Table of Content

10 July 2020, Volume 28 Issue 7

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Progress in the treatment of inborn errors of metabolisms

ZHANG Yao

2020, 28(7):  721-724.  DOI: 10.11852/zgetbjzz2020-0873

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Inborn errors of metabolisms (IEMs) are a group of single-gene genetic diseases,characterized by abnormal metabolic pathways.With the popularization of neonatal metabolic screening,more and more IEMs are diagnosed and treated in time.According to the pathogenesis of IEMs,the treatment includes the reduction of substrates,removal of toxic metabolites,enzyme replacement therapy,enhancement of enzyme activity,cell or organ transplantation,and gene therapy.Therefore,many IEMs have been improved or even cured.However,some therapies are still in the stage of research,and more effective treatments are warranted.Prenatal diagnosis is an effective method to prevent IEMs.

Study on controllable factors of pregnancy in neonates with behavioral neurological development during pregnancy

YIN Xiao-guang, LIU Yang, XIE Jun, JIAO Xue-chun, YU Wan-qi, WANG Hui-qin, ZHU Peng

2020, 28(7):  725-728.  DOI: 10.11852/zgetbjzz2019-0592

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Objective To analyze the controllable factors affecting the outcome of neurobehavioral development in term neonates during pregnancy,in order to provide scientific basis for early prevention and intervention. Methods From April 2016 to March 2018,601 pairs of mothers and infants were randomly selected from Anhui Maternal and Child Health Hospital to evaluate the neurobehavioral development of newborns by neonatal behavioral neurological assessment (NBNA).The social demographic characteristics,health status and lifestyle of pregnant women were obtained by questionnaires. The multivariate Logistic regression analysis was used to analyze the influencing factors of neonatal neurobehavioral development. Results Among 601 full-term newborns,63 (10.5%) had abnormal NBNA scores.The risk of abnormal NBNA was significantly increased in pregnancy again within one year (OR=2.95,95%CI:1.30-6.68),early (OR=2.71,95%CI:2.46-5.02) or late (OR=2.70,95%CI:1.34-5.44)full-term infants,while the risk of abnormal NBNA was significantly reduced in pregnant women who took physical exercise at least once per week (OR=0.50,95%CI:0.28-0.88).The risk of neonatal NBNA abnormality was significantly lower in pregnant women with long gestation interval (OR=0.31,95%CI:0.11-0.86) and those with physical activity (OR=0.45,95%CI:0.20-0.98). Conclusion Pregnancy interval and physical activity during pregnancy are controllable factors affecting the behavioral neurological development of full-term newborns,which is of important public health significance in promoting fetal neurobehavioral development.

Association of the expression of miR-182 in amniotic fluid with intrauterine infection and brain injury in premature infants

ZHANG Qiang, LU Hong-yan, JIANG Feng, WANG Qiu-xia, JU Hui-min

2020, 28(7):  729-732.  DOI: 10.11852/zgetbjzz2019-1462

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Objective To study the association of the expression of micro-ribonucleic acid-182(miR-182) in amniotic fluid with intrauterine infection and brain injury in premature infants,in order to provide reference for predicting the occurrence of brain injury in preterm infants after intrauterine infection. Methods Totally 125 singleton infants with gestational age less than 34 weeks were included in this study in Affiliated Hospital of Jiangsu University from December 2015 to January 2019.10 ml amniotic fluid was collected by pregnant women at birth for pathological diagnosis.The contents of TNF-α,IL-1β,IL-10,TGF-β and IL-8 in amniotic fluid were detected by enzyme-linked immunosorbent assay.The expression of miR-182 in amniotic fluid was detected by real-time quantitative PCR.Placenta was examined by pathology to determine the presence of chorioamnionitis.All premature infants conducted brain imaging to detect brain damage at the right timing.All cases were divided into intrauterine infection group and non-intrauterine infection group according to clinical chorioamnionitis result. Results There were 60 cases in intrauterine infection group,including 20 cases (33%) with brain injury.And 65 cases were in non-intrauterine infection group,including 10 cases (15%) with brain injury.The levels of IL-1β,TNF-α,TGF-β,IL-8 and miR-182 in intrauterine infection group were significantly higher than that in non-intrauterine infection group except from IL-10 (t=8.04,17.23,17.37,15.56,4.90,18.13,P<0.001).The expression of miR-182 in amniotic fluid was significantly higher in intrauterine infection group combined with brain injury than that without brain infection,which was also higher in non-intrauterine infection group combined with brain injury(t=14.41,16.39,P＜0.05). Conclusion s The expression of miR-182 in amniotic fluid has synergistic effect with inflammatory cytokines in amniotic fluid.It is presumed that miR-182 in amniotic fluid can promote intrauterine infection and brain injury in premature infants,and can also predict brain damage in preterm infants after intrauterine infection when combined with cytokines.

Reference role of carpal bone age in the diagnosis of child growth hormone deficiency

