weight infants (VLBWI), in order to provide new clues for improving the prognosis of the preterm infants. Methods A total of 115 cases of premature VLBWI admitted to Department of Neonatology, The First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were included in this study, and were divided into fortified breastfeeding group (HFM group), mixed feeding group, and premature formula feeding group (PF group) based on their feeding methods. The effects of different feeding Methods on the nutritional metabolism and growth rate of premature VLBWI were analyzed. Results 1) The hospitalization time of infants in the HFM group was shorter than that in PF group and mixed feeding group (t=7.185, 6.924, P<0.05). 2) The proportion of necrotizing enterocolitis (NEC) in the HFM group during hospitalization was lower than that in the PF group (P＜0.05); the proportions of late onset septicemia(LOS) and extra uterine growth restriction(EUGR) in the HFM group during hospitalization were lower than those in the PF group (χ²=5.030, 4.147, P＜0.05); the proportion of LOS was lower than that of the mixed feeding group(χ²=6.589, P＜0.05). 3) During hospitalization, the proportions of abdominal distension, bloody stools and increased eosinophils in the HFM group were lower than those in the PF group (P＜0.05), which in mixed feeding group was lower than those in PF group (Fisher exact test, P＜0.05). 4) At discharge, the weight and length growth rate of the HFM group were higher than those of the mixed feeding group (t=3.722, 0.425, P<0.001) and the PF group (t =6.015, 0.496, P< 0.001). Conclusion Fortified breastfeeding can more effectively increase the growth rate of VLBWI in premature infants, improve nutritional metabolism, reduce complications and adverse feeding reactions related to premature infants, and is safer and more effective.

Height development of 25 225 children aged 6 to 15 years in Nanning City

GAN Na, LIANG Yubo, LONG Yongmei, TANG Xianlan, XIE Xu, WANG Qiang, ZHOU Desheng

2024, 32(1): 89-92. DOI: 10.11852/zgetbjzz2023-0040

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Objective To analyze the height growth of children aged 6 - 15 years in Nanning, Guangxi Zhuang Autonomous Region, so as to provide evidence for the assessment of local children's height development. Methods A total of 25 225 children aged 6 - 15 years were selected to get their physical examination data from 41 primary schools in Nanning by stratified cluster sampling method in December 2021.Then the height data were compared with the current domestic standards. Results The average height of boys in Nanning was lower than the national standard before the age of 10 years and 7 months, and the gap with the national standard gradually narrowed after the age of 10 years and 7 months. The average height of boys in Nanning City exceeded the national standard between the age of 11 years and 1 month and 13 years and 6 months, and then lagged behind the national standard again after the age of 13 years and 7 months. The mean height of girls in Nanning City was lower than the national standard height in several age groups, and it was more obvious before the age of 9 years and 7 months. The proportion of height ≤-2s,≤-s,≥ +sand ≥+2s in boys aged 6 to 15 years in Nanning City fluctuated from 2.59% to 6.04%, 12.09% to 23.43%, 7.18% to 18.79% and 0.93% to 3.14%, respectively; the total proportions were 4.56%, 17.46%, 11.35% and 1.74%, respectively; the minimum/maximum proportion values of each height group were at 11 years old /8 years old, 14 years old/8 years old, 8 years old/12 years old, and 6 years old/11 years old, respectively. The proportions of girls aged 6 - 15 years in Nanning City with height ≤-2s, ≤-s, ≥+s, and ≥+2s fluctuated from 2.06% to 5.19%, 9.35% to 25.15%, 8.21% to 15.80% and 1.23% to 3.49%, respectively; the total proportions were 3.38%, 16.91%, 11.97% and 2.29%, respectively; and the minimum/maximum proportion values of each height group were at 13 years old/6 years old, 12 years old/6 years old, 7 years old/12 years old, and 6 years old/11 years old, respectively. Conclusions The overall height level of children in Nanning is still lower than the national level, with short prepubertal basal heights, an earlier age of onset of accelerated pubertal height, and a shorter duration of accelerated pubertal height in boys. Strengthening pre-pubertal height management and emphasizing the onset and duration of children's pubertal development, especially the height development of boys during puberty, can help improve the adult lifelong height of children in this region.

