Table of Content

10 October 2019, Volume 27 Issue 10

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Changes in the definition of bronchopulmonary dysplasia and related researches progress

ZHU Xue-ping

2019, 27(10):  1047-1049.  DOI: 10.11852/zgetbjzz2019-0831

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Bronchopulmonary dysplasia(BPD) is a kind of chronic lung disease in neonates which can severely impact patients′ survival rate and life quality.Given its complicated etiology and pathogenesis, there is still no specific treatment for BPD.Therefore, the key intervention of BPD should focus on the prevention rather than treatment.However, the definition of BPD has been developing for decades with controversy.Thus, it is very critical to summarize the developement of BPD definition.

Progress on the prevention and treatment of bronchopulmonary dysplasia

CUI Hong, WANG Xin-bao

2019, 27(10):  1050-1053.  DOI: 10.11852/zgetbjzz2019-0830

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Bronchopulmonary dysplasia(BPD) is one of the important causes for of neonatal death and a common chronic lung disease in premature infants.Since first reported in 1967, there is still no effective treatment over the past 50 years.High concentration of oxygen, barotrauma, volumetric injury and infection are the important causes for immature lung injury in premature infants.The application of prenatal hormones and anti-infection are helpful to reduce the incidence of premature birth.Positive nutritional support and protective ventilation strategy are beneficial to reduce lung injury.However, the current research Results on the effect of nitric oxide inhalation therapy on BPD are still inconsistent.It is believed that vitamin A and caffeine can prevent and treat BPD, and mesenchymal stem cells are currently being explored on the treatment of BPD.

Research on the functional impairment in children with attention deficit hyperactivity disorder

ZHANG Xiao-lin, ZHANG Yi-wen, WU Hong, MA Jun, JIANG Yan-rui, YU Jun-chun, SHEN Zhi-min

2019, 27(10):  1054-1058.  DOI: 10.11852/zgetbjzz2019-0274

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Objective To assess the function in children with attention deficit hyperactivity disorder(ADHD),and to study functional impairment of ADHD children with different genders,ages,and intelligence quotient(IQ). Methods A total of 1 718 children with clinically suspected ADHD were investigated and interviewed from March 2018 to January 2019.Weiss Functional Impairment Rating Scale-Parent Report(WFIRS-P) was used to evaluate functioning of all children.ADHD group was diagnosed according to DSM-5 criteria for ADHD and children who did not meet the diagnostic criteria were assigned to non-ADHD group. Results Finally 1 011 children were in ADHD group,and 707 in non-ADHD group.ADHD children had significantly higher functional impairment than non-ADHD group in 6 dimensions,including family,school and learning,life skills,self-concept,social activities,risky activities and total score(Z=12.484,-15.629,-12.917,-9.435,-8.145,-11.026,-17.328,P<0.001).In ADHD group,boys had much severer deficits than girls in 2 dimensions of functioning such as social activities and risky activities and total score(Z=-3.322,-3.086,-2.350,P<0.05).Functional impairment of children over 9 years old were severer than children under 9 years old in family,school and learning,life skills,self-concept,social activities domains and total score(H=10.226,16.725,13.466,42.177,6.523,22.548,P<0.05).Three intelligent groups with IQ 85-99,70-84 and <70 had severer functional impairment in school and learning than other two groups with IQ 100-114 and 115-129(H=54.528,P<0.05). Conclusion ADHD children have significant functional impairment,and ADHD children with different gender,age and IQ levels show different patterns of functional impairments.

Analysis of factors influencing bronchopulmonary dysplasia in extremely preterm infants

ZHANG Shu, WANG Hui-qin

2019, 27(10):  1059-1061.  DOI: 10.11852/zgetbjzz2018-1247

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Objective To explore the risk factors of bronchopulmonary dysplasia(BPD) in extremely preterm infants,in order to provide reference for the prevention and treatment of BPD. Methods Clinical data in 102 extremely preterm infants in neonatal intensive care unit(NICU) were collected and retrospectively analyzed,who were admitted in Maternal and Child Health Hospital of Anhui Province at 24 hours after birth from January 2012 to December 2017,with gestational age less than 28 weeks and survived 28 days after birth.According to the diagnosis standard of BPD,these infants were divided into BPD group(n=77) and non BPD group(n=25). Results Among 102 extremely preterm infants,77(75.5％) cases developed BPD.Univariate analysis Results showed that male,gestational age,birth weight,days in hospital,maternal chorioamnionitis,early-onset neonatal sepsis,retinopathy of prematurity,pulmonary hypertension,the time of invasive mechanical ventilation,the duration of oxygen therapy were associated with the BPD occurrence in extremely preterm infants.Multivariate Logistic regression analysis indicated that pulmonary hypertension(OR=25.595,95%CI:1.155-567.379) and the duration of oxygen therapy(OR=1.676,95%CI:1.250-1.893) were the independent factors of BPD occurrence in extremely preterm infants. Conclusions The prevalence of BPD which can be influenced by many factors is really high in extremely preterm infants.Lowering pulmonary artery pressure,shortening the duration of oxygen therapy and adopting a comprehensive and standardized treatment at an early stage may decrease the development of BPD.