ZHU Dan, YU Wen, XU Jian

2020, 28(7):  733-736.  DOI: 10.11852/zgetbjzz2019-1682

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Objective To analyze the role of carpal bone development evaluation in the diagnosis of growth hormone deficiency (GHD),in order to provide basis of diagnosis and treatment of GHD. Methods A total of 82 prepubescent short-statured children who had completed the growth hormone provocative test in child care clinic of International Peace Maternity and Child Health Hospital were enrolled in this study from January 2018 to June 2019,including 41 cases with GHD at chronological age of (5.78±1.49) years old and 41 cases with idiopathic short stature (ISS) at chronological age of (5.17±1.44) years old.Children's bone age was assessed using China 05 method.The ages of radius,ulna,and short (RUS) bone and carpal bone were compared with the chronological age respectively.ROC curve was used to evaluate its role in predicting GHD. Results The carpal bone age in GHD group [(3.88±1.68) years old]was significantly lower than that in ISS group [(4.75±1.47) years old](t=2.48,P<0.05),while significant difference was not found on RUS bone age between the two groups(P＞0.05).Significant delays in bone maturation were both observed in the GHD group using the carpal bone [(1.89±1.05) years old]and RUS bone [(1.13±0.78) years old]assessments,which were higher than those of ISS group [carpal bone:(0.41±1.02) years old,RUS bone:( 0.33±0.86 )years old](t=-4.48,-6.47,P＜0.05).The correlation between maturation delay and GHD in carpal bone (OR=4.208,95%CI:2.246-7.884, P＜0.01) was stronger than that in RUS bone (OR=3.311,95%CI:1.763-6.221, P＜0.01).ROC curve analysis showed that GHD was moderately predicted by the degree of carpal bone maturation delay (AUC=0.840,sensitivity:0.707,specificity:0.854, P＜0.01),and its prediction ability was better than that of RUS bone (AUC=0.746,sensitivity:0.683,specificity:0.756,P＜0.01). Conclusion s Hand bone maturation is helpful for the diagnosis of GHD in preadolescent children.Compared with RUS,carpal bone maturity may be a better reference index for the diagnosis of GHD.

Correlations between the expression of malondialdehyde and advanced oxidation protein product in fetal cord blood and fetal distress as well as adverse outcomes

LIU Yong-li

2020, 28(7):  737-739.  DOI: 10.11852/zgetbjzz2019-1096

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Objective To analyze the relationship between malondialdehyde (MDA) and advanced oxidation protein product (AOPP) expression in fetal cord blood and fetal distress as well as adverse outcomes,so as to provide basis for the prevention of fetal distress. Methods A total of 134 neonates with acute fetal distress in Shijiazhuang Maternity Hospital were selected as study group from August 2016 to August 2018,and 120 normal neonates were selected as control group.Umbilical arterial blood was collected immediately after delivery of the fetus to detect MDA and AOPP levels.Pearson analysis was used to analyze the correlation between umbilical arterial blood MDA,AOPP level and fetal distress,fetal distress duration,neonatal 1 min Apgar score and adverse pregnancy outcome. Results The levels of MDA and AOPP in the umbilical arterial blood of study group were significantly higher than those in control group (t=18.481,14.501,P<0.05).There were significant differences on the levels of MDA and AOPP in neonatal umbilical artery blood among control group,fetal distress duration group ≤30 min and the group>30 min (F=499.522,185.460,P＜0.05).The MDA and AOPP levels of new umbilical arterial blood increased significantly with the prolongation of fetal distress (P＜0.05).Compared with 0-3,4-7 and 8-10 at 1 min Apgar score,the levels of MDA and AOPP in neonatal arterial blood were statistically significant (F=777.902,234.601,P<0.05),with the highest score in group 0～3 and the lowest in group 8～10.Pearson analysis indicated that MDA and AOPP in neonatal umbilical arterial blood were significantly positively correlated with fetal distress and fetal distress duration(r=0.792,0.819,0.835,0.867,P＜0.01),and negatively related to neonatal 1 min Apgar score (r=-0.796,-0.763,P＜0.01).The levels of MDA and AOPP in umbilical arterial blood of neonates with aspiration pneumonia,hypoxic ischemic encephalopathy,neonatal asphyxia and death after delivery were significantly higher than those without corresponding adverse outcomes (P＜0.05). Conclusion MDA and AOPP levels in umbilical arterial blood are closely related to fetal distress,which can reflect the duration and extent of fetal distress.

Comparison of brainstem auditory evoked potential results between children with attention deficit hyperactivity disorder and autism spectrum disorder

HUANG Yi-ying, WANG Wen-qiang, WU Wei-ge, LI Yu-mei

2020, 28(7):  740-743.  DOI: 10.11852/zgetbjzz2019-0919

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Objective To explore whether there is abnormal brainstem auditory evoked potential (BAEP) in children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD),and to analyze the differences. Methods A total of 27 children with ADHD (53 ears) and 26 children with ASD (52 ears) aged 6 to 16 years old were selected as ADHD group and ASD group respectively in Xiamen Xian Yue Hospital from October 2018 to April 2019,meanwhile 50 healthy volunteers (100 ears) were recruited as the control group.BAEP was detected in ADHD group and ASD group by evoked potential instrument.The latency of Ⅰ,Ⅲ,Ⅴ waves,the interval of Ⅰ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ waves and the abnormal amplitude of Ⅰ,Ⅴ waves were analyzed and compared. Results Compared with the control group,the ADHD and ASD groups showed shorter Ⅰ-wave latency,shorter Ⅰ-Ⅴ interval,and higher I and Ⅴ amplitudes.The rate of shorter Ⅰ wave latency in ADHD group and ASD group was 5.66% and 25.00% respectively,and the rate of increasing amplitude of wave Ⅰ was 24.53% and 50.00% respectively,and the differences were statistically significant(χ²=7.601,7.294,P<0.05).Compared with ASD group,the I wave amplitude in the ADHD group significantly reduced,the Ⅴ wave amplitude and the Ⅴ/Ⅰ amplitude ratio significantly increased (Z=-2.491,-2.205,-3.140,P<0.05). Conclusion There are differences on auditory pathways between ADHD and ASD children,and the difference in Ⅴ/Ⅰ amplitude ratio can be used as an important objective indicator for the diagnosis of ADHD and ASD.