Dynamic changes of platelet-related indicators in infants with cow's milk protein allergy

DONG Wenxin, ZHANG Hua, LI Zailing

2024, 32(1): 93-97. DOI: 10.11852/zgetbjzz2023-0149

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Objective To dynamically monitor and analyze the changes of platelets and related indicators in infants with cow's milk protein allergy (CMPA) during clinical treatment, in order to provide clues for further diagnosis and treatment of CMPA. Methods From August to November in 2022, 59 children aged from 1 month to 3 years old with CMPA in the pediatric outpatient clinic were selected as the CMPA group, and 29 healthy children who took physical examination were selected as the control group. The differences in platelet related indicators from a routine blood test were compared between the two groups, and their diagnostic value for CMPA was analyzed by receiver operating characteristic (ROC) curves. Results The mean platelet count (PLT) and plateletcrit (PCT) at baseline in the CMPA group were (374.68±113.21)×10⁹/L and 0.37±0.10, significantly higher than those in control group[(271.07±40.32)×10⁹/L, 0.26±0.05] (t=6.27, 6.43, P<0.001). In the CMPA group, after treatment, the mean PLT level was (316.39±94.68)×10⁹/L, and the mean PCT level was 0.31±0.10, indicating a statistically significant decrease in PLT and PCT levels after treatment compared to baseline (t=4.32,4.75,P<0.05). The diagnostic performance, indicated by the area under the curve (AUC), for PLT and PCT in diagnosing CMPA was 0.811 and 0.823, respectively. The cutoff values for PLT and PCT were determined to be 304.5×10⁹/L and 0.305, respectively. Conclusion The PLT and PCT levels in children with CMPA are found to be higher than those in healthy controls, suggesting their potential diagnostic value in the diagnosis of CMPA.

Influencing factors of attention deficit hyperactivity disorder and the correlation between bone mineral density and physical growth in children

ZHENG Yuxia, WANG Huiping, WANG Zuohua, YANG Yanfei, ZHANG Xia

2024, 32(1): 98-102. DOI: 10.11852/zgetbjzz2023-0420

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Objective To analyze the contributing factors of attention deficit hyperactivity disorder (ADHD) in children and the correlation between bone mineral density and physical growth, in order to provide new clues for the prevention and early intervention of ADHD. Methods A total of 116 children with ADHD were included into the observation group from June 2020 to June 2022, while another 80 healthy children in the same period were included as the control group.Clinical data of the two groups were compared, and the factors influencing ADHD in children were analyzed using multivariate Logistic regression. Children with ADHD were further divided into boys group and girls group based on gender. Bone mineral density (BMD) and physical growth (height and body weight) of the two groups were measured, and the correlation between the two was analyzed. Results In the observation group, the proportion of boys, maternal bad behaviors during pregnancy, their educational level below high school, critical parenting, and parental stress index were significantly higher compared to the control group (χ²=14.430, 5.689, 5.630, 6.738, t=6.936, P<0.05). Additionally, family environment score was significantly lower than that in the control group (t=6.328, P<0.05). Logistic regression analysis revealed that factors including boys (OR=3.298, 95%CI: 1.759 - 6.184), maternal bad behaviors during pregnancy (OR=2.730, 95%CI: 1.169 - 6.375), maternal education level of senior high school or below (OR=2.032, 95%CI: 1.127 - 3.663), critical parenting (OR=2.349, 95%CI: 1.223 - 4.513), and parental stress index (OR=1.089, 95%CI: 1.055 - 1.124) were positively correlated with ADHD in children (P<0.05), while family environment score was negatively related to ADHD (OR=0.868, 95%CI: 0.820 - 0.919, P<0.05). There were no significant differences in BMD, height and body weight between boys and girls in ADHD group (P>0.05). Pearson correlation analysis indicated a positive correlation of BMD with height and body weight (r=0.409, 0.317, P<0.05). Conclusions The development of ADHD in children is associated with gender, maternal bad behavior during pregnancy, family parental style and so on. Bone mineral density is closely related to physical growth in children with ADHD, clinical interventions can be implemented to prevent or early intervene ADHD.

