Table of Content

10 August 2019, Volume 27 Issue 8

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Physical and psychomotor development of children conceived by assisted reproductive technology

ZHANG Lin, ZHANG Yuan, ZHANG Dan, LI Jing, QIN Zhen-ying,
SONG Jia, XIA Xin-ru, GAO Li, CUI Yu-gui, HU You-fang, LIU Jia-yin

2019, 27(8):  816-819.  DOI: 10.11852/zgetbjzz2018-1267

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Objective To study the long-term status of physical and psychomotor development in children born after assisted reproductive technology(ART),in order to evaluate the safety of ART.Methods Totally 210 children aged 6 months to 6 years,who were born after ART in Reproductive Center of Jiangsu People′s Hospital from January 2010 to June 2015,were enrolled as ART group,and 139 children matched with general characteristics were selected as control group.The psychomotor development of participants were assessed with Chinese Wechsler Preschool and Primary Scale of Intelligence(C-WPPSI) (for children under 4 years old) and Gesell Developmental Diagnosis Scale (GESELL) ( for children over 4 years old). Results Totally 349 children participated in this study,of which 225 were assessed with GESELL test and 124 were tested with C-WPPSI.In addition to the parents′ age (father 33.21±4.46 vs.31.16±3.52,t=2.99;mother 31.65±5.21 vs.29.55±4.07,t=3.93),the proportion of twins (20.0% vs.7.3%,χ²=7.24) and the cesarean section rate (80.4% vs.57.6%,χ²=11.31) of ART group were significantly higher than those of normal control group (P＜0.01).However,there were no significant differences on Z scores of height,weight and body mass index (BMI) between ART group and normal control group (P＞0.05).The long-term physical and psychomotor development of the offspring by ART group were not statistically significant compared with that in NC group (P＞0.05). Conclusion The offspring born after ART and normal delivery have no significant differences on physical and psychomotor development when followed up to 6 years old,indicating ART is relatively safe on physical and psychomotor development.

Analysis on the diagnosis,treatment and gene mutation of neonatal primary carnitine deficiency

SUN Ying-mei, SONG Dong-po, WANG Wei-qing, LI Wen-jie

2019, 27(8):  820-823.  DOI: 10.11852/zgetbjzz2018-1589

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Objective To investigate the mutation characteristics of SLC22A5 gene of neonatal primary carnitine deficiency(PCD) in Qingdao area,and to discuss the diagnosis and treatment of PCD.Methods The free carnitine(C0) and acylcarnitine levels in the blood of 278 180 neonates from newborns screening program in Qingdao were measured by tandem mass spectrometry from January 2015 to August 2018.The mutations of carnitine transporter protein were tested in children with low C0 level and the diagnosis was made. Results A total of 5 cases were diagnosed with PCD,with the incidence rate of 0.001 8%(1/55 636).PCD Children were treated with 100-300 mg/(kg·d) of carnitine,and were followed up for 1 month till the blood free carnitine rose to normal.Five child were detected with gene mutations,and one children was homozygous mutation of c.1400C>G(p.S467C)/ c.1400C>G(p.S467C).The compound heterozygous mutations in four cases included c.1400C>G(p.S467C)/c.1433C>T(p.P478L); c.1400C>G(p.S467C)/c.760C>T(p.R254X); c.1400C>G(p.S467C)/c.428C>T(p.P143L); c.1400C>G(p.S467C)/c.393+1G>A (error splicing). Conclusions c.1400C>G(p.S467C) is the major mutation(60%) in SLC22A5 gene of PCD children in Qingdao area.Genetic analysis is helpful for the diagnosis of PCD.And carnitine is effective in the treatment of PCD and will promote better prognosis of PCD children.

Mediation effect of executive function in the relationship between language impairment and hyperactivity/inattention symptoms

MA Xi-rui, ZHANG Yi-wen, LIN Yuan-yuan, LIU Xue-man, Lee Wendy

2019, 27(8):  824-827.  DOI: 10.11852/zgetbjzz2019-1790

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Objective To investigate whether executive function can mediate the effect of language impairments on hyperactivity/inattention symptoms or not,in order to provide evidence for diagnose and treatment of comorbidity of language impairment with attention deficit/hyperactivity disorder in children.Methods The clinical data were retrospectively analyzed in 19 language impairment children(boys∶girls=12∶7),with average age of(57.5±11.8) months from September to November in 2014. Meanwhile 41 healthy children with normal language development(boys∶girls=29∶12) were selected as control group,with average age of(63.0±15.9) months. A case-control study was performed between two groups 1∶2 matched by age and sex. All data on language,executive functions,the Strengths and Difficulties Questionnaire(SDQ) and nonverbal intelligence quotient were collected. t-test was used to test the group differences on short-term memory(STM),inhibitory control and the SDQ hyperactivity/inattention scores. Bootstrapping was used to identify mediation effect of executive functions on the relationship between language impairment and hyperactivity/inattention symptoms. Results Children with language impairment had significantly poorer STM and inhibitory control functions(t=3.72,3.30, P＜0.01,Cohen′s d=0.96,0.82) than normal children. Moreover,children with language impairment scored significantly higher on the hyperactivity/inattention than normal children(t=-2.24,P=0.029,Cohen′s d =0.65). Bootstrapping results showed that short-term memory and inhibitory control had no evident mutual impact on language impairment′s effect for hyperactivity/inattention,but mediating effect of short-term memory and inhibitory control remained significant when testing independent mediating effect separately. And nonverbal IQ did not influence these results. Conclusion Language impairment′s influence for hyperactivity/inattention symptoms can be independently mediated by short-term memory and inhibitory control respectively.

