Chinese Journal of Child Health Care

Factors affecting perinatal growth and development as well as health care of perinatal infants

LI Ting-yu

2019, 27(6): 581-583. DOI: 10.11852/zgetbjzz2019-0590

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Perinatal period is the period of rapid growth and development of perinatal infants.Maternal nutrition,disease,emotion and environmental exposure all affect perinatal growth and development,resulting in high mortality and disability rate.It is of great significance to understand the factors affecting perinatal development for perinatal health care,reducing adverse pregnancy outcomes and achieving eugenics.

Effect of childhood high blood pressure on the risk of hypertension in adulthood

LOU Xiao-huan, WANG Ming-ming, XI Bo

2019, 27(6): 584-587. DOI: 10.11852/zgetbjzz2018-1056

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Objective To investigate the effect of childhood high blood pressure (BP) on the risk of hypertension in adulthood, in order to provide evidence for the early prevention of high BP in adults. Methods Based on the data from the China Health and Nutrition Survey (CHNS, 1991-2011), a total of 1 984 subjects aged 6 to 17 years and followed up from childhood (6-17 years) to young adulthood (18-38 years) with complete data were included. In childhood, elevated BP was defined as systolic and/or diastolic BP (SBP/DBP) ≥P₉₀ cut-off value and<P₉₅ cut-off value for sex and age, and high BP as SBP and/or DBP≥P₉₅ cut-off value for age and sex according to the references of high blood pressure in Chinese children and adolescents. In adulthood, pre-hypertension was defined as SBP/DBP≥120/80 mmHg and<140/90 mmHg, and hypertension as SBP/DBP≥140/90 mmHg, or having hypertension history or self-reported use of antihypertensive medications. Covariance analysis and Cox proportional hazards models were used to assess the influence of childhood elevated and high BP on the risk of development of pre-hypertension and hypertension in adulthood, with adjustment for sex and age in childhood, and body mass index (BMI), smoking status and alcohol intake in adulthood. Results Totally 1 984 subjects aged 6 to 17 years were included, with a median follow-up duration of 11.7 years. There were 108 (5.4%) subjects with elevated BP and 199(10.0%) subjects with high BP at childhood baseline. In adulthood, there were 697(35.1%) subjects with pre-hypertension and 104(5.2%) subjects with hypertension. After adjusting for confounding factors, SBP and DBP levels in adulthood increased with the increase of BP percentiles in childhood (P_{for trend}<0.001). Children with high BP had an increased risk of pre-hypertension in adulthood (HR=1.41, 95% CI: 1.12-1.77) and hypertension in adulthood (HR=1.73, 95% CI: 1.01-2.98). Conclusions Childhood high BP increases risk of pre-hypertension and hypertension in adulthood. It is important to monitor BP status in childhood and to prevent and control high BP during this period, so as to reduce the risk of hypertension in adulthood.

Longitudinal study on physical catch-up in 178 extremely premature infants within one year old

QU Xiao-li, CHEN Jie-rong, LIU Shi-xin, SUN Bin-bin , ZHONG Xia, JIANG Wen, WAN Guo-bin

2019, 27(6): 588-591. DOI: 10.11852/zgetbjzz2019-0021

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Objectives To observe the catch-up growth characteristics of the extremely premature infants from discharge to the age of 1 year after birth,and to explore the growth rhythm of catching up,so as to provide reference for clinical intervention. Methods A total of 178 extremely premature infants (103 males and 75 females) in Shenzhen Maternal and Child Health Hospital were enrolled in this study and were followed up from August,2013 to April,2018. The weight,length and head circumference were evaluated by Z score according to the criterions of actual age and corrected age. Results The extremely premature infants showed catch-up growth in weight,length and head circumference in the first year of life. The growth velocity in length was the lowest within 3 months of correlated age. There was the poorest head circumference growth from 4 to 9 months of correlated age. The best catch-up growth velocity was in the time from 4 to 6 months after birth. Conclusions The fastest catch-up growth period of extremely premature infants is in the time from discharge to 6 months after birth.And there is an imbalance among the growth velocity of weight,tenget and head circumference.

Prevalence and risk factors of preterm birth among singletons from 2013 to 2017 in Tongzhou district of Beijing

MA Hai-hui, JIN Chu-yao, WANG Hai-jun, LIU Zheng, LIN Li-zi, LIU Jue

2019, 27(6): 592-596. DOI: 10.11852/zgetbjzz2018-0944

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Objective To know about the prevalence and risk factors of preterm birth among singletons from 2013 to 2017 in Tongzhou district of Beijing,in order to provide scientific evidence for effective interventions to reduce preterm birth rate. Methods The information of all pregnant women with singleton births from 2013 to 2017 were collected from hospital information system,including demographic data,pregnancy history and current pregnancy information.A retrospective study was conducted to analyze the incidence and influencing factors of preterm birth,and multivariate Logistic regression analysis was used for exploring the risk factors related to preterm birth. Results The prevalence rate of preterm birth in Tongzhou district of Beijing from 2013 to 2017 was 4.1% (1 418/34 726).Spontaneous preterm birth and iatrogenic preterm birth accounted for 68.8%(975/1 418) and 31.2%(443/1 418) of all preterm birth,respectively. Maternal age≥35 years old (OR=1.314,95%CI:1.113-1.551),multipara(OR=1.399,95%CI:1.223-1.600),male fetus(OR=1.237,95%CI: 1.100-1.390),placenta previa (OR=10.162,95%CI:7.100-14.546),placental abruption (OR=9.201,95%CI: 6.596-12.837),premature rupture of membranes(OR=3.328,95%CI:2.953-3.750),gestational diabetes mellitus (OR=1.232,95%CI:1.082-1.403),and hypertensive disorder complicating pregnancy (OR=3.283,95%CI:2.755-3.911) were risk factors of preterm birth.Being unemployed or underemployed (OR=1.159,95%CI:1.003-1.339),paternal age≥35 years old(OR=1.243,95%CI:1.036-1.490),being pregnant for the first time (OR=1.407,95%CI:1.157-1.710),multipara(OR=1.295,95%CI:1.049-1.598),and male fetus (OR=1.273,95%CI:1.109-1.462)were risk factors of spontaneous preterm birth. Conclusion For pregnant women who were over 35 years old,multipara,with male fetus,placenta previa,placental abruption,premature rupture of membranes,complicated with gestational diabetes mellitus and hypertensive disorder,it is supposed to take preventive measures in order to reduce the premature rate.