Effects of breastfeeding on immune response of CD4⁺T lymphocytes in infants

ZHU Simin, TU Wenjuan, ZHANG Wenting, TU Ziqi, WANG Cheng'an

2024, 32(1): 103-107. DOI: 10.11852/zgetbjzz2023-0633

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Objective To explore the effects of breastfeeding on the immune response of CD4⁺T lymphocytes in infants in non-inflammatory state, and to analyze the immunomodulatory significance of the whole composition of breast milk. Methods A retrospective cohort study was conducted. From January to September 2022, six-month-old infants who took physical examination in the Child Healthcare Department of Changzhou Children's Hospital Affiliated to Nantong University, were selected based on inclusion criteria, and were divided into breastfeeding group (n=33) and formula feeding group (n=27) based on their feeding patterns. Flow cytometry was used to detect the percentage of CD4⁺ T cells, including helper T cell (Th) 1, Th2, Th17, regulatory T cell (Treg), and the levels of related cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IL-17 in peripheral blood. The differences in these indicators between the two groups were compared. Results Compared with the formula feeding group, the breastfeeding group showed significantly higher percentages of Th1(t=3.038), Treg (t=2.088). The ratio of Th1 to Th2(Z=2.756), IL-10(Z=2.297) and IFN-γ (Z=2.076) in the peripheral blood of the breastfeeding group were also significantly higher. Conversely, the breastfeeding group had significantly lower percentage of Th17(Z=2.704) and IL-17A (t=2.187) (P<0.05). There was no significant difference the percentage of Th2, as well as in the levels of IL-2, IL-4, IL-6 and TNF-α between the two groups (P>0.05). Conclusions Breastfeeding has a regulatory effect on the immune response of infant CD4⁺ T lymphocytes. It promotes the development of Th1/Th2 towards Th1 and the immunomodulatory effect of Treg. Moreover, it inhibits the Th17 type immune response. These findings suggest that the complete composition of breast milk contributes to the development and maturation of infant immune system, enhancing immune defense and immune tolerance.

Prevalence and associated factors of electronic screen exposure in preschool children in Longhua District, Shenzhen

LUO Anfei, MO Chunqi, CHEN Wensheng, CHEN Zhaodi

2024, 32(1): 108-112. DOI: 10.11852/zgetbjzz2022-0846

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Objective To investigate the electronic screen exposure of preschool children in Longhua District of Shenzhen, and to analyze the influencing factors. Methods A total of 25 266 children in kindergarten in Longhua District of Shenzhen were selected as study subjects. A self-designed questionnaire (completed by their guardians) was used to investigate the use of electronic products in the families of preschoolers in April 2019. Results A total of 23 407 valid questionnaires were collected in this survey, of which 12 593 (53.80%) were boys and 10 814 (46.20%) were girls; and 17 188(73.43%) children were 5 years old. Among the surveyed children, the rate of excessive exposure to electronic screens (＞1h/d) was 37.72%, and 6.40% of preschool children used electronic products for more than 2 hours per day. There were statistically significant differences between the excessive exposure group and the non-excessive exposure group in gender, household registration, parents' educational level, average monthly household income,whether exclusive electronic products,whether restriction of children's use of electronic products, whether living with elders, only children or not, and the type of main caregiver (P<0.05).Multivariate binary Logistic regression analysis showed that girls,mothers with college education or above,not living with elders,primary caregivers being parents or nannies/others,and no exclusive electronic products were protective factors for children's excessive exposure to electronic products(P<0.05).Non-household resident population,not-only child,and non-restriction of children's use of electronic products were risk factors for children's excessive exposure to electronic products(P<0.05). Conclusions The excessive use of electronic products in preschoolers is a common phenomenon in Longhua district, Shenzhen. Therefore, it is necessary to strengthen the intervention on the use time of electronic products in preschoolers, and pay more attention to the influence of family environmental factors.

Galactosemia caused by GALT gene mutation:A case report and literature review

2024, 32(1): 113-116. DOI: 10.11852/zgetbjzz2022-1325

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