Table of Content

10 August 2021, Volume 29 Issue 8

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Expert Consersus

Expert consensus on growth and development follow-up management techniques for high-risk newborns discharged from NICU at 0-3 years old

Child Health Care Group, Pediatrician Branch, Chinese Medical Association

2021, 29(8):  809-814.  DOI: 10.11852/zgetbjzz2020-2035

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Professional Forum

Catch-up growth and catch-up fat of infants born small for gestational age

CHEN Jin-jin, WU Dan

2021, 29(8):  815-819.  DOI: 10.11852/zgetbjzz2021-0999

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Small for gestational age (SGA) infants have a predisposition to catch up growth and fat catch-up after birth. The onset of fat regrouping in SGA infants undergoing rapid catch-up growth is earlier than that in normal infants. It is not yet clear whether this predisposition is due to low birth weight itself, rapid postnatal catch-up growth, or a combination of both. Studies have focused on the impact of different catch-up growth patterns on long-term health outcomes. This article reviews the latest published research progress and reports the possible best catch-up growth model for SGA infants.

Original Articles

Effects of breastfeeding and artificial feeding on the prognosis of premature infants with white matter injure

PAN Wei-wei, TONG Xiao-mei, LI Zai-ling

2021, 29(8):  820-823.  DOI: 10.11852/zgetbjzz2020-1855

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Objective To analyze the effect of breastfeeding and artificial feeding on the prognosis of premature infants with white matter injury(WMI), in order to provide evidence for improving the prognosis of brain injury in preterm infants. Methods A retrospective study was conducted on cases of premature infants with WMI during the hospitalization in the neonatal ward of Peking University Third hospital from January 2014 to December 2018 and followed up at the Children's Health Development Center after discharge till corrected gestational age at 12 months. Then children were divided into breastfeeding group (n=69) and artificial feeding group (n=62). The gender, gestational age, birth weight, daily weight gain during hospitalization, hospitalization time, parenteral nutrition time, mechanical ventilation time, nosocomial infection rate and disease incidence rate during hospitalization were compared between breastfeeding group and artificial feeding group. Besides, the weight,total motor development quotient of Peabody Developmental Motor Scales(PMDS) and neuropsychological development score at the corrected gestational age of 2, 6 and 12 months old were compared between the two groups. Results Compared with those in the artificial feeding group, the nosocomial infection rate(25% vs. 58%) and the incidence of periventricular leukomalacia (11% vs. 39%) in breastfeeding group were significantly higher(χ²=4.431, 5.380, P<0.05). The total motor development quotient of the PMDS at the corrected age of 2 months old was significantly higher in the breastfeeding group (95.5±8.8 vs. 91.1±6.7, t=3.238, P＜0.05). Conclusion Breastfeeding plays a crucial role in improving the prognosis of WMI of preterm infants.

Analysis on the influencing factors of postoperative malnutrition in children with congenital heart disease and the quality of life

HU Li-shu, WEI Bing, LIAO Shi-e, ZHOU Nan, QI Shuang-hui, ZHANG Xu, FANG Min-hua

2021, 29(8):  824-828.  DOI: 10.11852/zgetbjzz2020-2155

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Objective To evaluate the incidence of postoperative malnutrition in children with congenital heart disease(CHD), and to analyze the influencing factors of malnutrition as well as its effect on postoperative quality of life. Methods From July 2016 to July 2020, a total of 312 children aged 2-12 years with previous cardiac surgery were selected from the Department of Cardiac Surgery, Department of Primary Cardiology and Department of Pediatrics in the General Hospital of the Northern Theater Command. Whether the subjects had malnutrition or not was assessed, and the general data of the children were collected to analyze the influencing factors of malnutrition. The Chinese PedsQL^TM3.0 Cardiology Module Scale and the PedsQL4.0 Universal Core Scale were used to evaluate the postoperative quality of life of CHD children aged 2 to 12 years. Results 1) The incidence of postoperative malnutrition in CHD children was 17.9%. 2) Multivariate Logistic regression analysis showed that the independent risk factors for postoperative malnutrition in CHD children included younger age, complex type of heart disease, surgical treatment, poor family economic status, family residence in rural areas, parents with primary or junior high school education (P<0.05). 3) The scores of heart problems and symptoms, perceived physical appearance, treatment anxiety and cognitive psychological problems in the PedsQL^TM3.0 Scale in the malnutrition group were all lower than those in the non-malnutrition group (P<0.05). The score of physiological function of children aged 2 to 4 years in the PedsQL4.0 Scale of malnutrition group was lower than that of the non-malnutrition group (P<0.05). The scores of four subscales and total scores of PedsQL4.0 quality of life in children aged 5 to 12 years in the malnutrition group were lower than those in the non-malnutrition group (P<0.05). Conclusion Children with CHD have high probability of malnutrition and poor quality of life, which are affected by many factors, and should be paid more attention to.

