Table of Content

10 June 2022, Volume 30 Issue 6

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Expert Commentary

Development of children's movement skills and the cultivation of exercise habits should be valued in early childhood development

TONG Mei-ling

2022, 30(6):  581-584.  DOI: 10.11852/zgetbjzz2022-0598

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As a crucial component of early childhood development, physical activity can facilitate the development of children's physical, mental and social abilities. Caregivers incorporate physical activities into daily nurturing care to progressively develop children's movement skills and to cultivate children's exercise habits, which contributes to early childhood development and children's long-term health, and is also an important move to upgrade population quality as well as to strengthen the country and individuals.

Professional Forum

Physical activity and early childhood development of preschool children

WANG Jian

2022, 30(6):  585-590.  DOI: 10.11852/zgetbjzz2022-0597

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Physical activity is the main form of play, games and daily life for preschool children and the important means of early nurturance, education and medical rehabilitation. It plays a positive and beneficial role in promoting the early brain, body, cognition, emotion and social development of children, shaping the overall life development trajectory and physical-mental health of children. This article highlights the latest research advances and future research perspectives in the areas of physical activity and early physical development, brain, cognitive development and social development.

Exercise ability and early childhood development

GUO Jian-jun, WANG Chao

2022, 30(6):  591-593.  DOI: 10.11852/zgetbjzz2022-0565

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Early childhood development is crucial for the wellbeing and health of individuals in adulthood and even in old age. It has attracted more and more concerns from society. This paper summarizes the role of motor ability development in early education from the perspective of early physical growth, intellectual development, neuropsychological development and its effect on the intervention of special children's diseases, in order to find pathways and directions to promote children's healthy growth.

Original Articles

Chinese norm of General Physical Activity Scale for children aged 3 to 6

HE Yan-lu, YANG Zhi-yong, LIU Feng, DONG Wen-hong, KUANG Xiao-ni, ZHANG Xue-jiao, WANG Nian-rong, LUO Yan,YANG Lin, WANG Xiao-juan, WU Jian-xin, ZHANG Ting, ZHU Zong-han, WANG Jian, GUAN Hong-yan, TONG Mei-ling

2022, 30(6):  594-598.  DOI: 10.11852/zgetbjzz2021-1495

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Objective To establish Chinese norm of General Physical Activity Scale for children aged 3 to 6, and to explore its cut-off score for the norm, thus to provide a practical tool for clinical application.Methods From August 2020 to May 2021, a stratified cluster sampling approach was utilized to recruit 1 616 children aged 3 to 6 years from eight cities in six major administrative regions of China. The norm distribution and scores were analyzed, and its cut-off score was discussed.Results The scores of each dimension was significantly different among eight cities(F=10.964 - 117.766, P<0.001). The area under the receiver operating characteristic curve of the total score of the scale is 0.937(95%CI:0.916 - 0.957). The maximum Yuden Index(YI) was 0.74, and the corresponding total score was in the 17th percentile(P₁₇) in the norm, with the sensitivity of 0.871 and specificity of 0.864. When P₁₅ (76)and P₂₀(80)were taken as the threshold point, the corresponding YI was 0.69 and 0.72, respectively, and the sensitivity and specificity were both above 0.8.Conclusions The norm sample of this study is representative, and the cut-off score is appropriate, which can be popularized and applied in clinic practice.