Influencing factors of head circumference in neonates

DENG Yu-hong, WU Jie-ling, XIAO Yuan-yuan, HUANG Han-lin

2019, 27(10):  1062-1067.  DOI: 10.11852/zgetbjzz2018-1885

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Objective To explore the influencing factors of neonatal head circumference,in order to provide basis for sample selection in reference range,and for screening microcephaly in zika virus infection. Methods A total of 48 928 cases born in Guangdong Women and Children′s Hospital were selected in this study from January 2014 to December 2017,and the clinical data were collected retrospectively.The influencing factors of head circumference at birth were analyzed by independent sample t test/variance analysis and multivariate generalized linear regression analysis. Results The average head circumference of neonates was(33.4±1.7)cm.The head circumference of male newborns,children with larger gestational age,neonates whose ancestral homes were from northern China,delivered by cesarean section and older pregnant women,children exposed to hydramnios multiple pregnancy,multiparity,gestational diabetes mellitus was larger(P<0.05).And the head circumference of children exposed to intrauterine growth restriction,umbilical cord around neck,umbilical cord torsion,oligohydramnios and gestational hypertension,cholestasis,anemia was smaller(P<0.05).There were no significant differences on head circumference among neonates with abnormal structure,assisted reproductive,amniotic fluid characteristics,maternal thyroid function,scarred uterus,placenta previa and reproductive tract infection(P>0.05). Conclusions The neonatal head circumference is influenced by many factors.When formulating the reference range of normal birth head circumference,In addition to considering the differences of physiological factors,it is supposed to exclude samples of related disease factors,such as intrauterine growth restriction,pregnancy complications(gestational diabetes mellitus,hypertension,cholestasis and anemia),abnormal amniotic fluid,umbilical cord abnormalities and so on,so that the scientificity of the reference range can be ensured.

Analysis of the screening results of 17α-OHP of 566 395 newborns in Qingdao

YU Chun-dong, SONG Hong, LI Wen-jie, ZHANG Jun

2019, 27(10):  1068-1070.  DOI: 10.11852/zgetbjzz2019-0002

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Objective To test the level of 17α-OHP in newborn blood spot test,in order to know about the screening result and the morbidity of congenital adrenal hyperplasia(CAH) in Qingdao. Methods Dried blood specimens in filter paper of newborns born from January 2013 to December 2017 in delivery institutions of Qingdao were collected and detected for 17α-OHP level by time-resolved fluoroimmunoassay(TRFIA). Specimens with 17α-OHP level ≥30 nmol/L(the first sampling specimen in the two detection Results) were considered as suspected positive. Newborns with suspected positive Results were informed and recalled for blood specimen recollection and 17α-OHP redetection. Those whose detection Results of two sampling specimens were both positive would be examined in Department of Children Healthcare of Qingdao Women & Children Hospital for further confirmation. Results The screening rate of 17α-OHP for newborns born from January 2013 to December 2017 in Qingdao was 99.23％. And 2 536(0.448％) cases were diagnosed as suspected positive by TRFIA,among whom 91.09％ were recalled for redetection. Finally 32(0.056‰) cases with CAH were confirmed. There were no significant difference on the incidence rate of CAH among Ningxia,Zibo,Shanxi,Ningbo,Nanchang and Qingdao(P＞0.05). Conclusions The initial screening of CAH has covered almost all newborns in Qingdao. The morbidity of CAH of Qingdao is slightly lower than that of China,with no drastic difference compared with the other areas in China. The reference range of 17α-OHP should be set according to the gestational age and the weight of newborns to decrease false positive rate and to increase accuracy of screening.

Analysis of gene mutation characteristics of medium chain acyl-CoA dehydrogenase deficiency by neonatal screening

SUN Ying-mei, YU Chun-dong, LYU Jin-feng, LYU Ya-nan, LI Wen-jie

2019, 27(10):  1071-1074.  DOI: 10.11852/zgetbjzz2018-1578

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Objective To investigate the prevalence,clinical and gene mutation characteristics of medium chain acyl-CoA dehydrogenase deficiency(MCADD) in neonates in Qingdao area. Methods The acylcarnitine levels in the blood of 278 180 neonates from newborns screening program in Qingdao area were measured by tandem mass spectrometry.from January 2015 to August 2018.The suspected MCADD neonates were diagnosed by retrospective analysis of the urine organic acids and medium chain acyl-CoA dehydrogenase(ACADM) gene mutation. Results Four cases were diagnosed with MCADD,with the prevalence rate of 0.001 4%(1/69 545).There was no obvious abnormality in clinical manifestations,and the levles of medium chain acyl carnitine(C6-C10) increased in the four patients.Seven different mutations in the ACADM gene were identified in four cases.And one case was homozygous mutation:c.1 040G>T(p.G347V)/ c.1 040G>T(p.G347V).The other three cases were detected with compound heterozygous mutations,including c.157C>T(p.R53C)/ c.709-1G>A,c.1085G>A(p.G362E)/ c.461T>G(p.L154W)and c.587G>A(p.G196E)/ c.387+1delG.One case had increasing levels of 4-hydroxyphenylacetic acid and 4-hydroxyphenylpyruvate and hepatic insufficiency.Dietary guidance was given to the MCADD patients.No clinical symptoms were manifested and physical and intellectual development were normal during the follow-up period. Conclusion Inherited metabolic disease screening by tandem mass spectrometry for neonatal screening combined with gene detection can help early diagnosis of MCADD,which is of great significance to prevent the arrest of disease and improve the quality of life in MCADD children.