Mediating effects of self-acceptance and parenting style on the association between gender roles and social anxiety of junior and senior high school students

WANG Bing, CAO Jian-qin, ZENG Cong

2021, 29(8):  829-833.  DOI: 10.11852/zgetbjzz2021-0491

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Objective To explore the relationship between gender roles and social anxiety of middle and high school students,and to analyze the mediating effects of self-acceptance and the moderating effects of parental rearing styles on the association between gender roles and social anxiety. Method The Bem Sex Role Inventory(BSRI),Interaction Anxious Scale(IAS),Self Acceptance Questionnaire(SAQ)and Egna Minnen Barndoms Uppfostran(EMBU)were used to investigate 2 399 junior and senior high school students from 9 schools in Daqing city in October 2018. Results The proportion of androgynous,masculine,feminine and undifferentiated in junior and senior high school students was 874(36.43%),378(15.76%),343(14.30%)and 804(33.51%).Gender(male/female)and education background(junior/senior high school)significantly affected gender role distribution(χ²=45.35,9.44,P＜0.01).There were significant differences in IAS and SAQ scores among the four sex roles(F=127.15,79.11,P<0.001).Androgynous had the lowest IAS score and highest SAQ score,while that of feminine was the opposite.When taking androgyny as control,self-acceptance fully mediated the relationship between masculinity and relationship anxiety,and partially mediated the relationship between femininity and undifferentiated and relationship anxiety,with a mediating effect of 62.36%,56.67% and 70.30%.Potential profile analysis was used to divide parenting styles into three types:positive,mixed and negative.When negative parenting style was used as control,there were significant differences in the predictive effect of self-acceptance on interaction anxiety among different parenting style types(△R²=0.005,P<0.001).Specifically,the predictive effect of positive parenting style was better than that of negative parenting style(β=0.33,P<0.001). Conclusions The level of self-acceptance of individuals with different gender roles can predict their level of social anxiety,but the effect of self-acceptance on social anxiety is different in different types of parenting styles.Therefore,when reducing the risk of social anxiety by improving the level of self-acceptance of junior and high school students,parents should adopt more positive parenting methods to facilitate self-acceptance.

Comparison of clinical characteristics of twin premature infants between assisted reproductive technology conception and natural conception

LIU Ya-xuan, DUAN Wen-li, WANG Yin-juan, ZHANG Yi, ZHANG Ru, JIN Xin-yun, XU Fa-lin

2021, 29(8):  834-837.  DOI: 10.11852/zgetbjzz2020-1862

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Objective To analyze the differences in clinical characteristics of twin premature infants between assisted reproductive technology (ART) conception and natural conception,in order to provide reference for perinatal healthcare. Methods A total of 2 900 twin premature infants delivered in 53 hospitals in 17 cities of Henan Province from January 1st,2019 to December 31st,2019 were selected as participants,and were divided into ART conception group (n=604) and natural conception group (n=2 296). The infants' general characteristics,complications,treatment and outcomes,as well as their mothers' perinatal conditions were compared and analyzed. Results The average age,the proportion of advanced age,the utilization rate of antenatal corticosteroid and cesarean section rate of the ART group were higher than those in the natural conception group (t=7.254,χ²=10.319,7.735,4.855,P<0.05). And the incidence rates of gestational hypertension and gestational diabetes in the ART group were significantly higher than those in the natural conception group (χ²=23.664,54.040,P＜0.01). The average gestational age of preterm infants in the ART group was lower than that in the natural conception group,and the ratio of gestational age less than 34 weeks and the asphyxia rate were higher than those in the natural conception group (t=-2.298,χ²=8.780,6.315,P＜0.05). But there were no significant differences in the main complications,treatment and outcomes between the two groups (P>0.05). Conclusions The maternal age,the proportion of advanced age,the incidence of gestational hypertension and gestational diabetes of the ART are higher than those of natural pregnancy. But ART does not increase the risk of short-term adverse outcomes for twin preterm infants. In view of the small gestational age and high suffocation rate of the twin preterm infants,the infants should be paid close attention during perinatal care and management.

Construction of nomogram model for personalized prediction of neonatal necrotizing enterocolitis

LIU Yan-xia, LIN Ze-bin, HE Bo, ZHENG Zhu-ling

2021, 29(8):  838-842.  DOI: 10.11852/zgetbjzz2020-1901

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Objective To explore the construction of nomogram model for personalized prediction of neonatal necrotizing enterocolitis (NEC) risk,in order to provide scientific reference for the treatment and prevention of neonatal NEC. Methods The clinical data of 1 173 newborns delivered in Hainan Modern Women's and Children's Hospital and the outer hospital from October 2017 to December 2019 were retrospectively collected and analyzed,and were divided into NEC group(n=46) and non-NEC group(n=1 127). Logistic regression model was used to analyze the independent risk factors of NEC. Based on the selected independent risk factors,the nomogram model of NEC risk was constructed by R software,the area under ROC curve was used to test the prediction effect of the model,and the fit goodness was verified. Results The incidence of neonatal NEC was 3.92% (46/1 173). Multivariate Logistic regression analysis showed that gestational age ＜32 weeks(OR=3.186),birth weight ＜1.5 kg (OR=2.250),septic shock(OR=2.517),septicemia(OR=2.566),gestational diabetes mellitus(OR=1.973) and artificial feeding(OR=2.267) were independent risk factors of neonatal NEC(P<0.05),and prenatal use of dexamethasone was a protective factor (OR=0.475,P＜0.05). The area under ROC curve in this prediction model was 0.741. Hosmer-Lemeshow goodness-of-fit test showed good fit (χ²=7.859,P=0.447). The calibration curve of nomogram was a straight line with slope close to 1. Conclusions The nomogram model for personalized predicting the risk of neonatal NEC has good discrimination and accuracy. It can effectively evaluate the occurrence probability of neonatal NEC,and can provide certain guidance value for the prevention and treatment of neonatal NEC.