Study on the effect on development quotient of 1 to 2-year-old infant in relation to infant-mother attachment and relative factors

WANG Bai-yin

2019, 27(8):  828-830.  DOI: 10.11852/zgetbjzz2018-1463

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Objective To know about the feature of attachment of 1 to 2-year-old infants and the effect of attachment on development quotient,and to analyze the influential factors of secure attachment,in order to help establish a good parent-child relationship.Methods Totally 200 infants were tested with Strange Situation Procedure,and their development quotient was assessed by Gesell Development Scale from January to August 2018.Questionnaires including family members′ general information,rearing patterns and Olson quality of marriage,were filled in by mothers.And Child Temperament Questionnaire was filled out by main caregivers.The development quotient of different types of infant-mother attachment was analyzed by t test,and influential factors of secure attachment were analyzed by χ² test and Logistic regression analysis. Results Among 200 infants,there were 137 infants of secure attachment,15 infants of avoidant attachment,44 infants of resistant attachment,and 4 infants of disorganized attachment (totally 63 infants with insecure attachment type).There were significant differences on development quotient between safety attachment type and insecure attachment type (t=6.327,P＜0.01).On the contrary,significant correlations were found among the duration of sleeping with parents at night,high-quality company from parents and marital satisfaction of mothers(χ²＝5.644、7.484、10.711,P<0.05). Conclusions There is a higher ratio of secure attachment among infants in this study.Development quotient of infants with secure attachment is clearly higher than infants with insecure attachment.The key factors to build secure attachment include,sleeping with parents at night,high-quality company with infants and high score of marital satisfaction.

Analysis of serum 25-hydroxy vitamin D level in girls with central precocious puberty and simple early breast development

HUANG Xiao-yan, CHEN Ji-xiong, LUO Hai-ling, XIANG Wei

2019, 27(8):  831-834.  DOI: 10.11852/zgetbjzz2018-1863

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Objective To investigate the clinical significance of serum 25-hydroxy vitamin D [25-(OH)D] level in girls with precocious puberty and simple early breast development.Methods A total of 84 girls diagnosed with precocious puberty and treated in Hainan Province Maternity & Child Health Care Hospital from January 2015 to January 2017 were enrolled in this study,and were divided into simple early development group and central precocious puberty group according to the diagnostic criteria. According to the international vitamin D nutritional status classificationMethods ,the precocious puberty girls were divided into normal level of vitamin D group,deficiency group and insufficiency group and another 80 healthy girls were selected as control group. The general information including age,body weight,height,body mass index(BMI),bone age(BA) and the ratio of bone age to chronological age(BA/CA) were recorded. And serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH),luteinizing hormone peak(P-LH),follicle stimulating hormone peak(P-FSH),serum estradiol(E2) were tested and analyzed. The level of vitamin D was assessed by serum level of 25-(OH)D. Results The level of serum 25-(OH)D in precocious puberty group was (53.02±20.64) nmol/L,which was significantly lower than that in control group[(74.32±14.30)nmol/L](t=-9.19,P＜0.05). Likewise,serum 25-(OH)D level in central precocious puberty group was significantly lower than that in simple early breast development group[(36.09±11.83) nmol/L vs.(55.29±23.08) nmol/L,t=-3.357, P＜0.05]. There were no significant differences on BA,CA,BMI,height,weight,and the levels of LH,FSH,E2,P-LH,P-FSH between 25-(OH)D deficiency group and insufficiency group(P＞0.05). There were significant differences on the levels of P-LH and P-FSH between 25-(OH)D insufficiency group and normal level of 25-(OH)D group[ P-LH:(30.31±13.45)U/L vs.(10.67±9.34)U/L,P-FSH:(22.66±7.70)U/L vs.(17.12±9.23)U/L,t=3.603,3.127, P＜0.05]. Meanwhile,there were significant differences on the levels of P-LH[(32.39±14.56) U/L] and P-FSH[(25.09±10.56) U/L] between 25-(OH)D deficiency group and normal level of 25-(OH)D group (t=4.825,5.242,P＜0.05). Conclusion Vitamin D level in precocious puberty girls is decreasing,and it may be related to the development and progress of precocious puberty.

Case-control study on the association between home environment and infant language delay

WANG Sha-sha, ZHANG Yuan-yuan, CHEN Jin-jin

2019, 27(8):  835-838.  DOI: 10.11852/zgetbjzz2018-1584

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Objective To explore the association between home environment and infant language delay,in order to provide reference for promoting the language development in early childhood.Methods A total of 112 infants diagnosed with language delay were enrolled as case group in Shanghai Children′s Hospital from November 2017 to August 2018,and 127 normal infants matched with gender and age who took physical examination in the same hospital at the same period were as control group.Chinese Home Nurture Environment Questionnaire and Infant Language Delay Questionnaire were used to conduct this survey. Results The education level of parents in children with language delay was significantly lower than that of normal children.Likewise,the developmental quotients (DQs) of motor,object,language and social abilities in children with language delay were lower (P＜0.01).Besides,the normal children had better home environment than language delay children(Z=-2.884,P=0.004),and the differences were statistically significant,especially on emotional warmth & home environment atmosphere,social adaptation & relfcane,language & cognitive information environment (Z=-2.032,-3.974,-4.835,P＜0.05 or 0<0.01).After controlling confounding factors,home nurture environment was found to be a significantly influential factor for language development of children (P＜0.01).The language developmental quotient was relevant to home environment(r=0.480,P＜0.01),and if children′s home environment scores increased 1 point,the language developmental quotient (DQ) increased by 0.45 on average. Conclusion Home nurture environment is one of important influential factors to children′s language development,so it is suggested to give more opportunities for children participating in cognitive activities,thereby improving the quality of parent-child interaction.