Relationship between serum betatrophin in cord blood and growth development of fetus

ZHENG Jun-hu, PAN Yi-cong, KE Ru-shu, CHEN Hong, ZOU Yue-ling, HU Xiao-na, WANG Da-hua, QIAN Ding-liang

2019, 27(10):  1075-1078.  DOI: 10.11852/zgetbjzz2019-0112

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Objectives To investigate the relationship between serum betatrophin and growth development among fetus,in order to provide reference for fetal healthcare. Methods Totally 30 large for gestational age(LGA)infants,30 appropriate for gestational age(AGA) infants and 30 small for gestational age(SGA) infants were enrolled in this study in Maternal and Child Health Hospital of Ruian People′s Hospital from January to July 2018. Serum betatrophin level in cord blood,maternal blood and amniotic fluid was tested,and the relationships among betatrophin in cord blood,indexes of fetal growth and development,glucose and lipid metabolic parameters,insulin resistance,leptin and serum adiponectin were analyzed. Results The serum betatrophin levels in cord blood of LGA,AGA and SGA were (1 009.210±98.761) ng/L,(929.487±80.949) ng/L and (910.590±105.518) ng/L respectively,with significant difference among three groups(F=8.986,P<0.001). There were no significant differences on lipid indexes among LGA,AGA and SGA infants(P>0.05). Pearson correlation analysis indicated that serum betatrophin level in cord blood was positively correlated with birth weight,ponderal index(PI) and gestational age of neonates,leptin and triglyceride(TG) in cord blood(r=0.537,0.502,0.250,0.422,0.832,P<0.05),and negative correlation was found between serum betatrophin and adiponectin level in cord blood(r=-0.257,P<0.05).However,there were no significant correlations between serum betatrophin level and betatrophin level in maternal blood or amniotic fluid,body weight before pregnancy and delivery,pre-pregnancy BMI,BMI increase during pregnancy,placental weight,plasma glucose(PG),insulin(INS) and HOMA-IR in cord and maternal blood(P>0.05). Multivariate linear regression analysis showed that blood betatrophin was an independently influencing factor for neonatal birth weight(P＜0.05). Conclusions Betatrophin level of cord blood is related to the adjustment of fetal growth. On the other hand,betatrophin level can reflect the status of feta1 growth and development.

Study on the clinical security of sustained lung inflation in low-birth-weight preterm infants with neonatal respiratory distress syndrome

RUAN Min-yi, RAO Hong-ping, YANG Yong, ZHANG Lan, SU Jin-zhen, LI Min-xu

2019, 27(10):  1079-1083.  DOI: 10.11852/zgetbjzz2018-1518

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Objective To study the clinical security of sustained lung inflation(SLI) in neonatal respiratory distress syndrome(NRDS) for preterm neonates,in order to provide evidence for clinical treatment. Methods A total of 80 NRDS infants in Dongguan Maternal and Child Health Care Hospital were enrolled in this study from May 2017 to September 2018,and were randomly divided into control group and experimental group,with 40 cases in each group.The experimental group received SLI after intubation,and then pulmonary surfactant prolonged the process of intubate-surfactant-extubate(INSURE).While the control group was given INSURE under the failure of nasal continuous positive airway pressure(nCPAP).The clinical treatment efficacy and complications,including intracranial hemorrhage,pulmonary air leakage,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),patent ductus arteriosus(PDA),neonatal necrotizing entercolitis(NEC),were compared between the two groups. Results The cases of the success of nCPAP within 72 hours after birth in experimental group was more than that in control group(P=0.021),and the time for invasive mechanical ventilation of experimental group was significantly shorter than that in control group(P=0.038).There were no statistically significant differences on the incidence of intracranial hemorrhage,pulmonary leakage,BPD,ROP,PDA,NEC and mortality between the two groups(P>0.05).The time effect on the change of blood gas indexes including pH,PaO₂,PCO₂ and BE of the two groups was significant(P＜0.05),while the intervention effect was not significant(P>0.05). Conclusion SLI as a treatment for NRDS,can reduce the invasive mechanical ventilation rate and shorten the invasive mechanical ventilation time within 72 hours after birth,whereas it does not increase the incidence of pulmonary air leakage,intracranial hemorrhage,BPD,ROP,PDA,NEC and other complications.

Research progress on deformational plagiocephaly and/or brachycephaly

GUO Sha-sha, CUI Yu-xia

2019, 27(10):  1084-1086.  DOI: 10.11852/zgetbjzz2018-1449

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Deformational plagiocephaly and/or brachycephaly(DPB) refers to the flattened malformation of the baby′s skull in different degrees in the posterior position or lateral position,resulting in an irreversible change in the nervous system lesions such as infants′ intelligence and exercise,which requires early intervention from clinicians in child care urgently. At present,relevant literatures at home and abroad have made great progress on the study of DPB. This review intends to describe the risk factors,classification,diagnosis,treatment and prognosis of DPB,thereby providing more detailed clinical data for infants′ health care. Meanwhile,clinical prevention and correction of various degrees of abnormalities in children′s skulls should be done as early as possible to avoid dislocation or limitation of brain structure growth,in order to further improve the quality of life of children.

Progress on the correlation between platelet and bronchopulmonary dysplasia in premature infants

FU Pei-pei, CUI Hong

2019, 27(10):  1087-1089.  DOI: 10.11852/zgetbjzz2018-0776

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Bronchopulmonary dysplasia(BPD) is common in premature infants.Because of its high mortality and bad prognosis,BPD has been a big problem for premature infants.With the intensive development of BPD researches recently,the new type of BPD mainly characterized by alveolar growth retardation and pulmonary microcirculation disorder is getting increasing attention,especially the role of pulmonary microcirculation disorder in the development of BPD.Platelet is an indispensable part of the formation and development of blood vessels,so it may be involved in the pathogenesis of BPD.This paper reviews research progresses and the possible effect of platelet on the pathogenesis of BPD.