Application of test of infant motor performance in motor assessment of preterm infants

WANG Cheng-ju, HU Bin, QU Fu-xiang, HUANG Tian-qi, ZHANG Yu-ping

2020, 28(7):  744-747.  DOI: 10.11852/zgetbjzz2019-1770

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Objective To analyze the characteristics of motor development in preterm infants by using the test of infant motor performance (TIMP),and to compare the results of term infants of the same gestational age,so as to provide a reference for the clinical application of TIMP. Methods A total of 617 infants who visited the premature infant clinic and child health care clinic of the Second Affiliated Hospital of Army Medical University were enrolled in this study from July 2018 to June 2019.The general data and TIMP test result were collected and were compared retrospectively according to the different corrected age groups [40~41⁺⁶weeks (62 cases),44~45⁺⁶ weeks (285 cases),48~49⁺⁶ weeks (155 cases),and 52~53⁺⁶ weeks (115 cases)]. Results With the increase of weekly age,the total TIMP score of premature infants increased from 49.46±7.91 in the corrected age of 40~41⁺⁶weeks to 78.09±12.09 in the corrected age of 52~53⁺⁶ weeks,showing a gradually increasing trend (F=67.853,P＜0.001).The scores of observation items and elicited items also showed a gradually increasing trend,and the difference was statistically significant(F=12.811,65.360,P＜0.001).The elicited scores and total scores of preterm infants at the corrected age of 48~49 ⁺⁶ weeks and 52~53⁺⁶ weeks were significantly higher than those of term infants in the same group(t=2.487,2.238,1.906,2.008,P＜0.05). Conclusion s The Chinese version of TIMP can reflect the change of motor capacity of preterm infants in different age groups,and is suitable for motor assessment.Since there is significant difference on motor development between preterm infants and term infants,it is necessary to consider this particularity and select appropriate assessment tools and methods when assessing preterm infants' motor performance and the formulation of early intervention programs.

Effect and mechanism of down-regulation of Toll like receptor 4 mRNA on dendritic cell in hand-foot-mouth disease mice model

ZHANG Juan-li, WANG Chun-yang, CHEN Min, AN Jian-feng, YAN Qin-qin

2020, 28(7):  748-751.  DOI: 10.11852/zgetbjzz2020-0050

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Objective To explore the effect and mechanism of down-regulation of Toll like receptor 4(TLR4) mRNA on dendritic cell in hand-foot-mouth disease (HFMD) mice model,so as to provide reference for the prevention and treatment of HFMD. Methods Forty-five 12-day-old BALB/c suckling mice of SPF grade were selected to isolate and culture the dendritic cells.TLR4 siRNA sequence was designed and synthesized for cell infection.The suckling mice model of HFMD was established and divided into model group,down-regulated group and up-regulated group,with 15 animals in each group.Mice in the down-regulated group were intraperitoneally injected with dendritic cells that down-regulated TLR4 gene,and those in the up-regulated group were intraperitoneally injected with dendritic cells that up-regulated TLR4 gene,and the mice in the model group were intraperitoneally injected with the same amount of sterilized water.The proliferation and apoptosis of dendritic cells,the levels of serum interleukin-6 (IL-6),interleukin-12 (IL-12),tumor necrosis factor-α (TNF-α) and the expression of mitogen activated protein kinase (MAPK) pathway protein were detected and were compared among three groups. Results The proliferation rates of dendritic cells in the down-regulated group were lower than those in the up-regulated group at different time points (t=20.160,19.050,55.380,P<0.001).The apoptosis rates of dendritic cells in the down-regulated group at different time points were higher than those in the up-regulated group (t=34.740,84.570,48.020,P<0.001).The serum levels of IL-6,IL-12 and TNF-α in the down-regulated group were lower than those in the up-regulated group(t=39.330,12.660,33.690,P＜0.001).The expression levels of P-P38MAPK,p-JNK and p-ERK1/2 protein in the down-regulated group were lower than those in the up-regulated group (t=33.690,17.470,27.800,P＜0.001). Conclusion Down regulation of TLR4 mRNA can down regulating the expression of IL-6,IL-12 and TNF-α through inhibiting MAPK pathway activation and regulating pathway protein,thereby promoting the apoptosis of dendritic cells in HFMD mice.

Advances on the treatment of Prader-Willi syndrome

WANG Xin, QU Shu-qiang

2020, 28(7):  752-755.  DOI: 10.11852/zgetbjzz2019-1166

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Prader-willi syndrome is a complex multisystem anomaly caused by imprinted genetic defects in the patent-derived 15q11.2-13 region,which is characterized by a combination of endocrine,metabolic,cognitive,behavioral and psychiatric symptoms.Associated respiratory disorders are highly disruptive to patients' daily lives and are the most common cause of death.Compulsive behavior in order to obtain food can lead to morbid obesity,which has extremely detrimental effects on social function and quality of life.Therefore,reasonable and effective treatment can greatly improve the prognosis of children.

Characteristics and treatment progress of cerebral palsy complicated with mental retardaion

WANG Ting, LI Xiao-jie, ZHU Qiong, HUANG Yu-zhu

2020, 28(7):  756-758.  DOI: 10.11852/zgetbjzz2019-0991

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Researches on mental retardation in children with cerebral palsy have raised widespread concerns over the past decade,and have achieved some progress.This review would focus on this aspect.Researches at home and abroad mainly begin with neuroimaging,genetic metabolism,cognitive function,motor function and other aspects.It is found that neuroimaging has certain specificity in mental retardation in children with cerebral palsy,and the level of dyskinesia in children interacts with their level of intelligence.In terms of related treatments,it is generally believed that early intervention is the key to prevention and treatment,while traditional medicine in the motherland plays a unique therapeutic role.

Research advances on evaluation and intervention of salivation in children with cerebral palsy

YANG Ning

2020, 28(7):  759-762.  DOI: 10.11852/zgetbjzz2019-1165

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Cerebral palsy (CP) is a group of persistent central motor and postural disorder and motor limitation syndrome,which is caused by non-progressive brain damage in developing fetuses or infants.Salivation is one of the common symptoms of cerebral palsy.Saliva is acidic and infants' skin is delicate,so cheeks,jaws and other parts are often immersed,thereby causing skin redness or erosion.Over a long period of time,it can form odor,cause infection,and,of course,affect children's language development and swallowing function.Moreover,children will also be discriminated against by society in varying degrees.This paper reviews the current situation of evaluation and intervention methods of salivation in children with cerebral palsy.