Research on sleep problem in children with language disorders

LIU Xiao-yan, YI Ming-ji, ZHANG Feng-hua

2019, 27(8):  839-841.  DOI: 10.11852/zgetbjzz2018-1486

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Objective To determine the situation of sleep in children with language disorders,in order to provide a new way for the prevention and treatment of language disorders from the perspective of sleep. Methods A total of 78 children with language disorders in Qingdao Women and Children′s Hospital Affiliated to Qingdao University were selected into the case group from January to April 2018,while 94 normal children were as the control group. Self-made questionnaires on children′s sleep were used to investigate children′s sleep status over the last one month. t test,Chi-square test and Fisher test were used for statistical analysis. Results There was statistical difference on the prevalence rate of sleep problems between case group and control group(52.56% vs. 37.23%,χ²＝4.062,P＜0.05).Compared with the controls,the prevalence rate of trouble in falling asleep in case group was significantly higher (47.44% vs. 31.91%,χ²＝4.318,P＜0.05), the bedtime of nocturnal sleep was significantly later in case group (21.91±0.73 vs. 21.51±0.55,t=4.070,P＜0.001),and nocturnal sleep duration of the case group was significantly shorter than the control[ (9.29±0.86) h vs. (9.67±0.76) h,t=-3.162,P＜0.05)]. Moreover,the prevalence rate of sleep disorders in children sleeping alone was significantly lower than that of children falling asleep with parents (41.30% vs. 68.75%,χ²＝5.706,P＜0.05). When children with language disorders suffered from night awaking,children who have immediate parental response had significantly lower sleep disorders than those without parental response (33.33% vs. 61.53% vs. 62.50%,χ²＝6.359, P＜0.05). Conclusions It is indicated that children with language disorders have high prevalence of sleep problems,and the bedtime of nocturnal sleep is later,the nocturnal sleep duration is shorter. Children sleeping alone and having positive parental response would experience less sleep disorders. Therefore,in the intervention of children with language disorders,the influence of sleep on language development is supposed to be taken into consideration.

Correlation between NLRP3 inflammasome activation and neurological damage in neonatal rat hyperbilirubinemia model

LI Liang-chen, BIAN Xiang-li, WU Zhi-min, ZHANG Jin-ping, LI Miao-chen

2019, 27(8):  842-846.  DOI: 10.11852/zgetbjzz2019-0238

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Objective To study the correlation between the activation of NOD-like receptor protein 3 (NLRP3) inflammasome and neurological damage in neonatal rat hyperbilirubinemia model.Methods A total of 36 3-days-old SPF-grade neonatal SD rats were randomly divided into control group,model group and VX group,with 12 rats in each group. The hyperbilirubinemia model of neonatal rats was established by intraperitoneal injection of 100 μg/g bilirubin in model group and VX group. The VX group was also given intraperitoneal injection of NLRP3 inflammasome inhibitor VX-765. The differences on bilirubin content in brain and serum,water content and ATP content in brain,Nissl staining and TUNEL staining,NSE and S100B contents in serum and the expression of NLRP3 inflammasome were analyzed among the three groups. Results The total bilirubin content,water content,TUNEL positive staining cell rate,NLRP3,ASC,cleaved-caspase-1,active-IL-1β,active-IL-18 expression levels in brain and serum total bilirubin,NSE,S100B contents in the model group were significantly higher than those in the control group (P<0.05). However,ATP content and the number of Nissl positive staining cells in the brain tissue were significantly lower than those in control group (P<0.05). The water content,TUNEL positive staining cell rate,cleaved-caspase-1,active-IL-1β,active-IL-18 expression level in brain and serum NSE,S100B contents in VX group were significantly lower than those in model group(P<0.05). ATP content and the number of Nissl positive staining cells in the brain tissue were significantly higher than those in model group (P<0.05). Conclusion NLRP3 inflammasome is involved in the process of nerve injury in neonatal rats with hyperbilirubinemia.

Research progress on the influence of maternal vitamin D deficiency on the neurobehavioral development of offspring

ZHANG Ying-kuan, YANG Shu-fen

2019, 27(8):  847-850.  DOI: 10.11852/zgetbjzz2018-1529

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Currently vitamin D deficiency is prevalent in the worldwide. And pregnant women are one of the high-risk groups with vitamin D deficiency. Maternal vitamin D deficiency would cause skeletal,immune and endocrine diseases. As a neuroactive steroid hormone,vitamin D has an indispensable effect on the neurobehavioral development of offspring,which has been paid more and more attention to. This review summarizes the effects of maternal vitamin D deficiency on neurobehavioral development in offspring.

Research advance on neuropsychological development and intervention of preterm infants

LI Yang, WANG Hai-na, YUE Jia

2019, 27(8):  851-853.  DOI: 10.11852/zgetbjzz2018-1539

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In recent years,the birth rate of preterm infants in China has increased year by year.With the improvement of perinatal medicine and neonatal critical care technology,the mortality rate of preterm infants continues to decline,but the incidence rates of brain damage and postnatal developmental abnormalities in surviving preterm infants remain high.Compared with the full-term infants,preterm infants have more psychological and behavioral problems.This review combs researches on neuropsychological development and intervention of preterm infants at home and abroad,summarizes the characteristics of neuropsychological development of preterm infants,and analyzes current intervention studies on preterm infants,in order to provide guidance for the nursing intervention of preterm infants.

Progress on the application of conductive education in pediatric rehabilitation

NIE Yin-yue, GUO Jin

2019, 27(8):  854-856.  DOI: 10.11852/zgetbjzz2018-1523

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As a new method of treating children with cerebral palsy (CP),conductive education (CE) is gradually applied in clinical practice.Many studies have shown that conductive education combined with other therapies can effectively improve the function of disabled patients.This article summarizes the progress on the application of conductive education in pediatric rehabilitation by literatures review,and describes the effects of CE combined with different treatments on pediatric rehabilitation.