Research progress on the screening for Wilson′s disease in children

XIONG Fu, ZHOU Jin, XU Xi-wei

2019, 27(10):  1090-1092.  DOI: 10.11852/zgetbjzz2018-1642

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Wilson′s disease in children is one of the few hereditary diseases that can be treated,and it is not rare in China.Early diagnosis and timely treatment can effectively control the disease,which could avoid liver transplantation and nervous sequelae.This review summarizes the progress on Wilson′s disease screening in order to attract enough attention from clinicians.

Visualization analysis of academic literature on breastfeeding based on Cite Space in China

WANG Xiao-fang, LIU Cai, TIAN Ya-ping, LI Ying, HE Qiang

2019, 27(10):  1093-1097.  DOI: 10.11852/zgetbjzz2019-0189

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Objectives To understand the research hotspots and trends of breastfeeding research,and to sort out the development of breastfeeding research,in order to explore the development direction and intervention of breastfeeding research and provide reference for breastfeeding behavior as well as increasing breastfeeding rate in China. Methods The breastfeeding literatures in core journals were retrieved from the CNKI database. With breastfeeding as the retrieval condition,a total of 2 394 literatures were retrieved. After eliminating the irrelevant literature and the literature with great deviation from the subject,finally 597 articles were searched. Then systematic analysis of searched literature was performed using Note Express 3.1.0 and Cite Space Ⅲ. Results The keyword collinear network has 246 nodes and 315 connections. In 597 breastfeeding literature statistics,high-frequency keywords included "breastfeeding","influencing factors","breastfeeding rate","neonatal","baby-friendly hospital","health education" and so on. Conclusions As the development of modern medical model and health management,the scope of research shifts to health care,and the research subjects are more targeted. The intervention measures to promote breastfeeding behavior are mature,but the measures still need to be taken to improve the effectiveness. Moreover,relevant researches on breastfeeding gradually consider the influence of socio-cultural background and scientific measurements such as related theories.

Risk factors and respiratory disease related follow-up analysis of bronchopulmonary dysplasia in premature infants with respiratory distress syndrome

YANG Nan, CUI Hong, XU Jun-mei

2019, 27(10):  1098-1101.  DOI: 10.11852/zgetbjzz2018-0777

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Objectives To explore the risk factors of bronchopulmonary dysplasia(BPD) in premature infants with neonatal respiratory distress syndrome(NRDS),and to observe the outcome of follow-up. Methods Preterm infants hospitalized in the Neonatal Pediatrics Department of Beijing Friendship Hospital Affiliated to Capital Medical University and diagnosed with NRDS were enrolled in this study from 1st January,2013 to 31st December,2016,and were divided into BPD group and control group(non-BPD group).The risk factors of BPD in premature infants with NRDS were analyzed.After discharge,the patients was followed up by telephone or through the outpatient to observe the incidence of respiratory infection,wheezing times and readmission rate under one year old,as well as the pulmonary function after 2 years old. Results Totally 79 children were enrolled in this study,of which 32 cases were in BPD group,and 47 cases were in control group.Single factor analysis showed that gestational age and birth weight in BPD group were significantly lower than those in control group(P＜0.01),and the time for mechanical ventilation,the ratio of the application of PS and maternal eclampsia during pregnancy were significantly higher than those in control group(P＜0.01).However,there were no significant differences on maternal age,the ratio of premature rupture of membranes and gestational diabetes(P＞0.05).The incidence of respiratory tract infection and wheezing times in BPD group was significantly higher than those in control group within one year after birth(P<0.01),but there were no significant differences on the readmission rate under 1 year old and pulmonary function in 2 years old between the two groups(P＞0.05).Multivariable Logistic regression analysis indicated that the gestational age(≤28 weeks OR=23.00,95%CI:6.767-78.172;>28-32 weeks OR=4.518,95%CI:1.359-15.020) and mechanical ventilation time more than 7 days(OR=4.380,95%CI:2.581-6.146) were risk factors for BPD. Conclusions Gestational age and mechanical ventilation more than 7 days may be the risk factors for BPD in NRDS premature infants.BPD may lead to repeated respiratory tract infection and wheezing in infants and young children,and whether it can lead to the change of long-term pulmonary function or not needs to be further studied.

Analysis of prevalence and related factors of bronchopulmonary dysplasia in premature infants in a hospital from 2015 to 2018