Quality of life and its influencing factors in children and adolescents with congenital adrenal hyperplasia

YU Li-rong, DU Xiang-ping, WU Xian, YUAN Yi, YANG Yu, YU Zhen

2021, 29(8):  843-847.  DOI: 10.11852/zgetbjzz2020-2141

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Objective To investigate the quality of life and its influencing factors in children and adolescents with congenital adrenal hyperplasia(CAH),so as to provide evidence for improving their quality of life. Methods From January 2013 to December 2018,a total of 48 children and adolescents with CAH aged 5 to 18 years in Jiangxi Provincial Children's Hospital and their parents were investigated by using the Pediatric Quality of Life Inventory Measurement Models 4.0(PedsQL4.0).Meanwhile 119 healthy children and adolescents aged 5 to 18 years and their parents were selected as control group.SPSS 22.0 software was used for statistical analysis. Results Significant differences existed between CAH children and healthy controls in social function(self-report:t=2.711,caregivers proxy-report:t=3.048),school performance(self-report: t=2.718,caregivers proxy-report: t=4.671),social psychological function(self-report: t=3.674,caregivers proxy-report: t=5.587)and total scores(self-report: t=4.026,caregivers proxy-report: t=5.342)(P<0.05).There was no significant difference in health-related quality of life between male and female children and adolescents with CAH(P>0.05).The scores of each domain of PedsQL in CAH children and adolescents with poor hormone control,complications and no regular follow-up were significantly lower than those in the normal control group(P<0.05).CAH children who were older and with longer course had lower scores in each domains. Conclusions The quality of life of children and adolescents with CAH is significantly impaired,especially in children and adolescents with poor hormone control,complications,no regular follow-up,long course of disease and old age,which needs more attention from society and family.

Study on the reliability and validity of 3- to 6-year-old Children's General Physical Activity Scale

HE Yan-lu, XIE Ya-chun, LIU Feng, CHEN Wei-ding, YANG Zhi-yong, ZHANG Guang-bao, HONG Qin, CHI Xia, TONG Mei-ling

2021, 29(8):  848-851.  DOI: 10.11852/zgetbjzz2021-0122

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Objective To assess the reliability and validity of 3- to 6-year-old Children's General Physical Activity Scale, so as to provide reference for the establishment of national norm and clinical application. Methods With stratified cluster random sampling method, 210 children from 3 kindergartens in Nanjing were tested to analyze and evaluate the reliability and validity of the scale.Cronbach's α coefficient, half reliability coefficient, test-retest reliability coefficient and intraclass correlation coefficient (ICC) were used to evaluate the internal and external reliability of the scale.Exploratory factor analysis was used to evaluate the construct validity of the scale.The content validity was evaluated by expert argumentation and related analysis.Using Peabody Developmental Motor Scales-2 (PDMS-2) as the calibration standard, the correlation between the scores of the two scales in 30 children was analyzed to evaluate the correlation validity of the calibration standard. Results The Cronbach's α value of the scale was 0.815, the Guttman half-split coefficient was 0.804, the test-retest reliability was 0.91, and the rater reliability was 0.994.The KMO measure of sampling adequacy was 0.783.The correlation coefficient between total score and each dimension score ranged from 0.596 to 0.721.Except the body flexibility, the ability of children in each item showed an increasing trend with age (F=6.070—65.355,P<0.01).The total standard score of 3- to 6-year-old Children's General Physical Activity Scale was positively correlated with the standard score of PDMS-2 (r=0.552, P=0.002).There were significant differences in each dimension between the typically developed group and the motor delay group (t=4.536—16.072, P<0.01). Conclusion 3- to 6-year-old Children's General Physical Activity Scale has acceptable reliability and validity, reaching the basic psychometric demands, which can be used to make the norm.