Factors in determining the initial colonization of intestinal microbiota in infants

NIE Yao, WANG Zhao-xia

2019, 27(8):  857-860.  DOI: 10.11852/zgetbjzz2018-1467

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Normal microbiota of the intestinal tract plays an important role in human health and disease. The alterations in microbial population and profile caused by certain factors may disturb normal physiological functions of human. In this review,the effects of factors on intestinal microbiota were extensively discussed,including gestational age,delivery route,feeding mode,growth environment,antibiotic use,bacterial interference,and application of probiotics.

Research progress on equine-assisted interventions in autism spectrum disorder children

ZHOU Qi-min, ZHU Yu-xiang, HONG Qi

2019, 27(8):  861-863.  DOI: 10.11852/zgetbjzz2019-0167

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Equine-assisted interventions(EAI) is an important subdiscipline of animal-assisted intervention(AAI),which is an interdisciplinary field of sports medicine,rehabilitation medicine and psychology. Recently,many clinical studies and reports around the world have shown that EAI facilitates the rehabilitation of multiple psychosomatic diseases and neurodevelopmental disorders,such as promoting neuromotor equilibrium,cognition,sensory integration,emotions and behavior,social communication and so on. This review systematically analyzes development history,clinical mechanism,quality control and effect evaluation of EAI through searching the clinical research literatures about EAI application in autism spectrum disorders,so as to provide a scientific basis for standardization practice and evidence-based research of EAI in China.

Visual analysis of studies on the sleep in children

KONG De-ling, LI Xiao-ying, KOU Xiao-hui, CHANG Fang-li, LI Xiang-li

2019, 27(8):  864-868.  DOI: 10.11852/zgetbjzz2019-0408

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Objective To understand the current status and hotspot issues on the sleep in children through analtyzing for related literatures.Methods Literatures on sleep in children were retrived in PubMed from January 1st,2014 to February 28th 2019.Bibliographic information co-occurrence mining system (BICOMS) analysis software was used to extract and collate the information of topic words,and co-occurrence matrix was generated.Netdraw was used to arrange the relationships among the main headings and draw social network diagrams.And gCLUTO cluster analysis was used to generate visual surface maps and visualization matrix according to the actual clustering effect. Results Totally 2 070 studies on the sleep in children were included.And 34 main keywords with frequency greater than 28,were currently the main research directions of sleep in children,as well as the promotion of safe sleep.Finally,the hotspot issues were summarized in three aspects,including 1)Safe sleep in infants and the correlation of sleep with physical activity,obesity and dietary behavior; 2)Sleep circadian rhythm in children and its impact on growth and development; 3) Sleep disorders and its correlation with psychological and behavioral development. Conclusions There are few studies on the hazard mechanism of the effect of sleep circadian rhythm and sleep continuity on the mental and physical health of children.Further studies are warranted in this area to enrich related research in China.

Analysis of the results of Gesell Developmental Scale of 1 979 children with suspected developmental retardation

LI Ping, XIONG Fei, WU Jin-hui, YANG Fan

2019, 27(8):  869-872.  DOI: 10.11852/zgetbjzz2018-1074

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Objective To understand the general situation of mental development of children with suspected mental retardation,in order to provide scientific evidence for early screening and timely intervention.Methods A total of 2 178 children with suspected mental retardation who completed the Gesell Developmental Scale were enrolled at West China Second Hospital in this study from 1st January,2014 to 1st January,2017. The mental development was assessed by Gesell Development Scale,and the developmental quotient was analyzed. Results Totally 1 979 children with completed data were analyzed,of which 1 514(76.5%) were boys and 465(23.5%) were girls. The proportion of boys was significantly higher than that of girls at different month groups(χ²=44.652,P＜0.05). The proportion of developmental defects in language area was 86.2%,and it was 68.6%,68.0%,57.3% and 52.8% in adaptive behavior,personal-social behavior,fine motor and gross motor area,respectively. The proportion of developmental defects in language area of boys was higher than that of girls(P＜0.05). Correlation analysis indicated that there were significant positive correlations between the degree of developmental defects in language area and the degree of developmental defects in adaptive behavior,personal social behavior,gross motor and fine motor area(r=0.731,0.795,0.676,0.690,P＜0.001). Conclusions Language developmental defects are prominent in children with suspected developmental retardation,which are comorbid with different degrees of developmental defects in other functional areas. In particular,attention should be paid to the language development of boys. Therefore,the early intervention of comprehensive mental development based on the language development should be the focus of clinical work right now.

Nation-wide epidemiological study on the association between sleep bruxism and height in childhood

ZHANG An-yi, LI Sheng-hui, MA Jun

2019, 27(8):  873-876.  DOI: 10.11852/zgetbjzz2018-1704

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Objective To investigate the prevalence of sleep bruxism in Chinese school-age children,and to explore the influence of sleep bruxism on the height increase in childhood.Methods Totally 21408 school-age children aged 5 to 12 years from 8 different cities in China were enrolled in this study from November to December in 2005. Children′s basic information,sleep-related condition and health condition were collected by questionnaire survey. Heights and weights were measured by the trained health-care teachers in each school. The influence of sleep bruxism on height increase was analyzed by using multivariable liner regression. Results The overall prevalence of sleep bruxism was 23.7%(5 084/21 408) in school-age children in China. Factors that could influence height include gender(β=-0.007),age(t=7.73),light in the sleep room(F=30.10),time spend on sports(F=14.58),time spent on watching TV(F=22.76) and co-sleeping with parents(t=6.62) in the univariable analysis. Multivariable liner regression indicated that having sleep bruxism would attenuate the children′s height(β=-0.127). While the sensitivity analysis showed that the influence of sleep bruxism on height increase became larger with the increase of children′s age(5-6 years old:β=-0.131,7-8 years old:β=-0.098;9-10 years old:β=-0.115;11-12 years old:β=-0.196). Conclusion In Chinese school-age children,having sleep bruxism could negatively influence the height,especially in elder children,which might provide new evidence for clinical intervention.