Research progress on the treatment of Menkes disease

MAO Yu-ge, LI Yong-qin, QIN Jiong

2020, 28(7):  763-765.  DOI: 10.11852/zgetbjzz2019-1028

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Menkes disease is a rare X-linked recessive genetic disease caused by ATP7A gene mutation,with varying clinical symptoms.Present treatments mainly include copper supplement,antiepileptic therapy,gene therapy and support therapy.With the development of molecular genetics technology,progress has been made on the treatment of Menkes disease.This review aims to provide reference for the individualized treatment of this disease.

Research progress on oral motor intervention in premature infants

MENG Fan-zhe, WANG Jun

2020, 28(7):  766-768.  DOI: 10.11852/zgetbjzz2019-1104

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Due to the increase of premature infants year by year,oral feeding is becoming increasingly crucial as an important indicator to improve the survival quality of preterm infants.It is of great significance to use reasonable and effective intervention on oral movement of premature infant as an auxiliary means to promote the oral feeding.This paper summarizes the assessment methods,intervention methods,problems related to intervention and development prospects of premature infants' oral movement,in order to provide a new scheme for promoting the early realization of oral feeding in premature infants,thereby giving theoretical support for intervention on oral movement in premature infants.

Research progress on the sensitivity of reinforcement in children with attention deficit and hyperactivity disorder

XIAO Hong, LIU Bin, CAO Ai-hua

2020, 28(7):  769-773.  DOI: 10.11852/zgetbjzz2019-1401

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Attention deficit and hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood.Early neuropathological models mainly focused on inhibition deficit.Currently,attention has been paid to the motivation deficit and the rewarding mechanisms of ADHD.Based on this,it is suggested that the change of "sensitivity of reinforcement" may be an important reason of ADHD.The reinforcement sensitivity refers to the behavior which the change tendency and the range of the individual to the external stimulus,including reward sensitivity and penalty sensitivity.The neurobiological basis is the behavior approach system (BAS),the behavior inhibited system (BIS),and fight-flight-freeze system (FFFS).These three systems form the theory of reinforcement sensitivity to describe the character of personality.This review illustrates the concept of "sensitivity of reinforcement" and "the theory of reinforcement sensitivity",psychological measurement and experimental paradigm for sensitivity of reinforcement,the characteristics of sensitivity of reinforcement in ADHD children,and neuropathological models of altered sensitivity of reinforcement in ADHD in detail,thereby better explaining the core defects of ADHD.

Meta-analysis on the associations of reduced folate carrier A80G polymorphism with neural tube defects

WEI Hong, SONG Xi-yuan, LIU Xue, CAO Hui-ling, KONG Ling-ling, WANG Xu

2020, 28(7):  774-779.  DOI: 10.11852/zgetbjzz2019-1022

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Objective To systematically evaluate associations between gene polymorphism of maternal and offsprings' reduced folate carrier (RFC1) A80G and the risk of neural tube defects (NTDs),so as to provide evidence for the prevention of NTDs. Methods Case-control study on the correlation between RFC1 A80G polymorphism of maternal and /or offspring' with NTDs were searched in CBM,CNKI,Wan-Fang Data,Pubmed,Embase and Cochrane Library from establishment of the database to May 2019.And RevMan 5.3 software was used to analyze data. Results 1) There was significant association between maternal RFC1 A80G polymorphism and increasing risk of NTDs in Asia (GG vs.AA:OR=4.13,95%CI:1.97―8.67;GA vs.AA:OR=3.03,95%CI:1.72―5.32;GG+GA vs.AA:OR=3.25,95%CI:1.90―5.56;G vs.A:OR=1.94,95%CI:1.15―3.28).2) There was significant association between offsprings' RFC1 A80G poly morphism and increasing risk of NTDs in Asia (GG vs.AA:OR=2.20,95%CI:1.34―3.63;GG+GA vs.AA:OR=1.58,95%CI:1.02―2.46;GG vs.GA+AA:OR=1.89,95%CI:1.31―2.72;G vs.A:OR=1.55,95%CI:1.21―1.98). Conclusion Both maternal and offsprings' RFC1 A80G polymorphism are risk factors of NTDs in Asian population.

Evaluation of dietary therapy in 41 children with phenylketonuria

PEI Jing-jing, WANG Ran, GUO Bing-bing, WEI Ya-rong, JIANG Xin-ye

2020, 28(7):  780-783.  DOI: 10.11852/zgetbjzz2019-0553

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Objective To evaluate the physical and neuropsychological development of children with dietation-treated phenylketonuria (PKU). Methods A total of 41 PKU children with phenylalanine hydroxylase deficiency in Wuxi city from January 2004 to December 2014 were enrolled. Height (length),weight and neuropsychological development scale for children aged 0-6 years were monitored,and phenylalanine dietary control index was calculated. Results 1)The blood phenylalanine concentration of PKU children decreased significantly before and after treatment,with an average decrease(506.57±40.54) μmol/L,which was statistical significance (H=21.232, P＜0.05).2)Among children aged 6 months,1 year,2 years and 3 years,the medium level height and weight accounted for the most,the height accounted for 70.7%,65.9%,68.3% and 68.3%,respectively,and the medium weight accounted for 78.0%,73.2%,75.6% and 73.2%,respectively.3)There were no significant differences on the physical and neuropsychological between children of different ages and types of PKU(P>0.05).4)The level of neuropsychological development was negatively correlated with the diagnosis and treatment time,blood phenylalanine concentration and dietary control index of PKU children (r=-0.601,-0.838,-0.792,P <0.05). Conclusion PKU children treated with diet and standardized follow-up can maintain normal physical and neuropsychological development levels,which are affected by the time of diagnosis and treatment and the concentration of phenylalanine in blood.