Basic Expeximental Artictes

Study on the expression of NLRP3 and related inflammatory factors in necrotizing enterocolitis in newborn rats

ZHAO Ming, QIN Miao, SUN Meng-ya, JIANG Hong, LI Xiang-hong, JIANG Jian, LIU Yan

2021, 29(8):  852-856.  DOI: 10.11852/zgetbjzz2020-1858

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Objective To investigate the expression level of nucleotide-binding oligomerization domain like receptor protein 3(NLRP3) and related inflammatory factors in newborn rats with necrotizing enterocolitis. Methods Twenty-four 3-day-old Sprague-Dawley (SD) rats were selected and randomly divided into control group (n=12) and experimental group (n=12). The rats were decapitated on the seventh day of life, their intestinal tissues of the caecal part were retrieved for related indexes. HE staining was used to observe the changes of ileocecal intestinal histopathology and double-blind method was used to score the pathology. Apoptosis in ileocecal tissue was observed by TUNEL staining. The ultrastructure of cells was observed by electron microscopy. IL-18, IL-1β and IL-6 levels were detected by ELISA. The expression levels of Caspase-1, Bcl-2 and Bim were detected by Western-blot, and NLRP3 mRNA level was detected by RT-PCR. Results 1) HE staining showed that the intestinal wall villi of rats in the experimental group were seriously damaged, most of the villi were broken in the middle and roots, and some of the crypts could not be recognized with visible wall necrosis. The intestinal wall villi damage in the control group was less than that in the experimental group. 2) TUNEL staining showed that the number of apoptosis increased in the ileocecal tissue of the experimental group and decreased in the control group (t＝30.54,P<0.05). 3) Under electron microscope, mitochondria of the experimental group were swollen, the ridge structure was disordered, and some brittle fractures were observed. Mitochondrial injury in control group was significantly reduced compared with that in experimental group. 4) The expression levels of IL-18, IL-1β and IL-6 in the ileocecal tissues of rats in the experimental group was significantly increased compared with those in the control group (t=23.38, 29.78, 26.90, P<0.05). 5) The expression levels of Caspase-1 and Bim in the experimental group were significantly higher than those in the control group (t=15.12, 5.82, P<0.05), while Bcl-2 expression was significantly lower in the experimental group(t＝6.03, P<0.05). 6) The mRNA expression level of NLRP3 in the experimental group was significantly higher than that in the control group (t＝9.21, P<0.05). Conclusions NLRP3 plays a crucial role in the development of NEC in newborn rats. Blocking the activation of NLRP3 is expected to be an effective way to prevent neonatal NEC.

Review

Research progress on the neurobiochemical and immunological mechanism of vitamin D in tic disorders of children

YANG Xiao-yan, HOU Cheng, YI Ming-ji

2021, 29(8):  857-860.  DOI: 10.11852/zgetbjzz2020-0353

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Besides being a nutrient and a hormone,vitamin D is a neuroactive steroid.In addition to regulating calcium and phosphorus metabolism,as well as maintaining the health of teeth and bones,vitamin D has been shown to play several important roles in extra-skeletal system,such as affecting the normal development and function of the brain,regulating immunity and affecting metabolism.In recent years,some researches have shown that serum vitamin D level in children with tic disorders (TDs) was lower than that of the healthy controls.The mechanism of vitamin D deficiency on TDs in children may involve the following aspects,changing neurotransmitter concentration and disrupting the balance between various neurotransmitters in the CBGTC pathway and effecting body's immune function.This review aims to summarize the nutritional status of vitamin D in children with TDs and the neurobiochemical and immunological mechanisms of vitamin D in TDs.

Effect of folic acid supplementation during pregnancy on childhood asthma and allergic diseases

ZHANG Yao-yun, LIU Ju-fen

2021, 29(8):  861-864.  DOI: 10.11852/zgetbjzz2020-0512

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Asthma is a complex and heterogeneous chronic inflammatory disease with unclear pathogenesis.The risk factors of childhood asthma and allergic diseases have been the focus of research. As an essential nutrient, folic acid's supplementation during pregnancy can significantly reduce the risk of neural tube defects and other congenital abnormalities.At the same time, some studies have found that folic acid supplementation can affect the risk of asthma and allergic diseases in offspring.There are still some problems with the current researches.Meanwhile, further follow-up studies are warranted to explore the long-term health effects of folic acid supplementation.

Research progress on the relationship between attention-deficit/hyperactivity disorder and gut microbiota

WANG Ya-ping, DENG Lan-liu, LIU Rui-zhuo, CHEN Li

2021, 29(8):  865-868.  DOI: 10.11852/zgetbjzz2020-0802

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Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, which is characterized by inattention, hyperactivity and impulsivity that are not consistent with the developmental level, accompanied by functional impairment in social and academic performance.At present, the etiology of ADHD is not yet clear.It is generally believed that ADHD is a kind of behavioral disease caused by genetics, environment and their interaction, which may be related to dysfunction of the fronto-striatal brain and monoamine neurotransmitter system.Different gut microbiota can produce different neurotransmitters, participating in the regulation of the central nervous system through bidirectional communication of microbiota-gut-brain axis.Therefore, it will open up a new way for early intervention and treatment of ADHD.

Research progress on the association between iron and psychomotor development, cognitive function and neurobehavioral in children

ZHAO Chun, WANG Cheng-ju, HU Bin

2021, 29(8):  869-872.  DOI: 10.11852/zgetbjzz2020-0541

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Iron is an essential element of brain metabolism. Iron deficiency can cause changes in the temperate of neurotransmitters, decrease myelin production, damage synapses, and decline the function of the basal ganglia. Therefore, iron deficiency anemia can adversely affect psychomotor development and cognitive function and endanger the healthy development of infants. Understanding the relationship between iron deficiency and psychomotor development, cognitive function and neurobehavioral, clarifying the efficacy of iron supplementation and carrying out the test of serum iron content in child care is of great significance in formulating public health strategies for early prevention of iron deficiency.