Study on current status and risk factors for embryo loss

YANG Liu, ZHANG Jian-xin, ZHAO Shun-xia

2019, 27(6): 597-601. DOI: 10.11852/zgetbjzz2018-0588

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Objectives To understand the epidemic of embryo loss,and to analyze the risk factors for embryo loss,so as to provide scientific suggestions for decreasing the rate of embryo loss. Methods Totally 226 women with embryo loss were enrolled in this study in two counties where furniture manufacturers were located.Meantime,226 normal delivered women were selected as control matched by age,body mass index (BMI) and address (urban or rural areas).The influencing factors of embryo loss in early pregnancy were analyzed. Results The embryo loss rate rose from 4.34% in 2014 to 5.60% in 2016,significantly higher than the birth defect rate at the same period.Multiple regression analysis showed that regular period(OR=0.438,95%CI:0.230-0.830),health care during pregnancy (OR=0.179,95%CI:0.110-0.291) were protective factors for embryo loss.Taking emergency contraception pill during this pregnancy (OR=4.687,95%CI:1.533-14.334),second-hand smoking(OR=1.593,95%CI:1.146-2.215),and purchasing new furniture over the past 6 months(OR=2.572,95%CI:1.302-5.084) were risk factors for embryo loss. Conclusions Embryo development in early pregnancy is influenced by both material and natural environment.Improving life and working environment during pregnancy and accepting health care services in early pregnancy are helpful to reduce embryo loss rate in early pregnancy.

Application value of amplitude integrated electroencephalogram in early diagnosis of white-matter damage in late preterm infants and its correlation with short-term prognosis

SHEN Pei-ting, HUANG Jin-hua, WEN Xiao-hong, WANG Shui-yun, CHEN Meng-meng

2019, 27(6): 602-605. DOI: 10.11852/zgetbjzz2018-1200

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Objective To investigate the application of amplitude integrated electroencephalogram (aEEG) in early diagnosis of white-matter damage in late preterm infants and its correlation with short-term prognosis of nerve system,in order to provide reference for the treatment of brain damage in preterm infants. Methods Totally 146 late preterm infants with gestational age of 34-37 weeks in Neonatal Intensive Care Unit of the Third Affiliated Hospital of Anhui Medical University were enrolled in this study from January 2016 to June 2017.The participants were divided into white-matter damage (WMD) group (observation group,66 cases) and control group (80 cases) according to the Results of MRI result.The features of aEEG,including continuity (Co),sleep-wake cycling (Cy),amplitude of the lower border (LB),bandwidth span (B),total scores (T) and the difference with the mean total CFM scores were evaluated and compared between the two groups.The diagnosis value of each score index in WMD infants and the correlation of the Results of aEEG with brain MRI and Gesell Developmental Scale(GDS) score at corrected age of 12 months were analyzed. Results Cy,B,T scores were significantly lower in white-matter damage infants,while the differential value of aEEG score in white matter damage infants was signifincantly higher(P<0.05).The Results of brain MRI were correlated with Cy,LB,B and total scores(r=-0.261,-0.271,-0.253,-0.184,P<0.05).Chi-square test analysis indicated that the aEEG monitoring Results were related to cranial MRI examination (χ²=5.547,P=0.014),so was the relationship between aEEG monitoring Results and GDS score (χ²=5.979,P=0.014). Conclusions aEEG monitoring is of good diagnostic value for early white-matter damage in late preterm infants,and it can evaluate the short-term prognosis of preterm infants effectively.

Preliminary investigation and analysis of the difficulty in taking medicine for children in 15 cities in China

WEI Bing, SUN Ming-wei, MIN Shuang-shuang, YUE Xiao-zhe, QI Shuang-hui

2019, 27(6): 606-608. DOI: 10.11852/zgetbjzz2018-1176

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Objective To investigate the prevalence of Chinese children′s difficulties of taking medicine,in order to provide reference for formulating specific measures to improve the difficulties of taking medicine for children. Method A cluster random sampling Method was used to collect 23 492 children in 51 hospitals in 15 autonomous regions and municipalities of 13 provinces from June to December in 2017,and self-designed children′s drug difficulty screening questionnaires were adopted to investigate the parents of the children in the field. Results The prevalence rate of Chinese children′s difficulty in taking medicine was 75.44% (17 723/23 492).Among them,the mild,moderate,severe and very severe difficulty of taking drug accounted for 35.62% (8 369/23 492),26.81% (6 299/23 492),9.25% (2 173/23 492) and 3.75% (882/23 492),respectively.Children under 3 years old experienced difficulty in taking medicine most [81.42% (7 027/8 631)],followed by children aged 3 to 6 years [75.37% (7 792/10 339)]. Conclusion Difficulty in taking medicine for Chinese children is prevalent,especially for children aged 3 to 6 years,which needs wide attention.