Efficacy and intellectual influence of levetiracetam on children with benign epilepsy with central-sacral spine

ZHANG Xiao-long, ZHANG Yuan-da, HE Hua-fen, JI Chao-yu, YANG Xu, ZHANG Shao-hui

2020, 28(7):  784-786.  DOI: 10.11852/zgetbjzz2019-0832

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Objective To study the therapeutic efficacy and intellectual influence of levetiracetam on children with benign epilepsy with central-sacral spine,so as to provide scientific evidence for clinical treatment. Methods Totally 60 children with central pox epilepsy who underwent central fossa from August 2016 to July 2018 were enrolled in the study.All subjects were randomly divided into control group (n=30) and observation group (n=30) according to the envelope method.The control group was treated with carbamazepine,while the observation group was treated with levetiracetam.The clinical efficacy,P300 latency,intelligence level,visual and auditory attention,and adverse reaction rate were compared between the two groups. Results After treatment,the total clinical effective rate of the observation group was higher than that of the control group (96.67% vs.73.33%,P＜0.05).The incubation period of P300 was shorter than that of the control group,and the difference was statistically significant(t=3.527, P＜0.05).The language IQ,operational IQ,total IQ,the control quotient and attention quotient of visual stimulation and auditory stimulation in the observation group were higher than those in control group (t=9.186,2.347,3.143,2.113,4.171,2.052,3.592,P＜0.05).In terms of the incidence of adverse reactions,no significant difference was found between the two groups (P＞0.05). Conclusion Levetiracetam treatment can effectively control seizures in children with benign epilepsy with central-sacral region,and has a positive effect on P300 latency and intelligence level.

Application of general movements assessment combined with brain function monitoring in early diagnosis of neonatal brain injury

YUAN Dan, LIANG Yu-lan, CHEN Liang, LUO Jing, LI Mao, LEI Xiao-li, LI Hong-mei

2020, 28(7):  787-790.  DOI: 10.11852/zgetbjzz2019-0564

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Objective To explore the value of general movements (GMs) assessment combined with amplitude integrated electroencephalogram (aEEG) monitoring in the early diagnosis of neonatal brain injury. Methods A total of 82 high-risk neonates with brain injury born in Luzhou People's Hospital from August 2016 to January 2018 were enrolled in this study.All children were assessed twice by GMs before full term and 2 months after full term.Another assessment was conducted in 9 to 15 weeks after full-term,and all subjects were monitored for aEEG within 6 hours of birth.The results of GMs and aEEG and the diagnostic value of combined examination were observed. Results Among 82 neonates,3 (3.66%) cases were diagnosed with cerebral palsy by the gold standard,21(25.61%) cases had motor retardation,and 58(70.73%) cases had normal motor development.GMs result showed that 28 cases had abnormalities in torsional movement stage,including 23 cases of monotonic GMs (PR) abnormalities and 5 cases of spasmodic-synchronous GMs (CS) abnormalities.There were 5 cases had abnormalities in restless movement stage,of whom 3 cases were with cerebral palsy.Besides,aEEG test indicated that there were 24 mild abnormalities,6 severe abnormalities and 52 normal cases,with the total abnormality rate of 36.59% (30/82).The sensitivity and negative prediction value of GMs and aEEG for predicting cerebral palsy were both 100.00%,but its positive prediction value was low.Moreover,the sensitivity,specificity,and accuracy of predicting motor retardation separately were all higher than 80%.Additionally,the sensitivity,specificity,positive prediction value,negative prediction value,and diagnostic accuracy of the combination of GMs and aEEG were higher than those of single detection method. Conclusion GMs assessment combined with aEEG monitoring has high clinical predictive value for neonatal brain injury because of high sensitivity,specificity,and accuracy.

Anxiety and related factors after ventricular septal defect occlusion in children

MENG Ying, XIE Ai-ling, CHEN Mei

2020, 28(7):  791-793.  DOI: 10.11852/zgetbjzz2019-0585

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Objective To investigate the anxiety status of children after ventricular septal defect occlusion,and to analyze the related factors affecting the anxiety of children after ventricular septal defect occlusion. Methods A total of 186 children with congenital heart disease who underwent ventricular septal defect occlusion were assessed by modified Yale Perioperative Anxiety Scale (mYPAS) on admission day,1 day and 7 days after operation from March 2016 to February 2019. The causes of anxiety were investigated and the related factors of anxiety were analyzed. Results Compared with that at admission,the scores of each dimension and total scores of mYPAS in 1 and 7 days after operation were significantly higher than those at admission (F=10.247,9.551,8.781,11.362,7.051,6.995,P＜0.05). The total scores of mYPAS of pre-school children at admission,1 day after operation and 7 days after operation was significantly lower than those of school-age children (t=3.321,6.328,4.014,P < 0.05). Multivariate analysis showed that the influencing factors of anxiety on the first day after operation included age,fear of puncture pain,fear of operation process and fear of operation room/ward (R²＝0.66).The influencing factors of anxiety on the seventh day after operation included age,fear of operation room/ward,hemorrhage and hematoma(R²=0.59). Conclusion s Children with ventricular septal defect occlusion are prone to anxiety disorders. Fear of operating room/ward,postoperative hemorrhage and hematoma are the main factors affecting children's anxiety after ventricular septal defect occlusion.