Research progress of rhythmic auditory stimulation in improving gait of children with spastic cerebral palsy

XU Ye-tao, SHI Wei

2021, 29(8):  873-876.  DOI: 10.11852/zgetbjzz2020-0872

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Rhythmic auditory stimulation (RAS) can activate auditory center and brain motor area through certain external rhythmic stimulation (such as music and rhythm), control lower limb muscles to cooperate with rhythm training and adjust gait mode, so as to improve gait ability.RAS is a new rehabilitation method to improve the gait of spastic cerebral palsy children.The mechanism hypothesis includes rhythmic entrainment movement system motor auditory mechanism and motivation.RAS can effectively improve the gait parameters (step velocity and step length) and increase the range of the lower limbs' motion.In addition, different frequency and training time will affect the intervention effect.

Progress of neurodevelopmental characteristics and clinical diagnosis and treatment in premature infants

WANG Hua-qian, YAO Bao-zhen

2021, 29(8):  877-880.  DOI: 10.11852/zgetbjzz2020-0849

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With the improvement of medical treatment level, the survival rate of premature infants is continuously increasing.However, the surviving premature infants are more vulnerable to external adverse factors due to the imperfect development of various organs and systems, and face greater risks of various complications, especially neurodevelopmental injuries, such as cerebral palsy, cognitive disorders, autism and executive dysfunction, which bring heavy burdens to families, society and health systems.In this paper, the neurological development characteristics, neurological development assessment methods and early intervention measures of premature infants are systematically reviewed, so as to provide basis for clinical early and accurate identification of premature infants with neurological damage and individualized early intervention training for different premature infants, thereby improving the prognosis of premature infants.

Meta Analysis

Meta-analysis of the therapeutic effect of wax therapy for spastic cerebral palsy in children

XIE Wei-xiang, CHEN Shu, TAN Yu-hua, LI Ting

2021, 29(8):  881-885.  DOI: 10.11852/zgetbjzz2020-1310

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Objective To systematically evaluate the clinical effect of wax therapy on spastic cerebral palsy in children, in order to provide reference for the treatment of spastic cerebral palsy. Methods Studies on the clinical effect of wax therapy on spastic cerebral palsy published till December 31st, 2019 were systematically searched through CMB, CNKI and Wanfang,VIP,PubMed, Embase and Cochrane Library. Two evaluators performed document screening, data extraction and quality evaluation according to inclusion and exclusion criteria. Meta-analysis was performed by using the Review Manager 5.3 software. Results Totally 13 studies involving1 063 patients were included, with 552 cases in the wax therapy group and 511 cases were in the control group. Meta analysis result showed that the effective rate (OR=5.72, 95%CI: 3.6—9.11, Z=7.36, P＜0.001), MAS score (MD=0.54, 95%CI: 0.35—0.73, Z=5.57, P＜0.001), GMFM-88 score (MD=5.46,95%CI: 2.84—8.07, Z=4.09, P＜0.001), joint mobility (MD=10.89, 95%CI: 3.47—18.3, Z=2.88, P＜0.004) in the wax therapy group were significantly superior to the control group. Conclusions Wax therapy can improve clinical effectiveness, muscle spasm, grossmotor function and joint mobility of children with spastic cerebral palsy, and it is an effective method for treating spastic cerebral palsy. However, temperature should be strictly controlled during wax therapy.

Clinical Research

Cross-sectional survey on dental replacement and dental health in children in Qiqihar city

YANG Xiao-lei, LI Hong-jie, LIU Jing-hua, CHAO Hong, LI Gang, ZHOU Zhong-guang, LIU Ji-cheng

2021, 29(8):  886-890.  DOI: 10.11852/zgetbjzz2020-1737

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Objective To understand the current situation of children's oral replacement period,common dental health problems and influencing factors,and parents' knowledge of children's dental health,so as to provide basis for scientific maintenance of children's oral health. Methods A cross-sectional study was performed to select 1 023 children aged 4 to 7 years as participants in Qiqihar from January to May in 2019 by a stratified cluster sampling method. Common oral health problem and the influencing factors were investigated. Results A total of 435(42.52%) children were in the teeth replacement period in this survey. And 875 children took oral examination,founding that 266(30.4%) had dental caries. Logistic regression analysis showed that high frequency of drinks such as intake of juice(OR=2.254,95%CI:1.185—2.289,P＜0.05),often snacking before bed (OR=2.515,95%CI:1.437—4.403,P＜0.05) and no oral care after eating (OR=2.490,95%CI:1.412—4.390,P＜0.05) were the influencing factors of dental caries. Eating candy≥3 times/d(OR=3.924,95%CI:1.264—12.184,P＜0.05) and dessert for 1-2 times/d(OR=3.378,95%CI:1.219—9.361,P＜0.05) may be risk factors for children to enter teething earlier. Conclusions Some children's dental replacement period is earlier. Family factors,eating habits and lifestyle are the factors influencing children's dental health. Thus,parents are supposed to improve the understanding of children's oral health in order to protect children's oral health scientifically and reasonably.