Follow-up study on the neuropsychological development of 1 042 children at the age of 2 years old

TANG Liang, LIANG Jing-jing, SONG Yan-yan

2022, 30(6):  599-602.  DOI: 10.11852/zgetbjzz2021-0866

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Objective To analyze the neuropsychological development of children at the age of 2 years old, in order to provide reference for promoting the early development of children.Methods 1 042 children who were regularly followed up in the Early Childhood Development Clinic of Guangzhou Women and Children's Medical Center were selected into this study, and were divided into four groups according to their gestational age, including early preterm infants (28~33⁺⁶ weeks), late preterm infants (34~36⁺⁶ weeks), early term infants (37~38⁺⁶ weeks), and full term infants (39~41⁺⁶ weeks).Gesell Development Scale was used to assess their neuropsychological development at the corrected age of 2 years old.Results There were statistically significant differences in the development quotients (DQ) of adaptability, gross motor and fine motor among the four groups (F=3.152, 2.821, 5.256, P＜0.05).Pair comparison among groups showed that the DQ of adaptability, gross motor and fine motor of early preterm infants were lower than those of early term infants and full term infants, and late preterm infants were lower than full term infants in terms of fine motor (P＜0.05).The incidence rates of neuropsychological development delay (DQ<85) in gross motor and fine motor among the four groups were significantly different (χ²=12.440, 27.128, P<0.05), and the risk ranged from low to high group was as follows: full term infants<early term infants<late preterm infants<early preterm infants.Compared with full term infants, late preterm infants had an increased risk of fine motor developmental delay at 2 years old (OR=1.809,95%CI:1.102 - 2.970, P<0.05).Conclusions Early preterm infants and late preterm infants have different degrees of neuropsychological developmental delay at the age of 2 years old.So it is necessary to extend follow-up and strengthen intervention.

Effect of Peabody Developmental Motor Scales and the motor activities program in early intervention of children with motor development retardation

ZHOU Feng, JIANG Li-yan, GAO Ping-ping

2022, 30(6):  603-606.  DOI: 10.11852/zgetbjzz2021-0674

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Objective To study the early intervention effect of Peabody Developmental Motor Scales 2 (PDMS-2) and the motor activities program in children with motor development retardation, so as to provide scientific reference for the early intervention of motor development retardation.Methods From June 2019 to June 2020, a total of 101 children diagnosed with motor development retardation who met the inclusion and exclusion criteria were selected into this study, and were divided into the intervention group (n=51) and control group (n=50) according to different training methods. Both groups received routine early intervention training. Children in the observation group received motor activities program additionally based on the evaluation results of PDMS-2. After a course of treatment, PDMS-2 was used to evaluate the motor function of children in two groups, and the PDMS-2 evaluation results before and after intervention were compared between the two groups.Results Before intervention, there were no significant differences in gross motor quotient (GMQ), fine motor quotient (FMQ) and total motor quotient (TMQ) between the intervention group and control group (P>0.05). GMQ, FMQ and TMQ of the intervention group were significantly improved after intervention(t=4.00, 3.17, 3.97, P＜0.01), which were also significantly higher than those in the control group after intervention (t=2.13, 2.04, 2.44, P<0.05). Before intervention, the proportion of children with fine or gross movement deviation was significantly different between groups (χ²=2.60, P<0.05).Which was significant difference before and after intervention in the intervention group(χ²=7.71,P<0.01), but which was not significantly different before and afterinterventionin the control group(χ²=3.73,P>0.05). Conclusion PDMS-2 and the motor activities program in the early intervention training can effectively improve the development of motor function of children with motor development retardation

Research on the combination of nurturing care by medical, nursing, education and family parenting in promoting the development of high-risk premature infants