Study on current status and influencing factors of bisphenol A exposure among 235 children aged 6 to 8 years in Xiamen

WANG Shun-qin, WANG Hui, YUE Yi-huan, ZHENG Jian-shan, CHEN Zhi-jian, CHEN Tian-yi

2019, 27(6): 609-612. DOI: 10.11852/zgetbjzz2018-1153

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Objective To evaluate current status and influencing factors of urinary bisphenol-A (BPA) among children aged 6 to 8 years in Xiamen,in order to provide reference for the assessment and prevention of BPA exposure. Methods Questionnaires and spot urine samples were collected from 253 primary school students aged 6 to 8 years in Xiamen from September to October in 2017.Urinary BPA concentration was determined by Triple Quadurupole Liquid Chromatography-Tandem mass Spectrometry (LC-MS/MS) and its potential risk factors were analyzed through single-factor and multi-factors statistics methods. Results The detection rate of urinary BPA in 253 students was 89.33%,and the median concentration was 1.55 ng/ml,the interquartile range was 0.39-3.95 ng/ml.After adjusting gender,age,family socio-economic status and education level of parents,Logistic regression analysis indicated that the detection rate of BPA in 6-year-old children was higher than those in children at the age of 7 years(P=0.031) and 8 years(P=0.007).Moreover,using plastic cups for drinking water was a risk factor for BPA exposure (OR=2.640,95%CI: 1.039-6.707,P=0.041). Conclusions Children aged 6 to 8 years in Xiamen may be widely exposed to BPA,and children with lower age are more vulnerable to BPA exposure.Moreover,the use of plastic cups for drinking water may be one of the main risk factors of BPA exposure for school-age children.

Study on sleep conditions of children aged 2 to 3 years in Haidian district,Beijing

WANG Man-li, CHANG Xin-lei, AN Lin, ZHOU Yu

2019, 27(6): 613-616. DOI: 10.11852/zgetbjzz2018-1402

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Objective To find out sleep problems and provide reference for sleep improvement among children in Haidian district by analyzing their sleep conditions. Methods Questionnaires were filled out by caregivers of children.Sleep patterns,sleep problems and the effect of sleep patterns on sleep problems were analyzed. Results Totally 891 children aged (35.38±2.77) months on average were enrolled into the study.There were no significant differences on bedtime,wake time,sleep latency and nighttime sleep duration between boys and girls(P＞0.05).Bedtime and wake time were earlier in weekdays than in weekends.The incidence rate of total sleep problems was 82.0%(731/891),with 2.4% and 66.4% in each dimension of sleep problems.Parasomnia was more likely to occur in girls than boys.Moreover,the incidence of sleep problems in each dimension was significantly different in groups classified by nighttime sleep duration.The incidence rates of total sleep problems and most dimensions of sleep problems were higher in <9 h and ≥11 h groups than those in 9-<10 h and 10-<11 h groups(P＜0.05). Conclusion Sleep conditions are not satisfying in Haidian children and need to be improved.

Metabolomics progress on the influence of gestational diabetes mellitus on children′s lung maturity

XIAO Ping-juan, SHAO Qing-liang

2019, 27(6): 617-619. DOI: 10.11852/zgetbjzz2018-0623

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If pregnant women with gestational diabetes mellitus (GDM) maintain hyperglycaemia with bad control,fetal insulin secretion will be stimulated to grow in quantity,thereby causing maternal high insulin hematic disease.When maternal insulin concentration increases,the fetus glucocorticoid secretion will be suppressed,which will finally lead to fetal alveolus development lag and hypoglycemia.At present,fetal lung maturity is judged by amniotic fluid bubble test,and there is a big controversy about line amniotic cavity puncture because it is an invasive operation and has certain disadvantages.With the increasing researches on metabonomics of gestational diabetes,this review will summarize recent progress on the impact of child lung mature from the perspective of metabolomics.

Research progress on perinatal ureaplasma urealyticum infection

LUO Bei, TONG Xiao-mei

2019, 27(6): 620-623. DOI: 10.11852/zgetbjzz2019-0267

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Ureaplasma urealyticum (UU) is a conditionally pathogenic microorganism,which transmits primarily through sexual contact,mother-to-child transmission and iatrogenic transmission.UU infection in adults can lead to nongonococcal urethritis and infertility,and is associated with adverse pregnancy outcomes.Neonatal UU infection can cause chronic pneumonia,bronchopulmonary dysplasia,intraventricular hemorrhage,neonatal meningitis,necrotizing enterocolitis,neonatal retinopathy and so on.Macrolide antibiotics is preferred for UU treatment.The key to preventing UU infection is to strengthen routine UU infection screening in child-bearing women for the purpose of early detection,early diagnosis and early treatment.

Research advances on the relationship between socio-economic status and adverse birth outcomes

LUO Xiu, ZOU Shi-pu

2019, 27(6): 624-628. DOI: 10.11852/zgetbjzz2018-1543

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Socio-economic status (SES) is closely related to adverse birth outcomes.Existed evidence has indicated that low SES may lead to poor nutrition status,unhealthy life styles,gestational syndrome,exposure to environmental contaminants and so on.In turn,these factors increase the risk of adverse birth outcomes.As SES disparities are difficult to change over a short time,this review will summarize high risk factors accompanied by low SES,in order to provide scientific evidence for reducing adverse birth outcomes.

Research progress on probiotics in preventing necrotizing enterocolitis in premature infants

FENG Meng-ni, KE Hua, LI Zhan-kui, ZHANG Li

2019, 27(6): 629-632. DOI: 10.11852/zgetbjzz2019-0070

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Necrotizing enterocolitis (NEC) is an extremely serious acquired gastrointestinal disease in the neonatal period,especially in premature infants.Because of its high morbidity,mortality and high risk of poor prognosis,NEC has been receiving much attention for many years,but its pathogenesis has not been fully understood.In recent years,there have been many studies pointing out that intestinal micro-ecological disorders are closely related to the occurrence of the disease.And probiotic,as a biological agent regulating intestinal micro-ecology,has gradually attracted the attention of researchers.This review summarizes the characteristics of neonatal intestinal flora and the research hotspots of probiotics in preventing NEC in premature infants.