Effect of early screen exposure on children's language development

XU Zhan-bin, NI Yu-fei, XU Xiao-jing, WANG Fei-ying, JIANG Cheng-cheng

2021, 29(8):  891-893.  DOI: 10.11852/zgetbjzz2020-1744

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Objective To explore the effect of early screen exposure on language development in children,so as to provide reference for the prevention of language development retardation in children. Methods In this study,a case-control study was conducted to evaluate the development of 54 children with language retardation in the case group and 56 children with typical development in the control group by Gesell Scale from January to December 2019. All participants were from 1 to 5 years old. The main caregivers of the children were investigated by a self-designed questionnaire to know about the early screen exposure. Results The proportion and duration of exposure to mobile phone/iPad in the control group was higher than those of exposure to TV. The proportion of children exposed to mobile phone/iPad and TV in the case group accounted for 88.9% and 81.5%,significantly higher than those in the control group (71.4% and 57.1%,P<0.05). The exposure time of mobile phone/iPad and TV in the case group was 38.0(15.0,60.0)] min/d,35(17.0,55.0)min/d,significantly higher than those in the control group [25.0(10.0,45.0)min/d,20(8.0,40.0)min/d,Z=2.936,2.438,P<0.05]. Logistic regression analysis showed that children's mobile phone/iPad exposure time≥30 min/d was a risk factor for language development retardation (OR=2.431,95%CI:3.188-12.723,P＜0.01). Conclusions Early exposure to mobile phones/iPad is a risk factor for language development retardation. Therefore,children's screen time for mobile phones and other electronic devices should be strictly limited,and more parent-child interactions are encouraged in order to promote children's health.

Effects of early specialized management on the growth and development and the incidence of anemia of premature infants

XIA Bin, WANG Jie, WANG Jie-yun, WANG Lan, YU Xiao-dan

2021, 29(8):  894-897.  DOI: 10.11852/zgetbjzz2020-1703

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Objective To investigate the effect of early specialized management on the growth and development of premature infants and the incidence of anemia,so as to provide reasonable basis for the follow-up management of premature infants. Methods In this study,120 premature infants,who were born in Changning Maternal and Infant Health Care Hospital of Shanghai from September 2017 to August 2018,were randomly selected,including 60 infants who were followed up at the special clinic for preterm infants and 60 infants followed up at other clinics in the Child Health Center. Specialized management was implemented in the study group, the premature infants in the control group were provided with routine child health care services. The weight,length,head circumference,catch-up growth,intelligence development,the incidence of iron deficiency and anemia were compared between the two groups at the corrected age of 12 months. Results At the corrected age of 12 months,the weight,length and appropriate catch-up growth rate in the study group were significantly greater than those in the control group (t=2.062,2.810,χ²=4.675,P＜0.05). There was no significant difference in head circumference between the two groups (P>0.05). The scores of fine motor skills,adaptability skills and language behavior in the study group were significantly higher than those in the control group (t=4.158,3.729,4.823,P＜0.05). However,there was no significant difference in gross motor skills and social competence between the two groups (P>0.05). The incidence of iron deficiency and anemia in the study group was significantly lower than that in the control group (χ²=4.093,4.183,P＜0.05). Conclusion Early specialized management can promote the physical and intelligence development of premature infants,and reduce the incidence of iron deficiency and anemia.

Correlation between intercellular adhesion factor-1 level and asthma severity, airway inflammation response in children

HAN Xu, WANG Shu-ju, GU Hua-li

2021, 29(8):  898-901.  DOI: 10.11852/zgetbjzz2020-1524

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Objective To explore the correlation between intercellular adhesion factor-1 (ICAM-1) and asthma severity,airway inflammation response in children,in order to provide scientific reference for early diagnosis and assessment of asthma. Methods The clinical data of 80 children with asthma admitted to Nanyang Central Hospital from August 2018 to July 2020 were retrospectively analyzed. According to different severity levels,children were divided into mild,moderate and severe asthma groups. And 80 healthy children who underwent physical examination in the hospital during the same period were enrolled as control group. The changes of ICAM-1 level in sputum of all groups were explored. The correlation between ICAM-1 and asthma severity,airway inflammation response was analyzed. Results The levels of sputum ICAM-1,interleukin-6 (IL-6),IL-13 and tumor necrosis factor (TNF-α) in asthma group were significantly higher than those in normal group (t＝40.251,27.532,48.393,23.096,P<0.05). The differences in levels of sputum ICAM-1,IL-6,IL-13 and TNF-α,as well as lung function indexes [vital capacity (VC),forced expiratory volume in the first second (FEV1),peak expiratory flow (PEF)] were statistically significant among children with different asthma severity levels (F=16.410,38.726,12.167,46.661,29.540,10.419,24.676,P<0.05). The levels of sputum ICAM-1,IL-6,IL-13 and TNF-α in severe asthma group were higher than those in mild and moderate asthma groups. FEV1,VC and PEF in severe and moderate asthma groups were lower than those in mild asthma group (P<0.05). Spearman correlation analysis showed that the level of sputum ICAM-1 was positively correlated with IL-6,IL-13,TNF-α and asthma severity (r=0.745,0.684,0.786,0.692,P<0.05),while negatively correlated with FEV1,VC and PEF (r=-0.457,-0.378,-0.692,P<0.05). Conclusions The level of sputum ICAM-1 in asthma children is higher than that in healthy children. Detecting the level of sputum ICAM-1 is of certain practical value in assessing disease severity and airway inflammation response.