WANG Cheng-qun, XU Hai-qing, WANG Hong, YUAN Li, ZHOU Ai-qin, LI Ming-hui

2022, 30(6):  607-611.  DOI: 10.11852/zgetbjzz2021-0843

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Objective To evaluate the effect of the combination of nurturing care by medical, nursing, education and family parenting in promoting the development of preterm infants, so as to provide basis for the follow-up monitoring of high-risk preterm infants. Methods A retrospective analysis was conducted in 71 cases of high-risk premature infants followed up in Hubei Maternal and Child Health Hospital from January 2017 to June 2018.Infants followed up in early development clinic were selected into the study group, those followed up in general outpatient clinic were enrolled in the control group. Infants in the study group adopted medical-nursing-education-family parenting intervention, while children in the control group were given conventional guidance. Physical development and neuropsychological development levels of high-risk premature infants within 12 months of corrected age were dynamically monitored and compared between the two groups. Results The difference between the study group and the control group at 1 month of corrected age was only significant in body weight (t=4.709, P<0.05). At the corrected age of 3, 6 and 12 months, the body length, body weight, head circumference, mental development index (MDI) and psychological development index (PDI) of infants in the study group were significantly higher than those in the control group(P＜0.05). Time effects, within-group effects and interactions for length, weight, head circumference, MDI and PDI scores were statistically significant between the two groups (P< 0.05).Compared with the control group, the pass rate of 20 neuromotor development items at the corrected age of 3 and 6 months in the study group were significantly higher (χ²=4.064, 8.414, P<0.05), and increased more significantly with the increasing of age. Moreover, the prevalence rates of intellectual deficits and motor development delay at the corrected age of 12 months of infants in the study group were significantly lower than those in control group(χ²=4.769, 5.182, P＜0.05). Conclusion Medical-nursing-education-family parenting care can not only promote the early development of high-risk premature infants, but also reduce the occurrence of intelligent defects and motor development delay, which is helpful to repair brain injury and to improve the development level of high-risk premature infants to a certain extent.

Construction of risk prediction model for functional constipation in preschoolers

NIU Yu-shuo, RAN Ni, HU Xiao-wen, LI Kui-nan, YANG Xiu-ling

2022, 30(6):  612-616.  DOI: 10.11852/zgetbjzz2021-1059

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Objective To explore the risk factors of functional constipation in preschoolers, and to establish a personalized risk prediction model.Methods Totally 108 preschoolers with functional constipation, who were admitted to the Children's Health Care Clinic of the Affiliated Hospital of Qingdao University from September 2020 to May 2021, were selected as study subjects. Meanwhile 324 healthy children who had normal physical examinations were enrolled in the control group. Logistic regression analysis was used to analyze the influencing factors of functional constipation in preschoolers. Nomogram model was established by R software to predict the risk of functional constipation, and the model was evaluated using ROC curve and Hosmer-Lemeshow goodness-of-fit test.Results Maternal or parental history of constipation(OR=2.708, 11.493), picky eating (sometimes, often, always)(OR=4.176, 7.097, 9.204), bad defecation habit(OR=3.465), blaming children(OR=7.067), family conflict (sometimes, often) were risk factors (OR= 4.807, 6.543) were risk factors for functional constipation of children(P＜0.05). Children who are not irritable and the time of father-son interaction >3 h were protective factors of functional constipation in preschoolers (OR= 0.213, 0.107, P<0.05). The area under the curve of ROC was 0.893, the goodness-of-fit test showed that the model fit well (P=0.986), and the calibration curve of nomogram was a straight line with slope close to 1. Conclusion The risk prediction model based on genetic, children's living habits and social psychological factors is simple and intuitive, with good differentiation and accuracy, which is significant for identifying children at high risk of functional constipation and making targeted intervention measures.

Current situation and related factors of idiopathic scoliosis in primary school children from Qingyang district Chengdu

HU Ting, ZHOU Jin-song, WANG Zhuo-hui, WU Zhi-jia, XU Jiang, ZHANG Gui-ming, LI Jin