Meta analysis on the correlation between the history of female cancer and neonatal birth outcome

HUANG Feng-yan, GAO Han, WANG Zhi-ping

2019, 27(6): 633-636. DOI: 10.11852/zgetbjzz2018-1148

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Objective To evaluate the risk of adverse pregnancy outcomes in female cancer survivors by systematic review and meta-analysis,in order to provide reference for the development of maternity protection technologies for cancer survivors. Methods Articles regarding adverse pregnancy outcomes in neonates born to female cancer survivors from January 1st,2008 to August 1st,2018,published in the Web of Science database and PubMed,were retrieved.Newcastle-Ottawa Scale (NOS) standard was used for literature quality evaluation.Outcomes included premature birth,low birth weight,congenital malformations,small for gestational age (SGA) infants and live birth.The heterogeneity test was carried out on the included literature,and the fixed effect model or the random effect model was used to perform the Meta analysis and to calculate the combined effect value according to the heterogeneity test result.Sensitivity analysis was performed using the one-by-one culling method.The publication bias of the research literature was evaluated using the Begg test and the Egger test. Results Finally 12 articles were included.According to the heterogeneity test results,the randomized effect model indicated that the combined RR (95% CI) values of premature delivery,congenital malformation in children,and live births in children born by cancer survivors were 2.058 (1.337-3.169)(P＜0.001),0.929 (0.676-1.277) (P=0.650),0.852 (0.756-0.960) (P=0.008),respectively.The fixed effect model showed that the combined RR (95% CI) values of SGA and low birth weight infants born to mothers with childhood cancer survivors were 1.563 (1.386-1.763) (P＜0.001),1.017 (0.859-1.205) (P=0.843). Conclusions Female cancer survivors have an increasing risk of preterm birth,low birth weight infants and stillbirths.However,the history of female cancer is not significantly associated with congenital malformations and SGA risk in neonates.

Analysis of intrauterine growth restriction in premature infants

YANG Yan, YU Sheng-lin

2019, 27(6): 637-641. DOI: 10.11852/zgetbjzz2018-0518

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Objective To explore the occurrence and hospitalization of intrauterine growth restriction (IUGR) in premature infants,in order to provide guidance for the treatment of premature infants during hospitalization. Methods A total of 200 preterm infants hospitalized in the Department of Neonatology in Children′s Hospital of Soochow University were studied from 2015 to 2017.The perinatal data of these preterm infants,nutrition and disease during hospitalization were analyzed retrospectively. Results Among 200 preterm infants in this study,23.5% (47/200)cases suffered from intrauterine growth restriction(IUGR),of which 10%(20/200) were serious.And 97.9% (46/47) IUGR children developed extrauterine growth retardation(EUGR),68%(32/47) were serious.In children without IUGR,the incidence of EUGR was 51.6%(47/153),and 6.5%(10/153) were serious.There were significant differences on the prevalence of EUGR and severe EUGR between IUGR group and non IUGR group (P<0.01).The smaller the birth weight was,the lower the percentage of the average weight in growth curve at the same gestational age would be (χ²=55.615,P<0.01).And with the increase of birth weight,the incidence of IUGR gradually decreased.Compared with the non IUGR group,the prevalence of pregnancy induced hypertension infants in IUGR group was significantly higher (P<0.01).The duration of milk opening,fasting time and total enteral nutrition time during hospitalization were longer in IUGR group than those in non IUGR group (P<0.05).The level of the lowest globulin in non IUGR group was lower than that of the IUGR group (P<0.05).The prevalence rates of PICC,blood transfusion (severe anemia),pneumonia,septicemia,hypoproteinemia,electrolyte disturbance,feeding intolerance and MRI indicating intracranial lesions were higher than those in non IUGR group (P<0.05). Conclusions The prevalence of IUGR in hospitalized preterm infants is high,and EUGR is more likely to occur in premature infants with IUGR.There were significant differences on the hospitalization conditions between IUGR and non IUGR children.Understanding the characteristics of IUGR preterm children can better guide the clinical treatment.

Analysis of nutritional status of preterm infants during hospitalization and the early period after discharge

FANG Xiao-yi, ZHANG Ai-run, LIN Han-ni, WANG Min, LI Jia-hong, WENG Li-jian

2019, 27(6): 642-645. DOI: 10.11852/zgetbjzz2018-1109

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Objective To investigate the energy and nutrients intake as well as physical development,and to explore the characteristics of the energy and nutrients intake,and their relationships with the weight gain in preterm infants at the early period of life. Methods Clinical data of 141 preterm infants were collected,who were hospitalized in the Department of Neonatology in the First Affiliated Hospital of Shantou University Medical College from January 2014 to January 2016 and were followed up for 3 months.The time for weight reaching to the birth weight and the caloric intakes reached to the reference dietary intakes (RDIs) were collected.The velocity of weight gain was calculated.The rate of intrauterine growth retardation (IUGR) and extrauterine growth retardation (EUGR) were recorded.And the weight gain and incidence of EUGR were compared between preterm infants with gestational age (GA)＜34 weeks and ≥34 weeks.The feeding status and the weight,length and head circumference were recorded after discharge. Results 1) The median days of weight reaching to the birth weight were 13.2 days.The median velocity of weight gain after reaching to birth weight was 16.7g/(kg·d).The median days of caloric intakes reaching to the RDIs were 10.6 days.2) The incidence of EUGR at discharge was higher than that of IUGR during at birth (46.1% vs.17.7%, P<0.01).The incidence of EUGR at discharge in infants with GA＜34 weeks was significantly higher than that in infants with GA≥34 weeks(P<0.05).3) The incidence of EUGR between preterm infants before and after 34 weeks of GA in 141 preterm infants at the third month after discharge was not significantly different from that during hospitalization (χ²=0.05,P>0.05). The incidence of EUGR was lower in preterm infants fed by breast milk combined with human milk fortifier (HMF) or post-discharge formula(PDF) (P＜0.05).The difference on the incidence of EUGR between preterm infants before and after 34 weeks of GA in the third month after discharge was not significant (χ²=2.75,P>0.05). Conclusions Preterm infants,especially those with lower GA,are easier to suffer from EUGR and it is difficult to be solved during a short period after discharge.If the preterm infants are fed by breast milk combined with HMF or PDF,the EUGR might be improved.