Analysis of clinical characteristics and copy number variants of intellectual disabilities-epilepsy

JIAO Li-hua, ZHANG Jing, WANG Yu-zhen

2021, 29(8):  902-905.  DOI: 10.11852/zgetbjzz2020-1612

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Objective To analyze the clinical features and copy number variants (CNVs) of intellectual disabilities-epilepsy (ID-E), so as to provide basis for clinical treatment of the disease. Methods From January 2013 to January 2017, 60 children with ID-E admitted to Tangshan Maternal and Child Health Hospital were enrolled in the study, and their general clinical data were collected. Meanwhile, peripheral blood samples were collected from the children and their parents for whole exome CNVs testing, and the data were analyzed. Results Children with ID-E included in this study were mainly male (61.67%), aged 1 to 3 years (31.67%), with normal or slightly higher BMI (93.33%), with normal birth weight (86.67%), born naturally (90.00%). Moreover, most children with ID-E in this study were with severe ID impairment (83.33%), mainly characterized by growth retardation (76.67%) and expressive language disorder (68.33%).Therapeutic agents mainly included sodium valproate, and 31 children (51.67%) received dual therapy. The rate of better prognosis was 46.67%. Six (10.00%) of the 60 children with ID-E were detected with abnormal CNVs, including 2 cases diagnosed with known syndrome (Wolf-Hirschhorn syndrome, Smith-Magenis syndrome), 2 cases with pathogenic CNVs, 1 with CNVs, and 1 with clinically unknown CNVs. Parental origin analysis showed that the cause of clinically unknown CNVs was maternal, and the others were new mutations. Conclusions Children with ID-E have certain clinical characteristics. CNVs can be used as an important detection method for genetic epidemiological analysis of etiological factors of ID-E, which can help to clarify the cause of ID-E and guide the diagnosis and treatment.

Evaluation of breastfeeding quality improvement in very/extremely low birth weight infants

CHEN Chang-chun, ZHOU Qin, WANG Min, MEI Ying-zi, JIANG Shan-yu

2021, 29(8):  906-909.  DOI: 10.11852/zgetbjzz2020-1817

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Objective To analyze the effect of breastfeeding quality improvement on in very/extremely low birth weight infants, so as to provide effective measures for clinicians. Methods Totally 160 very/extremely low birth weight infants admitted in Wuxi Maternity and Child Health Care Hospital during January 2018 to December 2019 were analyzed. Newborns admitted in 2018 were selected into the control group, while those admitted in 2019 were enrolled in the intervention group receiving breastfeeding quality improvement measures. Feeding indexes were compared between the two groups. Results The onset time for pumping milk, fasting times, fasting days and intravenous nutrition time in intervention group were shorter than those in control group(t=2.007, 2.666, 2.222, 3.187, P＜0.05). But there were no significant differences in the lactation start time, the average daily number of milk pumps, the first breastfeeding time, the amount of mother's breast milk during hospitalization, the starting time of feeding, the duration of micro feeding, and the time for reaching full enteral feeding between the two groups(P>0.05). The rates of feeding intolerance and bronchopulmonary dysplasia in the intervention group were significantly higher than that in control group (χ²=4.368, 3.963, P＜0.05), but the differences were not significant on the rates of neonatal necrotizing enterocolitis, sepsis and neonatal cholestasis syndrome(P>0.05). Conclusion The improvement of breastfeeding quality can shorten the time of starting to pump milk and intravenous nutrition, reduce the times and days of fasting, reduce the incidence of feeding intolerance and bronchopulmonary dysplasia, which can provide effective measures for clinicians to treat very/extremely low birth weight infants.

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Influence of gestational age and postnatal age on thyroid function of preterm infants