2022, 30(6):  617-621.  DOI: 10.11852/zgetbjzz2021-1301

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Objective To investigate the current status of adolescent idiopathic scoliosis (AIS), height growth, visual development and spirometry in children aged 6 - 12 years in Chengdu, Sichuan Province, and to explore the significance of these indicators in the development of AIS in children.Methods Children in all grades of five elementary schools in Chengdu were screened for AIS in 2019. The screening methods included visual physical examination, anterior flexion test and spine measuring tape measurement. Meanwhile, adolescents' bare eye visual acuity levels and spirometry were measured, and questionnaires were administered on their height changes, daily study and exercise hours over the past 1 to 3 years. Then children were grouped according to the screening results, and were divided into different subgroups according to their age. The differences and correlations of the indicators in each group were analyzed.Results Among the 963 children, a total of 928 agreed to undergo AIS screening, including 63(6.79%)positive Adams tests(male-to-female prevalence ratio 1∶6). And 23(2.48%) cases were positive for AIS. Compared with children in the AIS-negative group, children in the AIS-positive group had significantly lower spirometry and reduced daily exercise time (t=2.088, 2.104, P<0.05). Children were divided into three subgroups according to their age groups:6-7 years old, 8-9 years old, and 10 - 12 years old. Compared with the AIS-negative group, slower increase of stature was found in children of positive group aged 6 to 7 years over the last 3 years and children aged 8 to 9 years over the last 1 and 2 years, and reduced exercise time in children aged 10 to 12 years(t=0.691, 4.176, 4.246, 5.788, P<0.05). Pearson correlation analysis showed that positive correlations existed in the increase of stature over the past 1, 2 and 3 years for children in the AIS positive group (r=0.920, 0.830, 0.813, P<0.001), and the increase of stature was negatively related to everyday exercise time(r=-0.521, -0.533, -0.536, P<0.05).And a positive correlation between spirometry and age was also found in children in the AIS positive group (r=0.512, P<0.05). For children in the AIS negative group, positive correlations existed in the increase of stature over the past 1, 2 and 3 years for children in the AIS positive group (r=0.827, 0.765, 0.855, P< 0.001), the increase of stature was negatively related to age(r=-0.109, -0.112, -0.086, P<0.05), and spirometry was related to age and exercise time(r=0.595, 0.148, P<0.001).Conclusions The development and progression of AIS is negatively correlated withexercise duration. Prolonging the exercise duration, enhancing exercise capacity and lung capacity may reduce the incidence of AIS in children.

Basic Experimental Articles

Effect of melatonin regulating Akt/mTOR signal pathway on intestinal barrier function in neonatal rats with necrotizing enterocolitis

ZHOU Li-xia, CAI Dong, CHEN You-ping

2022, 30(6):  622-626.  DOI: 10.11852/zgetbjzz2021-1918

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Objective To explore whether melatonin(Mel) can protect the intestinal barrier function of neonatal rats with necrotizing enterocolitis(NEC) by regulating the Akt/mTOR pathway.Methods Ninety newborn rats were randomly divided into normal group, model group, low(15 mg/kg) and high(30 mg/kg) dose Mel groups, and Mel(30 mg/kg) + Akti(Akt inhibitor, 5 μmol/L) group. Except for the normal group, NEC models were established in rats of the other 4 groups. After the experiment, the ocular venous blood was collected to detect the contents of serum D-lactic acid, diamine oxidase(DAO) and endotoxin. The ileocecum was retrieved for HE staining and detection of IL-6, IL-1β, TNF-α contents and autophagy gene(Beclin-1), LC3B, p-Akt/Akt, p-mTOR/mTOR expression levels.Results Compared with the normal group, the cells in ileocecum of the model group obviously showed degeneration and necrosis, mucosal muscular layer edema and loss of villi. Serum D-lactic acid, DAO, endotoxin content and intestinal tissue IL-6, IL-1β, TNF-α contents and Beclin-1, LC3B protein positive rates significantly increased(P<0.05), p-Akt/Akt and p-mTOR/mTOR levels were significantly reduced(P<0.05). Compared with the model group, the pathological changes of the ileocecal intestine tissue of the rats in the low and high dose Mel groups were significantly improved. Serum D-lactic acid, DAO, endotoxin content and IL-6, IL-1β, TNF-α contents and the positive rates of Beclin-1 and LC3B protein were reduced in sequence(P<0.05), p-Akt/Akt and p-mTOR/mTOR were increased(P<0.05). Compared with the Mel high-dose group, the ileocecal intestinal tissue lesions in the Mel+Akti group were worse. Serum D-lactic acid, DAO, endotoxin content and IL-6, IL-1β, TNF-α contents in intestinal tissue and the positive rates of Beclin-1, LC3B protein were significantly increased(P<0.05), p-Akt/Akt and p-mTOR/mTOR were significantly reduced(P<0.05).Conclusions Mel can up-regulate the expression of Akt/mTOR signaling pathway protein to inhibit autophagy and protect the intestinal barrier function of NEC neonatal rats.