Comparative analysis of muscle strength of lower limbs between 6 to 11-year-old children with    Duchenne muscular dystrophy and typical children

ZHAI Chun, SHI Wei, LI Hui, LI Xi-hua, SU Yi, WANG Yan-na, LU Kai

2019, 27(8):  877-880.  DOI: 10.11852/zgetbjzz2018-1293

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Objective To compare the difference on the lower-limb muscle strength between 6 to 11-year-old children with Duchenne muscular dystrophy (DMD) and typical children, so as to provide more evidence for muscle strength training of DMD children.Methods Totally 20 DMD children and 20 typical children were enrolled from April 2015 to April 2017, including 19 males and 1 female in the DMD group and 18 males and 2 females in the typical group, both with an average age of (9.0±1.7) years old. Hand-held dynamometry (HHD) was used to measure the muscle strength of hip, knee, ankle and other parts of lower extremity. The differences on muscle strength between DMD and typical children were compared. Results The lower extremity muscle strength of DMD group was significantly weaker than that of typical group except flexor plantaris(all P<0.05), and there was no significant difference on muscle strength between children over 6-year-old and 9 to 11-year-old children in DMD group. Also, the difference on the bilateral hip abduction and toe flexion was not significant between children over 6-year-old in DMD group and typical group (P>0.05), and the toe flexion muscle strength in DMD group was even higher than that in typical group. Hip flexion, hip extension, hip abduction, knee flexion, knee extension and ankle dorsiflexion muscle strength except toe flexion in 9 to 11-year-old children in DMD group had been significantly weaker than typical children with the same age(all P<0.05). Conclusions The lower limb muscles of DMD children are significantly weaker than those of typical children except flexor plantaris. All muscle groups should be taken into consideration when carrying out lower limb strength training for DMD children. In addition, extra attention should be paid to extensor muscles of hip and knee in older children with DMD.

Study on the correlation between serum microRNA 20a and inflammatory response in children with pneumonia

LIU Chun-yan, KE Wen-ling, CHAI Lin, ZHANG Hui

2019, 27(8):  881-884.  DOI: 10.11852/zgetbjzz2018-1434

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Objective To explore the correlation between serum microRNA 20a and the progress of inflammatory response in children with pneumonia,in order to provide reference for clinical treatment.Methods Totally 90 children diagnosed with pneumonia from March 2015 to February 2017 were selected as pneumonia group (n=90) and 90 healthy children were enrolled in control group (n=90).Routine blood test and erythrocyte sedimentation rate were conducted in children after admission,and specific antibodies against pneumonia were identified by ELISA.Serum concentration of C-reactive protein (CRP) and rheumatoid factor (RF) was quantitatively detected by automatic specific protein analyzer and immunoturbidimetry.Total RNA was separated by TRIzol reagent and reverse transcription cDNA was synthesized from microRNA 20a in serum according to Prime-Script RT kit instructions.Then,the protein extracts were separated by 10%SDS-PAGE gel electrophoresis and transferred to PVDF membrane to express microRNA 20a protein in 20a.Finally,Kolmogorov-Smirnov test was used to analyze the correlation between the expression of microRNA 20a in serum and inflammatory response in children with pneumonia. Results Compared with the control group,serum levels of IgG and IgA in children with pneumonia increased,but IgM did not change significantly.Specific protein analysis showed that serum CRP,RF and IL-17 levels and the expression level of microRNA 20a in pneumonia group were higher than those in control group (P<0.05).The correlation analysis between microRNA 20a parameters and IL-17 level showed positive correlation and a steep correlation curve (r=0.571,P＝0.002). Conclusions Serum expression level of microRNA 20a may be related to the pathogenesis of pneumonia inflammation.MicroRNA 20a is promising to be a marker for the diagnosis of pediatric pneumonia and can be used as an indicator for the poor prognosis of pediatric pneumonia patients.

Research on the physical activity assessment in children with cerebral palsy using accelerometers

YANG Xue, CAO Jian-guo, WANG Yu-juan, YUN Guo-jun, LIU Qing

2019, 27(8):  885-888.  DOI: 10.11852/zgetbjzz2019-0149

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Objective To measure physical activity in children with cerebral palsy(CP),and to analyze the relevant factors,in order to provide scientific reference for clinical treatment.Methods Totally 98 CP children aged 2 to 12 years in Shenzhen Children′s Hospital were enrolled in this study from June 2017 to June 2018. The daily activity of the participants was recorded by accelerometers,and the results were compared with the recommendation standard for physical activity of Chinese children and adolescents. And the influences of gender,age and gross motor function classification system(GMFCS) on physical activity were ananlyzed. Results The average time of daily sedentary behavior of CP children was(470.73±107.21) min,and daily moderate-to-vigorous physical activity(MVPA) was(40.65±19.05) min. The time for sedentary activity in boys was significantly longer than that of girls(P＜0.05). Compared with other age groups,the time for sedentary behavior of CP children aged 4 to 6 years was the least,while the time for MVPA was the most(P＜0.001). The GMFCS level was negatively correlated with sedentary activity time,and positively related to MVPA time(P＜0.001).Conclusions Physical activity in CP children is significantly lower than the recommended level. Gender,age and GMFCS level are highly correlated with physical activity in CP children. So it is supposed to help CP children reduce sedentary behavior and increase moderate-to-vigorous physical activity in many ways.