Clinical significance and the levels of serum IL-17 and IL-36 in children with bronchial asthma

XIAO Xia-xia, LU Shan-shan, SHEN Qiu-yan, WANG Xiao-jing, REN Li-fang, SUN Zhong-hou

2019, 27(6): 646-648. DOI: 10.11852/zgetbjzz2018-1507

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Objective To analyze serum levels of interleukin-17(IL-17), interleukin-36 (IL-36) and eosinophil (EOS) count in children with bronchial asthma, and to discuss the clinical significance. Methods Totally 65 children with asthma were enrolled from July 2017 to July 2018 in Weifang People′s Hospital, of whom 30 cases were in acute exacerbation, 35 cases were in remission, and 25 health children were as control group. The serum levels of IL-17 and IL-36 were detected by enzyme-linked immunosorbent assay (ELISA), the eosinophil count in peripheral blood was measured by hematology analyzer, and the statistical analysis was performed. Results 1) The serum levels of IL-17 in acute exacerbation group[(45.73±8.86)pg/ml] and remission group[(21.06±5.51)pg/ml] were significantly higher than that in control group[(7.29±4.29)pg/ml] (P<0.01), and serum levels of IL-17 in acute exacerbation group was significantly higher than that in remission group(P<0.01). 2) The serum levels of IL-36 in acute exacerbation group[(53.76±10.60)pg/ml ] and remission group [(24.45±6.59) pg/ml] were significantly higher than that in control group[(8.46±4.86) pg/ml] (P<0.01), and serum level of IL-36 in acute exacerbation group was significantly higher than those in remission group(P<0.01). 3) In asthma children, serum level of IL-17 were positively correlated with the level of IL-36(P<0.01), and significant correlation were noted between the serum levels of IL-17, IL-36 and EOS count (P<0.01). Conclusion IL-17 and IL-36 are all involved in the pathogenesis of serum asthma in children, and serum levels of IL-17 and IL-36 may become a good biomarker for the diagnosis and evaluation of severity of asthma children.

Screening results of genetic metabolic diseases in 66 471 neonates in central Guangxi

CHEN Da-yu, TAN Jian-qiang, PAN Li-zhen, LI Zhe-tao, CAI Ren

2019, 27(6): 649-651. DOI: 10.11852/zgetbjzz2018-0814

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Objective To investigate the incidence of genetic metabolic diseases in different crowds in central Guangxi by retrospectively analyzing the Results of tandem mass spectrometry screening in 66 471 newborns and high-risk infants and the genetic test Results in confirmed cases. Methods Dried-blood spot specimens on filter papers of 63 190 newborns from central Guangxi area and 3 281 high-risk infants were selected from the neonatal screening center of Liuzhou Maternal and Child Health Hospital from January 2014 to April 2018.The amino acid and acyl carnitine spectrum were detected.Children with suspected Result were further confirmed by genetic methods. Results Totally 717 cases were screened as positive and 19 cases were confirmed among these 63 190 newborns,and the group incidence was 1/3 326.And 12 cases were confirmed in 57 688 infants with normal weight,with the detection rate of 1/4 807.Likewise,7 cases were confirmed in 5 502 cases with low birth weight,with the detection rate of 1/786.And 16 cases were confirmed in 3 281 high-risk infants,with the detection rate of 1/205.Totally 13 kinds of genetic metabolic diseases were confirmed in 35 cases. Conclusions Inherited metabolic disease is prevalent in central Guangxi,and infants with low birth weight are more likely to develop inherited metabolic diseases than normal weight infants.It is necessary to strengthen the screening of genetic metabolic diseases in the newborn and high-risk infants in the local area,to enhance the ability of intervention and later guidance in clinicians,thereby improving the diagnosis and treatment level and then reducing the missed diagnosis and misdiagnosis.So that the neonatal mortality and disability rate will be reduced and the quality of the population in the region will be improved.

Analysis of clinical efficacy on the walking ability of spastic cerebral palsy children with sling exercise therapy combined with kinesio taping

FAN Tao-lin, ZHOU Wen-ying, CHEN Dong-dong, ZHANG Na, YANG Yan-wen, WANG Chun-hua

2019, 27(6): 652-655. DOI: 10.11852/zgetbjzz2018-1081

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Objective To explore the therapy effect of sling exercise therapy combined with Kinesio taping on children′s walking ability in children with spastic cerebral palsy,so as to provide evidence for the rehabilitation training. Methods A total of 90 children with spastic cerebral palsy in Xiangya Boai Rehabilitation Hospital were enrolled in this study from March to December 2017,and were divided into routine group,muscle group and experiment group,with 30 cases in each group.Routine group was given general comprehensive rehabilitation therapy,muscle group received Kinesio taping additionally,and experimental group received sling exercise therapy based on muscle group.Clinical spasm index (CSI),Berg Balance Scale (BBS) and Gross Motor Function Measure E zone (GMFM-E) were used to assess muscle spasm situation,balance function and walking function before treatment and 100 days after treatment. Results After the treatment of 100 days,CSI score of three groups decreased,and the scores of BBS and GMFM-E both increased (P<0.001).The CSI score,BBS score and GMFM-E score of the experiment group improved obviously,better than those of the muscle group and routine group (P<0.01). Conclusion Sling exercise therapy combined with kinesio taping can effectively relieve muscle spasm of children with spastic cerebral palsy,and improve their balance ability and walking function.