Review

Research progress on abnormal regulation of gene expression in bronchopulmonary dysplasia

LIN Jie, DUAN Shan

2022, 30(6):  627-631.  DOI: 10.11852/zgetbjzz2021-0469

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Bronchopulmonary dysplasia (BPD) is one of the most common chronic lung diseases in primarily premature infants.BPD results from an imbalance between lung injury and repair caused by complex interactions between various environmental factors and genetic susceptibility in the developing lung.Studies have shown that BPD pathogenesis is mainly related to the abnormal expressions of inflammatory cytokines, non-coding RNA and signal pathway factors.The abnormal expression of pathogenesis-related genes not only affects the normal development of fetal or neonatal lung, but also impairs lung repair after early injury of the neonatal lung, and influences pulmonary insufficiency alone or cooperatively.Environmental risk factors, such as hyperoxia exposure and inflammation leading to abnormal gene expression, have also been found to be one of the causes of the development of BPD.The interaction between environmental factors and genetic susceptibility is an important mechanism for occurrence and development of BPD.

Research progress in health outcomes of adverse childhood experience

WANG Yi-nuo, LIU Yang, ZHUANG Xu-xiu, MA Ya-nan, WEN De-liang

2022, 30(6):  632-636.  DOI: 10.11852/zgetbjzz2021-0023

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As a serious public health challenge,the health outcomes of adverse childhood experiences(ACEs)should not be underestimated.This article summarizes the outcomes of ACEsexperience from the following four aspects:mental health,physical health,sexually transmitted diseases and unsafe sexual behaviors,health risk behaviors,so as to provide reference for related studies.

Assessment and treatment for sleep disorders in children with autism spectrum disorder

CHEN Cen, CHENG Hui, JIANG Fan, SHEN Min, WANG Guang-hai

2022, 30(6):  637-641.  DOI: 10.11852/zgetbjzz2021-0195

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Sleep disorders, as one of the most common comorbid disorders in children with autism spectrum disorder (ASD), have attracted extensive clinical and research attention in recent years.Sleep disorders are significantly related to the core symptoms of ASD, affect the children's function, quality of life and efficacy of intervention and rehabilitation, and also cause great parenting distress and economic burden on parents.At the international level, sleep disorders especially for insomnia have been integrated in the assessment and treatment for ASD, yet the relevant work in China is much less developed and pediatric professionals has insufficient ability to assess and treat sleep disorders in ASD children.Therefore, this review introduces the assessment and treatment strategies for sleep disorders in ASD children in order to inform clinical and research work.

Research status of pathogenesis of congenital central hypoventilation syndrome and intervention

YU Sha, XIAO Shu-fang, YANG Mei-fen

2022, 30(6):  642-645.  DOI: 10.11852/zgetbjzz2021-0342

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Congenital central hypoventilation syndrome (CCHS) is a rare hereditary disease for life. At present, the research shows that the brain function defect and the chemical sensitive respiratory control disorder of CCHS are related to the mutation of paired-like hemeobox gene 2B (PHOX2B). By reviewing case report of 70 cases of CCHS at home and abroad, this article reviews current research status of CCHS pathogenesis and intervention treatment, expounding the pedigree of PHOX2B gene mutation, and the relationship between PHOX2B gene mutation and brain function defect, chemosensory respiratory control disorder and complications, so as to provide reference for timely and effective diagnosis and treatment of the disease.