Influence of feed-forward control combined with trunk control training on motor function and follow-up in children with cerebral palsy

XU Yan, XIE Wen-long, HE Feng-xiang

2019, 27(8):  889-891.  DOI: 10.11852/zgetbjzz2018-0974

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Objective To analyze the effects of feed-forward control combined with trunk training on motor development and activities of daily living (ADL) in children with cerebral palsy(CP),so as to provide scientific basis for clinical treatment.Methods Totally 40 CP children were enrolled in this study and were randomly divided into treatment group (n=20) and control group (n=20). Both groups were treated with trunk control training while the treatment group was given feed-forward control combined additionally before trunk control training.The assessment tools including Berg Balance Scale (BBS) for balance function,the Gross Motor Function Classification System (GMFCS) for gross motor function,Fugl-Meyer Assessment (FMA) of Motor Function Rating Scale for motor function,and Modified Barthel Index (MBI) for ADL ability were adopted to assess the efficacy in both groups after 8 weeks,6 months and one year of the treatment respectively. Results There were no significant differences on BBS,GMFCS,FMA and MBI scores between treatment group and control group before treatment (P＞0.05).The above indexes of the two groups were significantly improved compared with those before treatment,and the improvement of the training group was obvious in 8 weeks after treatment.Additionally,the differences on the indexes between the two groups were significant(t=2.124,2.393,2.283,3.048,P＜0.05).And the improvement of the training group was still higher than that of the control group after six months and one year (P＜0.05).Repeated measurement anova analysis showed that the time effect,intra-group effect and interaction of BBS,GMFCS,FMA and MBI scores between the two groups were statistically significant (P＜0.05). Conclusion Feed forward control combined with trunk training might improve the motor function and ADL of children with cerebral palsy,and its effect still lasts after long-term follow-up.

Current status and influencing factors for intelligent development of children with language development delay

YANG Jing-yi, HUANG Sai-jun, LIAO Yan-wei, WU Cui-ling

2019, 27(8):  892-895.  DOI: 10.11852/zgetbjzz2018-1709

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Objective To analyze current status and influencing factors for intelligent development of children with language development delay,in order to provide reference for early intervention.Methods A total of 174 children with language development delay and firstly diagnosed with language development delay in Child Health Care Department of Foshan Maternity and Children′s Health Care Hospital were enrolled in this study. And children′s intelligence was assessed by Chinese Children Development Scale developed by Capital Institute of Pediatrics,meanwhile congenital factors and family environment factors were investigated by self-designed questionnaire. Results The development quotient of each dimension(F=4.999,5.479,25.546,16.401,13.733) and total development quotient(F=22.716) decreased significantly with the older of the age in children(P＜0.01). Single-factor analysis showed that language development quotient of left-behind children was lower than that of non-left-behind children(t=3.182,P＜0.05). Multivariate linear analysis found that left-behind children and children with other persons except parents as their caregivers were prone to have poorer language development(β=3.606,8.088,P＜0.05). Conclusions Language development is closely related to family environmental factors. Evaluating potential factors in children′s family environment is helpful to guide parents to create a positive language environment and promote children′s language development.

Comparison of different doses of caffeine citrate in the treatment of premature infants with apnea

YAN Qiu-xia, WANG Ya-yun, XUE Jiang

2019, 27(8):  896-899.  DOI: 10.11852/zgetbjzz2018-1852

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Objective To study the effect of different doses of caffeine citrate on the treatment of premature infants with primary apnea,so as to provide evidence for the appropriate use of caffeine citrate in clinical practice.Methods A total of 133 cases of premature infants diagnosed with primary apnea in the neonatal intensive care unit of the Second Hospital of Shandong University were selected from January 2015 to June 2016. Caffeine citrate was used to treat apnea,and the children were randomly divided into high-dose group (n=85) and low-dose group (n=50) according to the maintenance dose. In both groups,20 mg/(kg·d) caffeine citrate was used as the loading dose,which was maintained for 24 hours. After that,8—10 mg/(kg·d) caffeine citrate was given in the high-dose group and 5—7.9 mg /(kg·d) in the low-dose group. After 5 days of treatment,the effective rate of treatment,changes in attack frequency,changes in severity and ventilator utilization rate were compared between the two groups. Results The effective rate of treatment in high-dose group(86.0%) was significantly higher than that of low-dose group(72.0%),the average number of apnea episodes and severity of apnea were significantly lower in high-dose group(P＜0.05),while the difference on ventilator utilization rate between the two groups was not significant(P＞0.05). Also,children were divided into two groups according to their gestational age at birth,including <32 weeks and ≥32 weeks. The average number of apnea episodes and severity of apnea in high-dose group were significantly lower than those in low-dose group in the same gestational age group (P＜0.05). While there were no significant differences on apnea episodes and severity of apnea between different gestational age groups at the same dose(P＞0.05). Besides,the incidence of adverse reactions between the two groups was not significantly different either (P＞0.05). Conclusion Caffeine citrate is more effective in treating premature infants with apnea at maintenance of 8—10 mg/(kg·d ) than maintenance of 5—7.9 mg/(kg·d ),which does not increase the incidence of adverse reactions.

Effect of improving parenting stress on the rehabilitation of children with cerebral palsy

YAN Dong-mei, LU Si-guang, TONG Jiao, MA Shan, ZHAO Xing-xing

2019, 27(8):  900-903.  DOI: 10.11852/zgetbjzz2018-1530

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Objective To analyze the feasibility and the effect of improving parenting stress(PS) on the rehabilitation of children with cerebral palsy(CP).Methods Totally 68 CP children who received rehabilitation treatment in Lianyungang from March to December in 2016 and their mothers with moderate-to-severe PS were randomly divided into experimental group and control group. Comprehensive rehabilitation was given to all children,and rehabilitation training guidance was delivered to all mothers. Meanwhile,mothers in experimental group received psychological intervention additionally. After six months of intervention,the PS of mothers and the gross motor function,linguistic function and activity of daily living(ADL) of CP children before and after the experiment was analyzed and compared by SPSS 19.0. Results After six months of intervention,maternal PS score of the experimental group was significantly lower than that of control group(t=-7.051,P＜0.001). Also,children′s gross motor function,linguistic function and ADL in the experimental group were significantly better than those in control group(χ²=6.222,6.745,6.344,P＜0.05). Conclusion Reducing maternal parenting stress could improve the rehabilitation efficacy of CP children.