HUANG Xun-bin, ZHOU Qiu-jing, FU Qing-song, CHENG Guo-qiang, QIU Hui-xian

2021, 29(8):  910-913.  DOI: 10.11852/zgetbjzz2020-2037

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Objective To analyze the influence of gestational age and postnatal age on thyroid function indexes in premature infants, in order to establish a reference interval for thyroid function for premature infants based on gestational age and postnatal age. Methods The levels of thyroid stimulating hormone (TSH), thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) of premature infants in neonatal department of Longgang Central Hospital from May 2017 to May 2020 were collected. Infants were divided into early preterm infants, mid-term premature infants and late premature infants according to gestational age and postnatal age. The levels of thyroid function index in each group were compared, and the changes of each index with gestational age and postnatal age were analyzed. Results A total of 497 premature infants were included. The early, mid-term and late premature infants were 206, 128, and 163 cases, respectively. 1) The levels of thyroid function indexes of early premature infants were significantly different from those of mid-late and late preterm infants(P＜0.05), but the difference was not significant between mid-late and late preterm infants(P＞0.05). 2) The T₄, FT₄ and T₃ levels of early preterm infants were significantly different among infants with different gestational ages(H=36.588, 32.381, 43.021, P<0.05), while the significant difference was not found in TSH level(P＞0.05). 3)The T₄, FT₄ and T₃ levels of premature infants were significantly different between 7—14 days group and 14—28 days group (Z=8.706, 6.904, 9.497,P＜0.05), but the significant difference was not found in TSH level(P＞0.05). 4) The T₄, FT₄, T₃ level of premature infants was positively correlated with gestational age and postnatal age, but the correlation was not significant between TSH level and gestational age and postnatal age. Conclusion The levels of T₄, FT₄ and T₃ in early preterm infants are positively correlated with gestational age and postnatal age, so the reference interval of thyroid function for preterm infants should be established based on gestational age and postnatal age.

Retrospective analysis of objective audiological examination results of 530 children

DING Wei, HOU Xiao-juan, LIU Jing, ZHANG Jin

2021, 29(8):  914-917.  DOI: 10.11852/zgetbjzz2020-1650

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Objective To analyze the objective hearing results of children with complaints of hearing or speech retardation in Xinjiang,in order to provide references for the development of children's hearing screening. Methods During January 2018 to December 2019,530 children with complaints of hearing or speech retardation were collected from Otolaryngology Department of People's Hospital of Xinjiang Uygur Autonomous Region. The objective hearing of children was evaluated by click evoked auditory brainstem response,tone-burst evoked auditory brainstem response,distortion product otoacoustic emissions and tympanometry. Results There were 161 children with normal hearing (30.38%) and 369 children with hearing loss (69.62%). Among them,35 cases (6.60%) had monaural hearing loss and 334 cases (63.02%) had binaural hearing loss,79.13% of them had severe or very severe hearing loss,and there was no statistically significant difference between the proportion of children with severe or very severe hearing loss among different ethnic groups (P>0.05). There were 318 cases of sensorineural hearing loss and 51 cases of conductive hearing loss. The mean age at diagnosis was (3.75±1.38) years old for 369 children with hearing loss,and the difference was statistically significant among Han,Uyghur,Kazakh and Hui(F=9.411,P<0.01),with Uyghur being significantly later than Han and Hui (P<0.01),and the Kazakhs being significantly later than the Uyghurs (P=0.007). But there was no statistically significant difference between Hui and Han (P＞0.05). Conclusions This region should establish a perfect network platform of hearing screening,diagnosis and treatment,and follow-up. At the same time,it is supposed to carry out children's hearing screening as soon as possible,so that more children with hearing loss can receive early detection,early diagnosis,and early intervention.

Analysis of serum specific IgE in children with allergic rhinitis in Dalian

JIANG Tao, LI Rui, HUA Na, LI Xian-hua

2021, 29(8):  918-921.  DOI: 10.11852/zgetbjzz2020-1724

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Objective To explore the distribution and characteristics of serum specific IgE of children with allergic rhinitis(AR) in Dalian,so as to provide reference for clinical diagnosis,treatment and epidemiological prevention of AR. Methods The serum specific IgE results of 312 patients with allergic rhinitis aged less than 14 years from August 2014 to July 2020 were analyzed. The distribution of allergens was compared in different groups by gender,number of allergenic positive cases,number of types of allergenic positive and detection time. Results The top three allergens included house dust mite/duster mite (34.1%),mugwormwood (18.6%) and cat (8.9%),while mutton (0.3%),peanut (0.6%) and crab (0.9%) ranked in the last three places. There were 126 patients positive to single allergen and 186 patients positive to double or more allergens(χ²=15.75,P=0.031). Double (47.8%),triple (26.3%) and quadruple (14.0%) were the most common allergens. Pearson correlation test showed that there was a negative correlation between the original number of allergens and the corresponding number of people (r =-0.800,P= 0.017). There was only 1 case with a maximum of 11 allergens positive. Among the patients with the highest proportion of dual allergens,house dust mite/duster mite + mugwort combination was the most,followed by house dust mite/duster mite + cat combination. The top three allergenic species with the most positive cases in both sexes were house dust mite/duster mite,mugwort and cats. The number of male patients positive to some allergens was higher than that in females,including mugworm,house dust mite/dust mite,house dust,dogs,hops,beef and shrimp(χ²=13.64,11.67,9.45,8.63,10.31,8.36,5.37,P＜0.05). Egg white allergen was positive in females more than that in females(χ²=18.67,P=0.027). The number of allergic patients was highest in September (31.41%),August (20.51%) and July (8.01%),when it was the late summer and early autumn in local area,accounting for 59.93% of the total number of patients in the whole year. The month with the lowest number of allergic patients was January (1.60%),March (1.60%) and February (1.88%),when it was the end of winter and the beginning of spring locally,accounting for only 5.08% of the annual number of patients. Conclusion As the common allergens of allergic rhinitis in children in Dalian area,mites,mugwormwood and cats allergens are more prevalent in late summer and early autumn,which should be the focus of local prevention and control.