YANG Jiao, Nouery·ejiapu, LIU Yong-qiao

2019, 27(10):  1102-1104.  DOI: 10.11852/zgetbjzz2018-1854

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Objective To understand the prevalence of bronchopulmonary dysplasia(BPD) in premature infants,and to analyze the relevant factors for BPD,in order to provide evidence for clinical prevention and treatment. Methods A total of 1 426 premature infants born in Xinjiang Uygur Autonomous Region People′s Hospital were enrolled in the study from January 2015 to June 2018,and were divide into BPD group and control group.The clinical data of puerperae and neonates were compared between the two groups.And univariate analysis and multivariate Logistic regression analysis were used to find out the risk factors of BPD. Results Among 1 426 premature infants,88(6.17%) cases suffered from BPD,including 23(26.14%) mild cases,49(55.68%) moderate cases and 16(18.18%) severe cases.Univariate analysis showed that maternal age,gestational hypertension,long-term smoking or second-hand smoking,overwork,intrauterine infection,amnionitis,and neonatal gestational age,birth body weiyht,1 min Apgar score,neonatal acute respiratory distress syndrome(NRDS),pneumorrhagia,intracranial hemorrhage,retinopathy,anemia,mechanical ventilation,pulmonary surfactant(PS) use,oxygen use time and maximum oxygen concentration>40% were associated with the BPD in premature infants(P<0.05).Multivariate Logistic regression analysis showed that intrauterine infection of puerperae(OR=3.300,95%CI:1.367-7.967),and gestational age ≤28 weeks(OR=4.162,95%CI:2.379-7.281),birth body weight<1 500 g(OR=4.591,95%CI: 2.926-7.202),pneumorrhagia(OR=2.654,95%CI: 1.329-5.300),anemia(OR=5.836,95%CI: 2.129-15.993),and mechanical ventilation(OR=4.033,95%CI: 1.953-8.175) were risk factors for BPD in premature infants(P<0.05). Conclusions BPD in premature infants is related to intrauterine infection,preterm gestational age,birth body weight,presence or absence of pneumorrhagia,anemia and mechanical ventilation.Clinical prevention and treatment measures are supposed to be made according to maternal and neonatal conditions so as to reduce the incidence of BPD and to improve the survival rate and quality of life of premature infants.

Study on the incidence and risk factors of small for gestational age infant with single fetus and live births

CHEN Gan-ne, WU Yong, HUANG Wei-wen, LIU Yun-hui, HUANG Wan-ping

2019, 27(10):  1105-1108.  DOI: 10.11852/zgetbjzz2019-0431

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Objective To investigate the incidence of small for gestational age(SGA) in Huadu district of Guangzhou,and to analyze its risk factors,so as to provide evidence for prevention on SGA. Methods Totally 3 509 singleton live births in Guangzhou Huadu District Maternal and Child Health Hospital were enrolled in this study from October 2017 to September 2018.Data on neonatal gestational age,birth weight,maternal general condition,nutrient intake during pregnancy,environmental exposure,lifestyle behavior and so on were collected,the incidence of SGA was calculated,and the influencing factors were analyzed. Results The incidence of SGA infants was 8.78%(308/3 509).Multivariate Logistic analysis showed that oligoamnion(OR=3.275,95%CI:2.043-5.250),maternal age over 35 years old(OR=1.712,95%CI: 1.216-2.411),non-registered pregnant women(OR=1.620,95%CI:1.158-2.266;OR=1.660,95%CI:1.126-2.448 ),low weight prepregnancy(OR=2.300,95%CI:1.515-3.827),Low weight gain during pregnancy(OR=2.286,95%CI:1.572-3.326),frequent exposure to second-hand smoking(OR=5.690,95%CI:1.401~23.104) were risk factors for SGA(P＜0.05).Gestational diabetes mellitus(OR=0.674,95%CI:0.456-0.996), more gravidity(OR=0.802,95%CI:0.716-0.897) were protective factors for SGA(P＜0.05). Conclusions The occurrence of SGA is related to many factors,which is the result of the combination of social factors,environmental factors and pregnancy complications.To prevent the occurrence of SGA,comprehensive interventions are needed.

Application of Multidimensional Neonatal Nutrition Risk Screening Scale in patients of neonatal ward

BAI Bo-liang, ZHANG Lan, GAO Qiong, WANG LI, GUI Yan-hong, WANG Hui-ping

2019, 27(10):  1109-1111.  DOI: 10.11852/zgetbjzz2018-1743

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Objective To discuss the application value of the latest Multi-Dimensional Nutritional Risk Screening Scale in neonatal pediatric inpatients by comparing with different nutritional scales. Methods A total of 86 neonatal patients treated in the neonatal ward of the Second Affiliated Hospital of Xi′an Jiaotong University were enrolled in this study from July 2017 to May 2018,and were divided into premature infant group and full-term infant group,as well as internal medicine group and surgical group.Multidimensional Neonatal Nutrition Risk Screening Scale and Strongkids were used to assess children from birth to 28 days each week. Results Totally 70.9% of neonates were at risk of malnutrition,and premature infants had a higher risk of malnutrition than full-term infants(χ²=6.542,P=0.010).Multidimensional Neonatal Risk Screening Scale assessment Resultsshowed that neonates with surgical diseases had a higher risk of malnutrition than those with internal medical diseases(χ²=15.816,P＜0.001).The sensitivity of Multidimensional Neonatal Nutrition Risk Screening Scale for screening the malnutrition of children with surgical disease was significantly higher than that of Strongkids(χ²=10.400,P=0.001). Conclusion Multidimensional Neonatal Malnutrition Risk Screening Scale has a better effect on neonatal malnutrition risk screening,especially for neonates with surgical diseases,which is more sensitive than traditional screening method and can be used for clinical assessment widely.

Analysis on ultrasonic screening results of developmental dysplasia of the hip in 6 009 infants

LU Yan-hong, CHEN Xing, SONG Yuan, YE Kan, MAO Hong, KONG Rui

2019, 27(10):  1112-1114.  DOI: 10.11852/zgetbjzz2019-0308

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Objective To investigate the incidence of developmental hip dysplasia(DDH) among infants in Suzhou,in order to explore the clinical value of ultrasound screening in the diagnosis of DDH. Methods A total of 6 009(12 018 hips) infants suspected for DDH were selected as the participants in Soochow Municipal Hospital from January to December in 2018.All infants suspected for DDH were examined by ultrasonography,the α and β angles were measured and the category was made based on Results. Results There were 5 479 cases of normal hip joint and the incidence of DDH was 5.999%(721/12 018).The detection rate of DDH in female infants was significantly higher than that in male ones(χ²＝133.74,P<0.001).Also,the detection rate of DDH in left hips was significantly higher than that in right hips(χ²＝12.22,P=0.002). Conclusions Ultrasonic examination can assess the development of hips effectively.It can serve as a major method for early screening and follow-up of DDH in infants,and thus plays an important role in early intervention treatment.