Dynamic monitoring of platelet during bronchopulmonary dysplasia in premature infants

FU Pei-pei, XIE Meng, CUI Hong

2019, 27(6): 656-658. DOI: 10.11852/zgetbjzz2018-0774

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Objective To investigate the relationship between platelet and preterm infant with bronchopulmonary dysplasia(BPD). Methods Data of premature infants with gestational age less than 32 weeks,and living more than 28 days in Beijing Friendship Hospital were retrospectively analyzed from January 2013 to April 2017.Children were classified into case group and control group according to the BPD diagnosis.The mean values of four indexes of platelet during hospitalization,including platelet count (PLT),platelet width (PDW),mean platelet volume (MPV) and platelet count (PCT),and those at ≤7 days,7＜-14 days and 14＜-21 days were analyzed. Results Totally 87 preterm infants met the inclusion criteria,and 79 cases were included in this study finally.There were 30 cases in BPD group (case group) and 49 cases in non-BPD group (control group).The gestational age and birth weight in case group were significantly lower than those in control group(P＜0.001).The levels of PLT and PCT in case group were significantly decreased compared with control group (P=0.008,0.003).And the level of MPV in case group significantly lower than that in control group in 7 days after birth (P＜0.001). Conclusion The formation and development of pulmonary micro vessels play an important role in the development of BPD,and platelets may be the key role in this process of BPD.

Clinical study on vitamin K₁ and protein induced by vitamin K absence or antagonist-Ⅱ in neonatal umbilical cord blood

FAN Xiao-gang, XI Sha, WANG Ya-qin, XIAO Mi, CHEN Ru-juan, WANG Fang-hui, LIN Xiao-jie, LIU Li

2019, 27(6): 659-663. DOI: 10.11852/zgetbjzz2018-1256

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Objectives To investigate the level of vitamin K₁ (VK₁)and protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) in neonatal umbilical cord blood of different gestational age,and to discuss the influencing factors,so as to provide the basis for prevention and treatment of vitamin K deficiency hemorrhage and the application of vitamin K in clinical practice. Methods Neonates who did not have prophylactic use of vitamin K₁ born in the First Affiliated Hospital of Xi′an Jiaotong University and Shaanxi People′s Hospital from December 2016 to March 2017 were enrolled in this study,and the umbilical cord blood of 100 neonates were collected by random number method.The level of VK₁ was tested by high performance liquid chromatography-mass spectrometry,and the level of PIVKA-Ⅱ was tested by ELISA.Maternal history and related abnormal factors were investigated and recorded. Results The levels of VK₁and PIVKA-Ⅱin 100 neonates were (0.293±0.135) ng/ml and (22.479 ± 13.151) AU/ml.The level of VK₁ was negatively related to that of PIVKA-Ⅱ(r=-0.362,P<0.001).The levels of VK₁ and PIVKA-Ⅱin neonatal umbilical cord blood were significantly different on the maternal education level,residence place and the intake of green vegetables during pregnancy (P＜0.05).Moreover,the amount of green vegetables intake was independently influencing factors for the levels of VK₁ and PIVKA-Ⅱ (P<0.05). Conclusions Neonates have high level of VK₁ and low level of PIVKA-Ⅱ in umbilical cord blood.The rate of subclinical and clinical vitamin K deficiency is higher,so it is crucial to monitor the levels of PIVKA-Ⅱand vitamin K for pregnant women and newborn infants.Increasing green vegetable intake during pregnancy and timely monitoring the levels of PIVKA-Ⅱand vitamin K for pregnant women and newborn infants,will help to prevent and find the subclinical and clinical vitamin K deficiency early.

Influence of caffeine citrate on early pulmonary function and intelligent development in premature infants with primary apnea

FENG Zu-zhang

2019, 27(6): 664-668. DOI: 10.11852/zgetbjzz2018-0880

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Objectives To investigate the influence of caffeine citrate on early pulmonary function and intellectual development of premature infants with apnea of prematurity (AOP). Methods A total of 160 infants with primary AOP were enrolled in this study from January 2016 to January 2017,and were randomly divided into observation group (n=80) and control group (n=80). The control group was treated with aminophylline,while the observation group was given citrate caffeine. The treatment situation and complications were compared between the two groups. The early pulmonary function parameters,serum levels of IGFBP-3 and β-EP were measured after treatment,the Gesell Development Scale(GDS) score were compared at corrected age 6 and 12 months. Results The positive pressure ventilation time and total oxygen inhalation time in the observation group were significantly shorter than those in control group,and the apnea episodes at 24,48 and 72 hours after treatment in observation group were significantly lower than that of control group (P<0.05). After treatment,there were no significant differences on respiratory rate (RR) and respiration ratio between the two groups (P>0.05),but the minute ventilation (MV),tidal volume (VT),peak-to-peak time ratio (TPTEF/TE),peak-to-peak volume ratio (VPEF/VE),tidal breathing expiratory flow rate (PEF),tidal volume 25%,50%,75% exhalation flow rate (TEF25,TEF50,and TEF75) in observation group were significantly higher than those in control group (P<0.05). After treatment,the serum level of GFBP-3 in observation group was significantly higher than that in control group,while β-EP was significantly lower in observation group (P<0.05). The total complication rate in the observation group was significantly lower than that in control group (21.25% vs. 43.75%,P<0.05). The Gesell scores at 6,12 months of corrected age in the observation group were significantly higher than those in control group (P<0.05). Conclusion Citrate caffeine adjuvant therapy for primary AOP in premature infants can protect pulmonary function and neurological function,promote intelliectual development,and reduce complications.