Clinical efficacy of continuous positive airway pressure in the treatment of neonates with transient tachypnea of the newborn

PANG Wen-bin, YAN Qing-qing, YIN Yang-yan, FU Chui-shi, MENG Jing

2020, 28(7):  794-797.  DOI: 10.11852/zgetbjzz2019-0917

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Objective To investigate the clinical efficacy of nasal continuous positive airway pressure (CPAP) in the treatment of middle and late preterm infants with transient tachypnea of the newborn (TTN),in order to provide evidence for treatment of TTN in children. Methods A total of 41 preterm infants with TTN at gestational age of 32 to 37 weeks were enrolled in this study in the First Affiliated Hospital of Hainan Medical College from March 2018 to February 2019,and were randomly divided into observation group(n=20) and control group(n=21).Both of them took emergency pulmonary ultrasound and chest X-ray,and were treated with conventional therapy.Additionally,the observation group was given nasal CPAP (FiO₂ 21%,PEEP 4~6 cmH₂O),while the control group breathed air in the normal atmospheric pressure.The TTN clinical score,respiratory rate,percutaneous blood oxygen saturation,the hospitalization time,whether to start the emergency plan and complication at admission and after treatment in 30 minutes were compared between the two groups. Results There were significant differences on the total effective rate of treatment,the probability of starting emergency plan and TTN clinical score after 30 minutes of treatment between the observation group and the control group(χ²=5.236,8.912,t=-3.042,P<0.05).And there were significant differences on respiratory frequency,TTN clinical score and percutaneous oxygen saturation in the observation group and the control group (t=5.145, 3.608, 7.664,5.535,-4.260,-4.891,P<0.05).Also,significant difference was found on the incidence of complications between the two groups (P<0.05).The accuracy of ultrasonic diagnosis of TTN was 97.56%. Conclusion s Early application of CPAP (FiO₂ 21%,PEEP 4-6 cmH₂O) can significantly improve the symptoms of dyspnea in TTN premature infants and reduce the probability of oxygen use.The accuracy of ultrasonic diagnosis of TTN is high,ultrasonic testing is safe,radiation-free and easy to operate,which is worthy of promotion and application in NICU.

Study on the relationships between serum vitamin A and E levels and T cell   immunity in children with recurrent respiratory infection

ZHU Chang-long, WEI Hong, MA Xiao-yan

2020, 28(7):  798-800.  DOI: 10.11852/zgetbjzz2019-1783

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Objective To study on the relationships between serum vitamin A and E levels and thymus (T) cellular immunity in children with recurrent respiratory infection,in order to provide basis for clinical treatment. Methods A total of 60 children with recurrent respiratory infection admitted in Lu'an People's Hospital from March 2016 to August 2019 were enrolled in study group,and 53 healthy children were selected as control group.Serum vitamin A,vitamin E and T cellular immunological indicators of the two groups were detected and compared.Pearson correlation analysis was used to explore the relationship between serum vitamin A,E levels and T cellular immunity of children in the study group. Results The levels of vitamin A,cluster of differentiation (CD) CD3⁺,CD4⁺ and CD4⁺/CD8⁺ in the study group were significantly lower than those in control group,while the CD8⁺ in study group was significantly higher than that in control group (P<0.05).The vitamin E levels in the two groups were similar (P＞0.05).In the study group,the level of vitamin A was positively correlated with CD3⁺,CD4⁺ and CD4⁺/CD8⁺levels(r=0.769,0.814,0.795, P<0.05),and negatively correlated with the CD8⁺levels(r=-0.752,P<0.05).However,vitamin E level was not significantly related to the indexes of T cellular immunology(P＞0.05). Conclusion s There is a close correlation between serum vitamin A and T cell immunity in children with recurrent respiratory tract infection.The higher the serum vitamin A level,the stronger the T cell immunity,but there is no significant correlation between serum vitamin E and T cell immunity.

Effect of T tumor necrosis factor-induced protein 8 like-2 and immunoglobulin E on the occurrence and development of children with asthma

YU Yan-juan, ZHANG Ying-hui

2020, 28(7):  801-804.  DOI: 10.11852/zgetbjzz2019-1119

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Objective To analyze the effects of T tumor necrosis factor-induced protein 8 like-2(TIPE2) and immunoglobulin E(IgE) on the occurrence and development of asthma in children,in order to provide evidence for the diagnosis and treatment of children with asthma. Methods A total of 100 children with asthma treated in Zhengzhou Children's Hospital from January 2016 to December 2018 were enrolled in this study,and 98 children who took physical examinations at the same period were selected as control group.The expression levels of TIPE2 mRNA and protein,and the serum IgE level were tested in two groups of children,and the accuracy and sensitivity of various indicators were analyzed. Results The levels of TIPE2 mRNA and protein expression of mononuclear cells in patients with asthma were significantly lower than those in control group (t=15.165,21.265,P<0.001).The expression of IgE in asthma group was significantly higher than that in control group (t=138.139,P<0.001).The specificity and sensitivity of TIPE2 in combination with IgE for asthma diagnosis were significantly higher than those of only using TIPE2 or IgE for asthma diagnosis (χ²=14.624,13.455,18.000,14.559,P<0.001).After drug treatment,it was found that the expression level of TIPE2 in children with asthma increased significantly compared with that before treatment,while the expression of IgE decreased significantly (t=12.975,112.480,P<0.001). Conclusion s TIPE2 and IgE have important effects on the development of asthma children.The changes should be closely monitored during the treatment process,so as to provide new ideas for the diagnosis and treatment of asthma in children.

Study on vitamin D level and appropriate supplementary dose of full-term neonates in Wuxi

ZHANG Yan-yu, WANG Xiao-lei, ZHANG Le, CHEN Jing

2020, 28(7):  805-808.  DOI: 10.11852/zgetbjzz2019-1171

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Objective To investigate the nutritional status and influencing factors of neonatal vitamin D (VD) in Wuxi,in order to provide scientific basis for formulating the supplementation program suitable for neonates in this region. Methods A total of 347 full-term infants who were breastfed and aged≤7 days were selected in Wuxi Children's Hospital from March 2015 to March 2018.The serum 25-(OH)D level of the infants was tested,and those whose serum 25-(OH)D level≤50 nmol/L were divided into 400 U/d supplementation group and 800 U/d supplementation group.After six-week supplementation,25-(OH)D level of infants was retested.Mothers were investigated about their general situations and vitamin D intake in pregnancy by questionnaire. Results The proportions of vitamin D deficiency,insufficiency and sufficiency were 91.07%,8.07% and 0.86%,respectively.The serum levels of 25-(OH)D in neonates born in summer and autumn were significantly higher than those born in winter and spring(t=-3.467,P<0.05).Six weeks later,it was found that the overall level of serum 25-(OH)D increased,the proportion of vitamin D deficiency decreased (χ²=118.235,163.196, P<0.05).There was some correlation between the levels of calcium and vitamin D supplementation in mothers and 25-(OH)D level in infants(r=0.116,P=0.043). Conclusion s The vitamin D level of full-term newborns in Wuxi is generally deficient.In order to improve the situation,it is suggested to adjust the vitamin D supplementation dose of early-term newborns to 400-800 U/d for 6 weeks according to the supplementation of mothers during pregnancy.