Effect of repetitive transcranial magnetic stimulation combined with rehabilitation training on children with language development disorder

LI Man-man, MA Cai-yun, LI Xin, HAN Mei-mei

2019, 27(8):  904-906.  DOI: 10.11852/zgetbjzz2018-1216

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Objective To observe the effect of repetitive transcranial magnetic stimulation (rTMS) combined with rehabilitation training on children with language development disorder.Methods Totally 86 children hospitalized in the rehabilitation center of Henan Children′s Hospital from February 2017 to February 2018 were enrolled in this study,and were randomly divided into observation group and control group,with 43 children in each group.Before and after treatment,comprehension,expression,basic operation ability,communication attitude,development quotient and language development quotient of children in different groups were assessed with the Chinese version of S-S language development retardation evaluation method developed by China Rehabilitation Research Center. Results After treatment,the efficacy in observation group was significantly better than that in control group (95.35% vs.79.07%,χ²=5.108,P<0.05).Moreover,the developmental quotient andlanguage developmental quotient of children in both groups significantly increased after treatment (t=4.827,5.009,P<0.05). Conclusion As a new electrophysiological technique for early intervention of language development disorder,rTMS combined with rehabilitation training has better effect on improving the language development ability.

Expression of serum levels of interlukin-10 and transforming and growth factor-β in infants with cow′s milk protein allergy

ZENG Yong-mei, WANG Li-ting, ZHANG Ji-yong, DONG Guo-qing, LIU Pei-hui, XIAO Fei, WU Qian-zhen, WENG Bi-xia

2019, 27(8):  907-909.  DOI: 10.11852/zgetbjzz2018-1850

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Objective To study the roles of interlukin-10(IL-10) and transforming and growth factor-β(TGF-β) in pathogenesis of cow′s milk protein allergy(CMPA) in infants,in order to analyze the role of IL-10 and TGF-β in the process of cow′s milk protein allergy.Methods A total of 20 infants diagnosed with CMPA by oral food challenge(OFC) test in Shenzhen Maternity and Child Healthcare Hospital from January to June in 2018 were enrolled in CMPA group,meanwhile 15 healthy infants were selected as control group. Serum levels of IL-10,TGF-β and IgG4 were tested by enzyme-linked immunosobent assay,and total IgE and milk specific IgE were assayed as well. Results There were 5 cases with total IgE＞200,2 cases with total IgE between 100 and 200,13 cases with total IgE＜100 in CMPA group. Serum levels of IL-10,TGF-β and IgG4 in CMPA group were significantly lower than those of control group(t=-3.130,-2.811,-3.463,P＜0.05). CMPA group was divided into IgE positive sub-group and IgE negative sub-group,and there was no significant difference on IgG4 level between the two groups(t=-0.781,P＞0.05). Conclusions IL-10 and TGF-β play important roles in pathogenesis of CMPA in infants. On the contrary,there may be no significant correlation between IgG4 and IgE. It is necessary to know the prognosis and immunotolerance of infants with CMPA by dynamic observation of IL-10 and TGF-β.

Research onchildren′s health care and current situation in kindergartens in Zhejiang province from 2006 to 2017

WANG Jun, XU Yan-hua

2019, 27(8):  910-912.  DOI: 10.11852/zgetbjzz2019-0034

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Objective In order to further grasp the status of health care in kindergartens,standardize the health care management of children,so as to improve the level of health care in kindergartens in Zhejiang province. Method According to the annual report system of health care in kindergartens in Zhejiang province,the status of children′s health care,the health evaluation and health care personnel in kindergartens in Zhejiang province were investigated from 2006 to 2017. Results The prevalence of dental caries was the highest with the rate of 31.83% in kindergartens in Zhejiang province,followed by poor eyesight,anemia,obesity,malnutrition and amblyopia. The prevalence of anemia and malnutrition of children in kindergartens decreased,while the prevalence of obesity,poor eyesight and dental caries increased from 2006 to 2017. The prevalence rates of anemia and dental caries in urban kindergartens were significantly lower than those in rural areas(t=-3.26,-2.87,P＜0.05),while the prevalence rates of poor eyesight and amblyopia were significantly higher than those in rural areas(Z=-2.98,-2.56,P＜0.05). The rate of full-time health care personnel increased,with the rate of 36.05%. And the rate of full-time health care personnel in urban kindergartens was higher than that in rural areas(t=6.48,P＜0.05). The qualified rates of health evaluation in kindergartens and nurseries in Zhejiang province were 98.67% and 96.72%,respectively,and there was no difference between urban and rural areas(χ²=0.000,0.001,P＞0.05). Conclusions It is suggested to take corresponding countermeasures and focus on oral and visual health according to the incidence of common diseases of children in kindergartens. Meantime,increasing the rate of full-time health care personnel in kindergartens is conducive to promoting the improvement of children′s health care.