Effects of touching combined with hydrotherapy on the growth and jaundice of premature infants

LIU Yang, ZHENG Rong-xiu, WANG Shu-huan, WANG Yan

2019, 27(6): 669-672. DOI: 10.11852/zgetbjzz2018-1271

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Objective To explore the effect of touch therapy combined with hydrotherapy on the developmental index and jaundice index of preterm infants. Methods Totally 168 premature infants were prospectively enrolled as subjects, and were divided into intervention group (n=84) and control group (n=84) according to the number table method. The intervention group was treated with touch therapy combined with hydrotherapy, while the control group received routine intervention. The growth and development index and icteric index of two groups on the day of birth,the 3rd, 7th, 30th, 60th and 90th day after birth were compared. Results The body weight, body length, head circumference and milk consumption of the intervention group increased significantly more than those of the control group on the 7th, 30th, 60th and 90th day after birth(P＜0.05). The neuropsychological development assessment score of premature infants in the intervention group was significantly higher than that in the control group on the 7th, 30th, 60th and 90th day after birth(P＜0.05). The ability of gross motor, fine motor, language and communication in the intervention group were significantly higher than those in control group in 3 months(P＜0.05). Both groups showed an upward trend in the transcutaneous bilirubin levels from the second to the fourth day of birth, and the increase in control group was significantly greater than that in the study group(P＜0.05). However, there was a downward trend in the two groups after the fourth day of birth, and the decrease in the intervention group was larger than that in control group(P＜0.05). The remission time for jaundice, time for the first meconium, meconium turning yellow and meconium excretion in the intervention group were significantly lower than those in the control group(P＜0.05). The rate of hyperbilirubinemia in the intervention group was lower than that in control group(P＜0.05). Conclusion Touching combined with hydrotherapy can help the growth and development of preterm infants, as well as accelerate the process of jaundice regression.

Analysis of the risk factors for recurrent respiratory tract infection in preschool children and the correlation with vitamin D(VitD)

FANG Cai-wen, ZOU Xu-feng, XU Xiao-juan, LIU Zhi-ying, XU Mei-ying, XU Hong

2019, 27(6): 673-675. DOI: 10.11852/zgetbjzz2018-0712

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Objective To discuss the risk factors for recurrent respiratory tract infection (RRTI) in preschool children,and to analyze its correlation with vitamin D (VitD) level,in order to provide reference for preventing RRTI in preschool children. Methods Totally 98 cases children aged 2 to 6 years with RRTI in Shaoxing Central Hospital from August 2015 to August 2017 were selected as the observation group,and 101 healthy children admitted in the same period were selected as control group.Data on maternal pregnancy,preterm birth,birth weight,breastfeeding time,outdoor activities,second-hand smoking and the history of allergic diseases were collected by questionnaire survey.The serum levels of vitamin D,IgA,IgG,IgM,CD4+,CD8+,CD4+/CD8+and other humoral immune indexes in observation group and control group were determined.For children with VitD deficiency (<20 ng/ml),these indexes were tested again in three months after VitD supplementation.Besides,children with VitD deficiency were followed up to 12 months,and the times for respiratory tract infections in children were counted. Results Preterm birth,low birth weight,breastfeeding time,living environment,outdoor activities,VitD,IgA,CD4+,CD4+/CD8+ levels were the risk factors of RRTI.The serum levels of IgA,CD4+,CD4+/CD8+ were higher in children after 3 months of VitD supplementation,and the times for infection in one year was significantly lower than that before VitD supplementation (P<0.05).There were positive correlations among vitamin D level and IgA,CD4+,CD4+/CD8+ before and after treatment (r=0.56,0.73,0.68,P<0.05).There was a negative correlation between VitD level and the times for respiratory tract infection (r=-0.64,P<0.05). Conclusions Preterm birth,low weight,breastfeeding time,living environment and outdoor activities are risk factors for RRTI in children.VitD level and immunological indexes are abnormal in children with RRTI.Increasing VitD level can improve the immunity of children with RRTI and reduce the recurrence of respiratory tract infection.

Study on the immunocyte variation feature of children with hand-foot-and-mouth disease in different age groups

CHI Kun, JING Xiang-yu, JIANG Yu-hong

2019, 27(6): 676-680. DOI: 10.11852/zgetbjzz2018-0674

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Objective To disclose the immunocytes variation feature of children with hand-foot-and-mouth disease (HFMD) in different age groups, in order to provide guidance for the prevention and treatment of HFMD. Methods Totally 1 090 HFMD children were enrolled in this study from January 2015 to January 2018, and their EDTA anticoagulation peripheral blood samples were collected. Fluorescence labeling monoclonal antibodies against CD3, CD4, CD8, CD19 and CD16/CD56 were separately used to mark WBCs after erythrocytolysis and purification. Flow cytometry was employed to analyze the immunocyte content. Children were divided into three groups, including 0~6 months, 6 months＜-5 years old and 5＜-12 years old. The constituent ratio and variations of content of CD3, CD4, CD8, CD19 and CD16/CD56 among different age groups were analyzed and compared by SPSS 19.0. Results HFMD was prevalent in children aged 6 months to 5 years (89.1%). There were significant differences on the constituent ratio of the decrease of CD3+(χ²=9.824,P=0.007), CD4+(χ²=16.367, P＜0.001), NK(χ²=8.666,P=0.013) and constituent ratio of the increase of CD19+(χ²=13.867,P=0.001) cells between children aged 6 months to 5 years and other groups. Besides, the decrease level of CD3+ cells(F=3.907,P=0.020) and the increase level of CD19+ cells(F=9.952,P＜0.001)were significantly different between children aged 6 months to 5 years and other groups. Conclusions HFMD is prevalent in children aged 6 months to 5 years, and the immunocyte variation is more obvious in this age group. Deficiency of cellular immunity accompanied with increase of CD19+ cells indicates the acute transformation of the disease. So more attention should be paid to immunologic monitoring and balance regulation, thereby improving prophylaxis and prognosis of these patients.

Effect of high brightness blue LED light box irradiation on neonatal jaundice

LI Xue-rui, MA Zheng-min, FU Lin

2019, 27(6): 681-683. DOI: 10.11852/zgetbjzz2018-0721

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Objective To study the effect of high brightness blue LED light box irradiation on neonatal jaundice,in order to provide reference for the treatment of neonatal jaundice. Methods Totally 200 cases of neonatal jaundice were enrolled in this study from August 2013 to January 2018,and were divided into control group and observation group.The control group was treated with conventional drugs,and the observation group was treated with high brightness blue LED light box irradiation additionally.The clinical effects of the two groups were analyzed. Results The jaundice regression time and hospitalization time were shorter in observation group than those in control group,and the daily bilirubin decreased value was higher than that in the control group (P <0.05).Before treatment,there were no significant differences on serum bilirubin level,C-reactive protein (CRP),neuron-specific enolase (NSE),alkaline phosphates (ALP) and free fatty acid (FFA) between the two groups (P>0.05).After treatment,the levels of serum bilirubin,CRP,NSE,ALP and FFA in the observation group were significantly lower than those in the control group (P<0.05).The adverse reaction rate was 22.00% (22/100) in the observation group and 45.00% (45/100) in the control group,and the difference was significant (P<0.05). Conclusion High brightness blue LED lamp box can accelerate jaundice regression,reduce the serum bilirubin level in neonatal jaundice children,with few adverse reactions and high safety.