Relationship between cord blood 25-hydroxyvitamin D and atopic dermatitis within 6 months after birth in infants

WANG Jing, ZHANG Yue, TAN Mei-zhen, XIAO Yu-lian, WEI Ru, WANG Ling-hua

2019, 27(10):  1115-1119.  DOI: 10.11852/zgetbjzz2019-0497

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Objective To analyze the relationship between cord blood 25-hydroxyvitamin D [25-(OH)D] and infant atopic dermatitis(AD),in order to provide reference for the primary prevention and early intervention for AD in infants. Methods Totally 202 mothers and their infants were enrolled in this study from December 2016 to December 2017.Cord blood was collected at birth,and the children were followed up to 6 months old.A standard questionnaire was used to obtain the information of parents and infants,serum level of cord blood 25-(OH)D was detected by enzyme-linked immunosorbent assay.Objective Scoring of Atopic Dermatitis(SCORAD) was used to assess the severity of AD in infants.And the risk factors for AD in infants were analyzed by nested case-control study and Logistic regression analyzed. Results There was no statistically significant difference on cord blood level of 25-(OH)D between AD group and the healthy control group .Positive family history of allergy (OR=1.963),non-exclusive breastfeeding (OR=2.089),and birth in summer (OR=2.265) were risk factors for the occurrence of AD(P＜0.05).Cord blood levels of 25-(OH)D was negatively correlated with the severity of AD in infants (r=-0.325,P=0.023). Conclusions Cord blood 25-(OH)D can not predict the occurrence of AD in infants,but it is negatively correlated with the severity of AD.Reasonable vitamin D supplementation during pregnancy may reduce the severity of AD in infants.

Analysis on the maternal risk factors for retinopathy of prematurity in premature infants

CHENG Yang-yang, HU Jie, ZENG Ya-wei, SHI Jing

2019, 27(10):  1120-1123.  DOI: 10.11852/zgetbjzz2018-1258

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Objective To analyze the correlation between pregnancy and prenatal risk factors and occurrence of retinopathy of prematurity(ROP),in order to provide scientific evidence for the prevention and treatment of ROP. Methods Premature infants with profiles,who were completed the RetCam 3 fundus examination in eye clinic of Hunan Provincial Maternal and Child Health Care Hospital from June 2016 to June 2017,were included.RetCam 3 fundus examination Results,gestational age,birth weight,maternal age,parity,pregnancy related diseases were recorded and analyzed statistically to explore the risk factors for ROP. Results A total of 1 956 cases of premature were included and 354 ROP patients were identified(18.10%).Logistic regress analysis indicated that gestational age ＜28 weeks(OR=21.649,95%CI:18.485-24.327),low birth body weight(<1 000 g)(OR=13.013,95%CI:10.861-16.233),fetal distress(OR=2.328,95%CI:1.269-3.156),gestational hypertension(OR=2.121,95%CI:1.072-3.571),gestational diabetes mellitus(OR=1.995,95%CI:1.008-2.929) were high-risk factors for the development of ROP in premature infants,while pregnant women age,parity and anemia during pregnancy were not significantly correlated with ROP(P＞0.05). Conclusion Factors including preterm infants with gestational age＜28 weeks and low birth body weight(<1 000 g),fetal distress,mother with gestational hypertension and gestational diabetes mellitus,are closely related to ROP.

Clinical efficacy of budesonide combined with caffeine citrate for preventing bronchopulmonary dysplasia in preterm infants

CHEN Meng-Meng, WEN Xiao-hong, HUANG Jin-hua, SUN Ya-wei

2019, 27(10):  1124-1127.  DOI: 10.11852/zgetbjzz2018-0947

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Objective To explore the clinical efficacy of early inhaled budesonide combined with caffeine citrate for preventing bronchopulmonary dysplasia(BPD) in very low birth weight(VLBW) infants,in order to provide evidence for the prevention and treatment of BPD. Methods A total of 60 VLBW infants with gestational age under 32 weeks and weight under 1 500 g in Binhu Hospital of Southern District,the First Hospital of Hefei City were enrolled in this study from October 2014 to October 2017,and were randomly assigned into budesonide combined with caffeine group(n=30) and caffeine group(n=30).Duration of ventilation,duration of oxygen supplementation,duration of hospitalization,mortality,incidence of BPD and common complications between the two groups were compared. Results Compared with the caffeine group,budesonide combined with caffeine group had a shorter duration of ventilation and oxygen supplementation(t=2.09,Z=-2.36,P <0.05).The incidence of BPD in budesonide combined with caffeine group was lower than that in caffeine group,but the difference was not statistically significant(P＞0.05).There were no significant differences on the duration of hospitalization and the incidence of other common complications between the two groups(P>0.05). Conclusion Early inhaled budesonide combined with caffeine citrate can effectively shorten the duration of ventilation and oxygen supplementation,and can reduce the incidence of BPD to some extent.