Analysis of screening for neonatal inherited metabolic disorders by tandem mass spectrometry in parts of Sichuan province

ZHANG Ya-guo, SU Xing-yue, LI Ting, HU Qi, ZHOU Jing-yao, ZHANG Yu

2020, 28(7):  809-812.  DOI: 10.11852/zgetbjzz2020-0085

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Objective To explore the incidence and disease spectrum of neonatal inherited metabolic disorders (IMDs) in parts of Sichuan,so as to provide basis for determining the screening programs and making relevant policies by the government in future. Methods A total of 39 648 newborns in Sichuan were screened for IMDs by tandem mass spectrometry (non-derivative method),and the samples with abnormal initial screening results were recalled for reexamination.Those with abnormal reexamination results would be diagnosed by urine organic acid and gene analysis. Results A total of 39 648 newborns were screened,1 594(4.02%) of whom were abnormal in the initial screening.Eventually,9 kinds of 15 cases of IMDs were diagnosed,and the total positive predictive value was 1.05%,the total incidence was 1∶2 643.The confirmed diseases included 5 cases of short-chain acyl-CoA dehydrogenase deficiency(SCADD),2 cases of primary carnitine deficiency(PCD),2 cases of methylmalonic acidemia(MMA),1 case of propionic acidemia(PA),1 case of isovaleric acidemia(IVA),1 case of 2-methylbutyrylglycinuria(MBCD),1 case of 3-methylcrotonyl CoA carboxylase deficiency(MCCD),1 case of phenylalanine hydroxylase deficiency(PKU),1 case of neonatal intrahepatic cholestasis caused by citrin deficiency(NICCD). Conclusion s There are many kinds of IMDs with higher incidence in parts of Sichuan,of which short-chain acyl-CoA dehydrogenase deficiency is the most common.Therefore,newborn screening by tandem mass spectrometry is of great significance for the early detection and diagnosis of IMDs.

Study on the effects of different ventilation modes on respiratory support for premature infants after extubation by pulmonary surfactant

LI Ling-xiao, ZHAO Dan, MO Yan

2020, 28(7):  813-816.  DOI: 10.11852/zgetbjzz2019-0850

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Objective To compare clinical effects of different ventilation modes on respiratory support for premature infants after extubation by pulmonary surfactant (PS). Methods A total of 80 premature infants with neonatal respiratory distress syndrome (NRDS) treated in the Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region were enrolled from March 2017 to March 2019,and were divided into observation group(n=40) and control group(n=40) randomly.Both groups were given tracheal intubation,PS and pulling out tracheal intubation.The observation group was given synchronized nasal intermittent positive pressure ventilation (SNIPPV) for respiratory support,while control group received nasal continuous positive airway pressure (NCPAP) for support.The blood gas indexes,clinical indexes,invasive respiratory support rate and complications during treatment were compared between the two groups. Results At 1 h,12 h and 24 h after ventilation,partial pressure of carbon dioxide (PaCO₂) and oxygenation index (OI) in observation group were significantly lower than those in control group(P<0.05).And at 1 h and 12 h after ventilation,oxygen partial pressure (PaO₂) in observation group was significantly higher than that in control group (P<0.05).Moreover,the invasive respiratory support rate and the incidence of complications in observation group were significantly lower than those in control group during treatment (20.00% vs.52.50%;22.50% vs.47.50%) (χ²=9.141,5.495,P＜0.05).The invasive ventilation time,oxygen therapy time and hospitalization time in observation group were all shorter than those in control group (t=5.821,41.681,3.924,P<0.05). Conclusion Compared with NCPAP,SNIPPV can more effectively improve oxygenation of NRDS children,reduce CO₂ retention,shorten ventilation support time,milking time,hospitalization time,and reduce incidence of complications.

Effect of temperature control before mild hypothermia treatment on prognosis of neonatal hypoxic-ischemic encephalopathy

WANG Jin, HU Xu-hong

2020, 28(7):  817-819.  DOI: 10.11852/zgetbjzz2019-0758

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Objective To explore the influence of some links in clinical mild hypothermia on the short-term prognosis of neonatal hypoxic-ischemic encephalopathy (HIE),in order to provide scientific basis for the clinical treatment of HIE. Methods Data of mild hypothermia treatment of 90 children with moderate and severe HIE admitted in Chengdu Women's and Children's Central Hospital from August 3rd,2016 to December 31st,2018 were collected and analyzed retrospectively.There were 73 children with moderate HIE and 17 children with severe HIE.All cases were divided into two groups according to different time windows (6 h vs.12 h),and the 6 h group was divided into two groups according to whether being rewarmed or not.Amplitude integrated electroencephalogram (aEEG) data,hospitalization time and general clinical characteristics were collected before and after mild hypothermia treatment. Results Mild hypothermia therapy was started 6 hours and 6-12 hours after resuscitation of asphyxia,and there was significant difference on aEEG graph score between different time windows(5.54±2.06 vs.3.00±1.41,t=2.27,P＜0.05).The aEEG graph score of the active cooling group was higher 24 hours after the end of mild hypothermia treatment than that of the warm-keeping rewarming group (4.63±2.06 vs.7.00±1.00,t=-2.37,P＜0.05). Conclusion s Mild hypothermia therapy as soon as possible after resuscitation of asphyxia can increase aEEG waveform score after treatment and improve short-term prognosis to some extent.Further follow-up is warranted for long-term prognosis.