Study on the correlation between recurrent upper respiratory tract infections and vitamin D₃,LL-37 in children

WANG Bo-yu, BAI Jin-xiu, JIA Hao, LI Chen, WEI Qian, SU Dan-dan, GONG You-lan

2019, 27(8):  913-916.  DOI: 10.11852/zgetbjzz2018-1659

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Objective To investigate the correlation between human plasma antimicrobial peptides LL-37 and 25-(OH)D₃ and recurrent upper respiratory tract infections in children,in order to provide evidence for the prevention and treatment of recurrent upper respiratory tract infections.Methods Totally 24 children with repeated upper respiratory tract infection in the Affiliated Hospital of Hebei University from February to August in 2018 were enrolled in experimental group,and 24 healthy children in the same period were selected as control group.Blood samples were taken from both groups on an empty stomach to detect plasma LL-37 and 25-hydroxyvitamin D₃ levels,and the times for upper respiratory tract infections in children with repeated respiratory infections were recorded. Results The plasma level of 25-(OH)D₃ and antibacterial peptide LL-37 in experimental group were significantly lower than those in healthy controls[25-(OH)D₃ : (18.37±5.50) ng/ml vs.(29.24±9.04) ng/ml,LL-37: (3.45±0.98) ng/ml vs.(8.93±2.23) ng/ml,P<0.05)].The plasma level of 25-(OH)D₃ and LL-37 were negatively related to the times for upper respiratory tract infections(r=-0.645,-0.560,P<0.05),and the level of 25-(OH)D₃ was positively correlated with LL-37(r=0.908,P<0.05). Conclusions Vitamin D deficiency is associated with recurrent upper respiratory tract infections.Plasma LL-37 level decreases in children with repeated upper respiratory tract infections,and 25-(OH)D₃ deficiency may be an important cause of decreasing level of plasma LL-37 in children with repeated upper respiratory tract infections.

Clinical study and risk factor analysis on mixed infection of mycoplasma pneumoniae pneumonia in hospitalized children

MAO Lu-yi, WANG Yu-qing

2019, 27(8):  917-919.  DOI: 10.11852/zgetbjzz2018-1758

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Objective To understand the mixed infection of children with mycoplasma pneumoniae pneumonia(MPP) in Suzhou,in order to provide basis for the diagnosis and treatment of MPP mixed infection.Methods A total of 815 inpatients with MPP were selected from January 2015 to December 2016 in the Department of Respiration in Children′s Hospital of Soochow University. Multiple pathogens were detected in 815 inpatients,and clinical data were analyzed. Results 1) In 815 cases of MPP,350 cases had mixed infection,including 199 cases with virus infection,91 cases with bacterial infection,60 cases with virus and bacterial infection. The common virus pathogens included HRV,HBoV and RSV. The common bacterial pathogens were streptococcus pneumonia(SP) and haemophilus influenza(Hi). 2) Compared with the single infection group,the mixed virus infection group was younger,had a higher proportion of wheezing,dyspnea and gastrointestinal symptoms and was more likely to have severe pneumonia(χ²=27.126,12.093,8.466,5.031,7.267,P＜0.05).3)The mixed bacterial infection group was younger,with longer fever duration,and the proportions of dyspnea and WBC＞10×10⁹/L in mixed bacterial infection group were significantly higher than those in single infection group(χ²=5.392,4.944,4.155,4.742,P＜0.05). 4) The MPP with virus and bacterial infection group was younger,with longer fever duration,and the proportions of wheezing,dyspnea and WBC＞10×10⁹/L were significantly higher than those in single infection group(χ²=5.245,5.647,4.161,8.221,6.568, P＜0.05). X ray indicated that the proportions of hydrothorax and pulmonary dilatation were significantly higher in MPP with virus and bacterial infection group(χ²=4.946,5.382,P＜0.05).5) Logistic regression analysis showed that risk factors for MPP with virus infection included age under 3 years old(OR=2.23,95%CI:1.516—3.279) and gastrointestinal symptoms(OR=1.583,95%CI:1.020—2.455). Risk factors for MPP with bacterial infection were age under 3 years old(OR=1.841,95%CI:1.131—2.999),having fever > 10 days(OR=2.492,95%CI:1.191—5.212)and WBC＞10×10⁹/L(OR=1.648,95%CI:1.038—2.616). Age under 3 years old(OR=2.345,95%CI:1.250—4.399),having fever＞10 days(OR=3.291,95%CI:1.304—8.307), dyspnea(OR=4.427,95%CI:1.135—17.268) and WBC＞10×10⁹/L(OR=2.39,95%CI:1.357—4.212) were found to be the risk factors for MPP with virus and bacterial infection. Conclusions There is a certain proportion of mixed infection among hospitalized children with MPP,and the main mixed pathogen of MPP is virus,followed by bacteria. The clinical manifestations and risk factors of mixed infection are related to the pathogen of mixed infection.

Analysis on normal results of brainstem auditory evoked potential in 609 infants aged 1 to 18 months

WANG Xiao-yan, ZHANG Ping, WANG Hong, ZHAO Zhi-wei, ZHANG Xuan

2019, 27(8):  920-923.  DOI: 10.11852/zgetbjzz2018-1881

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Objective To investigate the characteristics of brainstem auditory evoked potential(BAEP) in healthy infants aged 1 to 18 months,so as to establish normal range of the peak latencies(PLs) of wave Ⅰ,Ⅲ,Ⅴ and interpeak latencies(IPLs) of Ⅰ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ.Methods Totally 609 healthy children with normal hearing(1 218 ears) in Hubei Maternal and Children′s Hospital were enrolled in this study from January 2017 to January 2018,and 40 healthy adults(80 ears) were selected as control group.BAEP test was conducted in the participants. Results The PLs of wave Ⅰ,Ⅲ,Ⅴ and IPLs of Ⅰ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ of normal infants aged 1 to 18 months became shorter with the increase of age.The PL of waⅤe I was not near that of adults until 6 months old. The PLs of Ⅲ,Ⅴ waⅤe and IPLs of Ⅰ-Ⅲ,Ⅲ-Ⅴ and Ⅰ-Ⅴ failed to reach adults levels even for 7-month-old infants(P＜0.05). And Ⅴ wave and Ⅰ-Ⅴ failed to reach adults levels even for 9-month-old infants(P＜0.05). No significant differences on the PLs of waves were found between different age groups or different side of ears(P＞0.05). Conclusion The establishment of normal range of PLs and IPLs for BAEP waves in infants aged 1 to 18 months can provide a reliable basis for early diagnosis and follow-up detection of hearing and development disorders.