Analysis of the prevalence and prognosis of preterm infants in a hospital over the past five years

WANG Hua, CHENG Yu-mei, CHEN Yong-ping, HOU Dong-min

2019, 27(10):  1128-1132.  DOI: 10.11852/zgetbjzz2018-1808

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Objective To investigate the prevalence and prognosis of premature infants in Beijing Obstetrics and Gynecology Hospital,Capital Medical University over the past five years,so as to provide epidemiological data for related research. Methods The data of 6 038 live-born premature infants(gestational age< 37 weeks) born in obstetrics department from January 2013 to December 2017 were collected.And the data were analyzed according to premature labor cause(spontaneous premature and iatrogenic premature) and gestational age of delivery,including very early premature infants with gestational age <28 weeks,early premature infants with gestational age of 28-< 32 weeks,middle premature infants with gestational age of 32-<34 weeks and late premature infants with gestational age of 34-<37 weeks. Results The annual prevalence of premature infants in this hospital was 7.38% to 8.57% from 2013 to 2017,with an average rate of 8.03%.However,the proportion of late premature infants in all preterm infants has been on the rise over the past five years,reaching 74.25% by 2017.The top three causes of iatrogenic preterm birth included gestational hypertension(978,39.96%),placenta previa(478,19.53%) and fetal distress(222,9.07%).The prevalence rate of severe asphyxia in iatrogenic early preterm infants was higher(4.1% vs.1.2%,P<0.05) and birth weight was lower than that in spontaneous early preterm infants[(1 338.0±264.4)g vs.(1 381.8±328.0)g,P<0.05)].Moreover,the birth weight of iatrogenic midterm preterm infants was lower than that of spontaneous midterm preterm infants[(1 843.9±341.5)g vs. (1 897.0±392.7)g, P<0.05)],and the hospitalization rate of iatrogenic late preterm infants was higher than that of spontaneous late preterm infants(43.9% vs.38.8%,P<0.01). Conclusions The proportion of late preterm infants is on the rise.Compared with spontaneous preterm infants in the corresponding gestational weeks,iatrogenic early preterm infants are prone to have higher rate of severe asphyxia,lower birth weight of early and middle preterm infants,and higher rate of hospitalization.So it is supposed to strengthen the management of iatrogenic preterm pregnancy and pay attention to iatrogenic premature infants.

Influencing factors of adrenocorticotrophic hormone and cortisol in neonatal cord blood

ZHANG Gang, WANG Wen-ge, TANG Xue-wu

2019, 27(10):  1133-1135.  DOI: 10.11852/zgetbjzz2019-0644

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Objective To investigate the levels of adrenocorticotrophic hormone(ACTH) and cortisol(COR) in neonates,and to analyze the influencing factors,so as to provide evidence for the health care of neonates. Methods A total of 88 neonates born in the Obstetrical Department of Air Force Medical Center were enrolled in this study from October 2018 to February 2019. The levels of ACTH and COR in umbilical cord blood in 88 neonates were tested. And categorical regression method was used to analyze the effects of parturition mode,gestational age,gender,birth weight and maternal health during pregnancy on the levels of ACTH and COR in umbilical cord blood. Results The levels of ACTH and COR in 88 neonates were (172.11±93.93) pg/ml and (310.05±125.33) ng/ml,respectively. Single factor analysis showed that there were statistically significant differences on COR level of umbilical cord blood among neonates with different parturition modes and gestational age(P<0.01),while it was not significant on COR level among children with different gender,birth weight and maternal health during pregnancy(P＞0.05). Moreover,these variables had no significant influence on ACTH level(P＞0.05). The optimal scale regression analysis showed that parturition mode(β=-0.522),gender(β=-0.221),gestational age(β=0.284) and body weight(β=-0.260) had significant effects on the level of cord blood COR in neonates(P<0.05). Conclusion Parturition mode and gestational age are the main influencing factors of COR level in umbilical cord blood in healthy full-term newborns,while the gestational age,gender,birth weight and maternal pregnancy status involved in this study do not affect the level of ACTH.

Effects of early essential newborn care on the onset of lactogenesis among primiparaes

CUI Min, LIU Zhen-fang, WANG Ai-hua, ZHANG Xiao-yan, ZHANG Yuan-yuan, WANG Xue-lian

2019, 27(10):  1136-1139.  DOI: 10.11852/zgetbjzz2019-0013

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Objective To study the effect of early essential newborn care(EENC) after birth on neonatal first breastfeeding success rate,maternal onset of lactogenesis and exclusive breastfeeding rate during 72 h postpartum. Methods A total of 89 primiparas mother-infant pairs were recruited from a tertiary hospital in Shandong from June to July 2018,and were randomly divided into intervention group(n=45) and control group(n=44). The intervention group received the EENC,while the control group was given routine care. The neonatal first breastfeeding was scored after the postpartum by the Breastfeeding Measurement Tool(BAT).The onset time for maternal lactogenesis and the exclusive breastfeeding rate per 24 hours were recorded during the follow-up. Results The first breastfeeding score in intervention group(10.84±1.36) was significantly higher than that in control group(10.23±1.43)(t=-2.085,P=0.040). The onset time for lactogenesis of the intervention group[(48.51±10.71) h] was significantly earlier than that of the control group[(53.66±10.99) h] (t=2.238,P=0.028). Moreover,the exclusive breastfeeding rates in 24 hours(33.3% vs.13.6%),48 hours(51.1% vs. 29.5%) and 72 hours(71.1% vs. 50.0%) after delivery in intervention group were significantly higher than those in control group(χ²=4.788,4.295,4.155,P<0.05),but the differences on the successful rate of breastfeeding,and the onset rate of lactogenesis between the two groups were not significant(P＞0.05). Conclusion Early essential newborn care can promote the first breastfeeding score and maternal lactation,and effectively increase the early exclusive breastfeeding rate,which is worthy of widely use.