Comparison on application of Alberta Infant Motor Scale in the early intervention between preterm and full-term infants

DUAN Zhi-xian, BAI Hua

2020, 28(7):  820-822.  DOI: 10.11852/zgetbjzz2019-0546

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Objective To compare the application value of Alberta Infant Motor Scale (AIMS) in the early intervention between preterm and full-term infants. Methods A total of 182 infants aged 1 to 15 months were selected from the General Hospital of Ningxia Medical University from January to December 2018 and were divided into observation group(premature infant group,98 cases) and control group (full-term infant group,84 cases).According to AIMS evaluation results,early intervention was conducted.The two groups were evaluated again after 3-month early intervention by AIMS. Results There were significant differences between the two groups on AIMS scores of each position and total AIMS scores training(t=4.097,5.315,4.802,2.334,5.083,P＜0.05 or ＜0.001).There were no statistically significant difference between the two groups on AIMS percentiles after 3-month treatment(P=0.664). Conclusion AIMS plays acrucial rule in assessing the motor development of preterm infants and the early intervention programs can be made according to the assessmen result,So that it can be popularized in clinic.

Clinical study on the effect of whole body vibration training on motor function in children with spastic hemiplegia

YUN Guo-jun, LIANG Xian-rong, WANG Jing-gang, LIU Qing, LI Rui-hao, CAO Jian-guo

2020, 28(7):  823-826.  DOI: 10.11852/zgetbjzz2019-0833

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Objective To observe the effect of whole body vibration training on motor and balance function of children with spastic hemiplegia,so as to provide scientific basis for treatment of hemiplegic cerebral palsy. Methods A total of 44 children with spastic hemiplegia aged 2 to 4 years in Shenzhen Children's Hospital were enrolled in this study from September 2016 to September 2018,and were randomly divided into study group (n=24) and control group (n=20).Both groups were given three courses of exercise,homework,isokinetic and electromyographic biofeedback therapy.The study group was given whole body vibration training on the basis of routine training.Modified Ashworth Scale(MAS),plantar support area,plantar pressure,track length,peripheral area and rectangular area were used to evaluate the efficacy of whole body vibration training. Result After treatment,the MAS score,plantar pressure,plantar support area,track length,peripheral area and rectangular area of study group were significantly better than those of control group (t=7.89,5.87,4.98,7.81,3.56,5.67,P＜0.05). Conclusion Routine rehabilitation therapy combined with whole body vibration training can reduce spasm,improve gait and balance ability more effectively than routine rehabilitation therapy.

Effect of ankle-foot orthosis combined with rehabilitation therapy on the recovery of muscle tension in children with cerebral palsy

HAN Liang, GAO Chao

2020, 28(7):  827-829.  DOI: 10.11852/zgetbjzz2019-1213

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Objective To analyze the effect of ankle-foot orthosis (AFO) combined with rehabilitation therapy on the recovery of muscle tension in children with cerebral palsy (CP). Methods A total of 62 CP children in Children's Hospital Affiliated to Zhengzhou University were selected from March 2016 to October 2018.According to the different treatment methods,the patients were divided into control group and observation group,with 31 cases in each group.The control group received routine rehabilitation training,while the observation group was given AFO add itionally.The clinical effect of two groups was compared after treatment. Results There were no significant differences on gross motor function Measure (GMFM) score,muscle tension score and gait parameters between two groups before treatment (P＞0.05).After treatment,the GMFM score of observation group was significantly higher than that of control group (t=4.794,P＜0.001),while the adductor score,gastrocnemius score and hamstring score in observation group were significantly lower than those in control group (t=4.916,5.694,8.786,P＜0.001).Beside,the stride length,step speed,step length in observation group were higher than those in control group,while the stride frequency steps/min was lower than that in control group (t=2.235,2.247,5.271,7.454,P＜0.05). Conclusion Wearing AFO in CP children can improve the gross exercise ability,decrease the muscular tension and improve the walking ability of the children.

Investigation on early essential newborn care in county and township health facilities in four provinces of western China

QU Wen, WANG Yan, YUE Qing, LIU Wei-xin, MA Li-ting, LI Ning, YI Jia-ling, HUANG Xiao-na, TIAN Xiao-bo, XU Tao

2020, 28(7):  830-833.  DOI: 10.11852/zgetbjzz2019-1176

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Objective To investigate the current situation of early essential newborn care and related health care service in health facilities of four provinces in Western China,so as to provide basis for developing targeted intervention. Methods A mail survey was conducted to collect data in the midwifery health facilities of Guizhou,Qinghai,Sichuan,Ningxia from June 2017 to September 2018.Descriptive statistical analysis was used to compare implementation rates of early essential newborn care interventions.Chi-square test was used to compare rates among different level of facilities. Results Totally 233 health facilities from county and township participated in the study.1) In terms of perinatal care service,the surveillance rate of high-risk pregnancy (98.9%),the treatment rate of pregnancy with syphilis (97.9%),folic acid consumption rate of pregnant women (88.8%) were relatively high.The rate of antibiotics usage among mothers with premature rupture of membranes was relatively low (60.1%).2) In terms of newborn care service after delivery,the rate of skin-to-skin contact in 90 minutes after birth was 41.8%.Early initiation of breastfeeding rate in 1 hour after birth was 77.7%.And 24.7% of health facilities could implement kangaroo mother care for preterm newborns.3) In terms of the treatment for newborn common diseases,the proportion of facilities that could diagnose and treat neonatal sepsis and neonatal pneumonia was 33.5% and 47.8%,respectively.And the rate for newborn receiving intramuscular injection of vitamin K₁ was 69.8%. Conclusion s There are gaps between the current early essential newborn care and the WHO recommendations in health facilities of county and township in four provinces of Western China.So targeted interventions are suggested to be developed to address these gaps.