Analysis of serum vitamin D,calcium,phosphorus and parathyroid hormone levels in children with mild rotavirus enteritis and benign convulsions

ZHANG Xiao-ying, LI Chao-xiong, OU Zhong-ai, LI Wang-bin

2019, 27(6): 684-686. DOI: 10.11852/zgetbjzz2018-0829

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Objective To detect serum levels of 25-(OH)D,calcium (Ca),phosphorus (P) and parathyroid hormone (PTH) in children with mild rotavirus enteritis and benign convulsions,in order to provide reference for clinical vitamin D supplementation. Methods A total of 58 cases of children aged 6 months to 2 years,who were with mild rotavirus enteritis and benign convulsions in Jiangmen Central Hospital from October to March in the following year from 2015 to 2018,were selected into case group.And 62 healthy children at the same time were selected as control group.Serum 25-(OH) D,calcium,phosphorus,PTH level and fecal rotavirus were tested in the two groups. Results 1)In all subjects,most serum 25-(OH)D concentrations were insufficient or deficient,only few were sufficient.2) Serum calcium and 25-(OH)D concentration in case group was significantly lower than those in control group (P<0.05),while the differences on serum P and PTH concentrations between the two groups were not significant (P>0.05).3) Serum 25-(OH)D concentration was negatively correlated with PTH concentration in case group and control group (r=-0.324,-0.264,P<0.05). Conclusion The serum level of 25-(OH) D in children in Jiangmen city is generally insufficient or deficient.And the low levels of serum Ca and 25-(OH)D may be the potentially risk factors for mild rotavirus enteritis and benign convulsions.The level of serum 25-(OH)D in the case group was lower than that in the control group.

Analysis on causes and characteristics of unintentional injuries among children

YU Xing-xia, WEI Jie, YANG Wei-ze

2019, 27(6): 687-689. DOI: 10.11852/zgetbjzz2018-1276

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Objective To analyze the causes and characteristics of unintentional injuries among children,so as to provide scientific basis for prevention of the preschool children injury. Methods A total of 482 cases of children with unintentional injuries in Renmin Hospital of Wuhan University were enrolled in this study from August 2014 to August 2016.The characteristics and causes of the unintentional injuries were analyzed retrospectively. Results Among 482 cases of children with unintentional injuries,the proportion of preschool children was 42.1%(203/482),which was significantly higher than that in other age groups(P<0.001).Fall injury accounted for 81.8% (18/22) and 49.3%(100/203) among infancy and preschool children,whereas play injury accounted for 63.0% (80/127) and 60.8% (79/130) among early-school and mid-school children,which was significantly higher than other injury types(P<0.001).Oral and maxillofacial injuries accounted for 68.2% (15/22) and 44.8% (91/203) among infancy and preschool children,whereas limb injuries accounted for 59.1%(75/127) and 60.8%(79/130) among early-school and mid-school children,which was significantly higher than other parts injuries(P<0.001).Among traffic accident injuries,98.0% (48/49) were complicated with fracture or organ damage,93.9% (46/49) were severe injuries,and the average cost of treatment was 21 038.4 yuan per person.The degree of injury and the average cost of treatment in traffic accident injuries were higher than those in other injury types. Conclusions Since the causes and characteristics of unintentional injuries among children are closely related to ages,targeted prevention and intervention measures should be carried out according to the age of children.

Retrospective analysis on foreign bodies in children′s digestive tract based on endoscopic treatment

LI Yu-pin, ZENG Ling-chao, LIN Yan, WANG Chun-hui, FANG Xue-juan, WANG Bao-xi, JIANG Xun

2019, 27(6): 690-693. DOI: 10.11852/zgetbjzz2018-1237

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Objective To summarize the clinical features,treatment Methods and effect of endoscopic therapy of foreign bodies in children′s digestive tract,so as to provide reference for clinical diagnosis and treatment. Methods A total of 103 children with foreign bodies in digestive tract were enrolled in this study,who were diagnosed and treated in Pediatrics Department of Tangdu Hospital of the Fourth Military Medical University from December 2016 to May 2018.And the general data,foreign body types,clinical manifestations,complications,foreign body retention sites,intervention and treatment were retrospectively analyzed. Results The prevalence of foreign bodies in digestive tract in boys(75.73%) were much higher than that in girls(24.27%),and it was higher in rural areas (59.22%) than in urban areas (20.78%).Also,foreign bodies in digestive tract most occurred in toddlers (69.90%) without the supervision of parents (65.05%).Coins were the most common (50.49%) type of foreign bodies in digestive tract,esophagus was the most common (43.69%) retention site and stomach fundus was the next (36.89%).Among 103 children,83 cases were removed by electronic gastroscope,19 cases were discharged spontaneously after observation in hospital,and 1 case was removed by surgery.88 cases had esophageal or gastric mucosal lesions,3 cases were complicated with esophageal perforation and esophagotracheal fistula,and were cured by gastroscopy and bronchoscopy after treatment with acid suppression and protective film,and 1 case complicated with intestinal obstruction was cured by general surgery. Conclusions Foreign bodies in digestive tract of children are diverse and could cause gastric mucosal damage.The key point to prevent foreign bodies in digestive tract is to improve parental supervision.Furthermore,electronic gastroscopy is simple,safe and has a high success rate,which could be taken as the first choice.

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