Investigation on influencing factors of childrens′ foreign body aspiration and parental awareness

SHENG Ying, LIANG Jian-min, REN Xiao-yong, LYU Hui

2019, 27(10):  1140-1142.  DOI: 10.11852/zgetbjzz2019-1205

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Objective To explore the influencing factors of foreign body aspiration (FBA) and parents′ knownledge regarding of FBA,and to provide theoretical basis for prevention and control of diseases. Methods A retrospective review was done in 202 patients who had FBA from October 2017 to January 2019 in the Second Affiliated Hospital of Xi′an Jiaotong University. During the same period,100 patients with acute laryngitis were recruited continuously as the control group. The questionnaire of parental awareness of children′s FBA was used to investigate the children’s parents about the knownledge related to FBA. Results Among the 202 children with FBA,86.2% were under 3 years old,with 1.85∶1 in male and female ratios,2.74∶1 in the ratio of urban and rural areas,and 68.4% of parents were under high school education. Wooden tracheobronchial foreign bodies were mainly in 191 cases (94.6%),including 158 cases (78.2%) of nuts and beans. The main causes was crying while having a meal (68.3%). Only 15.8% cases got effective treatment during the initial 24 hours after FBA. There were statistically significant differences in parents recognition of the types of foreign bodies,children′s eating patterns and the general cognition of FBA between FBA group and control group (χ²=4.47,5.32,11.17 respectively,P<0.05),with no significant difference in the cognition of FBA symptoms (χ²=0.61,P> 0.05). Conclusion Children′s FBA have obvious epidemic characteristics in age,gender,urban and rural areas,and caregivers′ educational level. Parents′ low cognition may be the main reason for the high incidence of FBA.

Analysis on the current status and influencing factors of difficulty in taking medicine for children

MIN Shuang-shuang, WEI Bing, LIAO Shi-e, JIANG Jing, ZHANG Ying-hui, LI Jian, WEI Ke-lun

2019, 27(10):  1143-1146.  DOI: 10.11852/zgetbjzz2018-1610

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Objective To know about the current status and influencing factors of difficulty in taking medicine for children,in order to provide evidence for improving medicine compliance of children. Methods A questionnaire survey was conducted in 600 children aged 6 months to 12 years in Northern Theater Command General Hospital from January to April 2018.Children were divided into difficulty in taking medicine group and without difficulty in taking medicine group according to the investigation Results.Statistical analysis was conducted on individual and family influencing factors and different intervention measures,then Logistic regression analysis was conducted on the meaningful factors. Results Totally 558 valid questionnaires were collected.Among 558 children,377(67.6%) children suffered from difficulty in taking medicine.And the rates of difficulty in taking medicine in children aged 6 months to 1 year,1 to 3 years,3 to 6 years and 6 to 12 years were 83.8%,68.0%,67.2% and 53.8%,respectively.Single factor analysis revealed that children′s age,parents′ education,occupation and intervention measures was significant factors for difficulty in taking medicine(P<0.05).Multivariate Logistic analysis showed that the children′s age,parents′ education were risk factors for difficulty in taking medicine,while taking intervention measures was a protective factor(P<0.05). Conclusion Difficulty in taking medicine is prevalent,and it is associated with children′s age,parents′ education and intervention measures.

Evaluation of the performance of genetic screening processor and setting the cut-off values in screening for congenital hypothyroidism in newborns

WANG Li-wen, NI Min, LIU Su-na, JIA Chen-lu, LUO Chun-wei, ZHAO De-hua

2019, 27(10):  1147-1150.  DOI: 10.11852/zgetbjzz2019-0210

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Objective To evaluate the feasibility of genetic screening processor(GSP) applied in the screening for congenital hypothyroidism(CH) in newborns by detecting thyroxine stimulating hormone(TSH) in blood, and to establish the cut-off value of TSH in screening for CH in newborns in Henan province.  Methods 1) The precision and accuracy of GSP were calculated by detecting the dired blood spots specimen of Centers for Disease Control and Prevention. The linear sample of 6 concentration gradient specimens was tested to calculate the linearity of GSP. 2) The samples of 1 273 newborns were tested by both Victor₂D 1420 and GSP, and the consistency of the two Methods was analyzed by paired t test. 3) The neonatal heel blood samples were collected and the TSH in the dried-blood spots was detected using the Perkin Elmer GSP test kit. TSH cut-off value was determined by the percentile method and the receiver operating characteristic(ROC) curve method. Results 1) The within-run coefficient of variation of GSP screening system was 4.32%—5.87%. The between-run variation was 4.45%—9.08%, which were less than 1/3 of the total error(TEa). The bias detected by the GSP system was -7.89%—0.12%, less than 1/2 TEa. The linear equation for observed TSH value by expected value was y=0.908x-0.915, and the correlation coefficient(R²) was 0.998. 2) The difference on TSH level in 1 273 neonatal samples detected by GSP and Victor₂D 1420 was statistically significant(t=7.764, P<0.01). 3) The cut-off value of TSH determined by percentile method of 99% confidence interval was 6.1 μU/ml and it was 6.45 μU/ml by the ROC curve method. Conclusion The quantitative performance of the GSP system can meet the laboratory requirements, and it is proved to be a feasible method for neonatal CH screening. However, the cut-off value of TSH needs to be reset to 6.1 μU /ml.