Effect or parental adverse childhood experiences on children and adolescents' psychological and behavior problems

LI Ruo-yu, WAN Yu-hui

2022, 30(6):  646-650.  DOI: 10.11852/zgetbjzz2021-0337

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The harmful effects of adverse childhood experiences(ACEs) on individual physical and mental health have been demonstrated in many aspects.In recent years,foreign studies have focused on the impact of parental ACEs on children and adolescents' psychological and behavior problems,and explored the role of many social psychological and biological factors in the relationship between them.This study reviews the intergenerational effects of parental ACEs on children and adolescents' psychological behavior and analyzes the possible mechanism,so as to provide reference for promoting children and adolescents' physical and mental health.

Research advances on the relationship between melatonin and sleep problems in children with autism spectrum disorder

WANG Jing-qiu, WANG Cheng-ju, HU Bin

2022, 30(6):  651-654.  DOI: 10.11852/zgetbjzz2021-0215

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Autism spectrum disorder(ASD) is a group of neurodevelopmental disorders,often accompanied by circadian rhythm disorders and sleep problems. Sleep problems may not only aggravate some of the core symptoms of ASD children,but also affect the effect of rehabilitation training. The clinical manifestations of sleep problems in ASD children are various,but the exact mechanism is not clear. Studies have found that it is closely related to abnormal melatonin secretion and metabolism,and melatonin treatment is effective and safe. This paper mainly reviews the sleep problems of ASD children and the research progress related to melatonin in order to provide basis for improving sleep quality of ASD children and formulating effective intervention programs.

Meta Analysis

Meta-synthesis on infant caregiving experience of fathers

WANG Li-ning, WANG Dong-xue, LI Ying-li, QI Na, LI Yang, ZHANG Hui

2022, 30(6):  655-659.  DOI: 10.11852/zgetbjzz2021-1154

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Objective To conduct systematic evaluation of fathers' experiences of caregiving during infancy, in order to provide reference for promoting father involvement and developing targeted interventions.Methods Chinese and English databases were searched from establishment to December 2020, qualitative studies related to father involvement in infant caregiving experience were collected. Then Meta-synthesis was conducted. Results A total of 10 studies including 205 fathers were enrolled. A total of 50 research results were extracted with 9 categories formed, and 3 integrated results were obtained: 1) Fathers face many challenges and difficulties, psychological and life changes, and adopt different coping ways to adjust themselves; 2)With the support of all parties, the father develops the close father-infant relationship, increases his sense of responsibility and grows;3) Fathers' needs. Conclusion Healthcare professionals are suggested to pay attention to the experience and needs of fathers in caring for infants, give guidance and support, enhance father participation in caring for infants, so as to promote early childhood development.

Clinical Research

Analysis of clinical characteristics and risk factors of poor prognosis in the 124 extremely premature infants

LIU Ying-ying, JIANG Qian-nan, TIAN Bao-li, LIU Xiu-xiang

2022, 30(6):  660-663.  DOI: 10.11852/zgetbjzz2021-0585

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Objective To analyze the risk factors of prognosis of extremely premature infants(EPI, ＜28 weeks) hospitalized in the Neonatal Intensive Care Unit (NICU) of Qingdao Women and Children's Hospital, in order to provide reference for the treatment.Methods Clinical data of 124 cases of EPI enrolled in the NICU of Qingdao Women and Children's Hospital from January 2017 to December 2020 were retrospectively analyzed. Differences between the survival (n=75) group and death group (n=49) were analyzed. Then binary Logistic regression model was established to analyze the risk factors for poor prognosis.Results Among 124 cases, 67 cases (54.0%) were male infants. The birth weight ranged from 680 g to 1 520 g, the gestational age ranged from 24⁺³ weeks to 27⁺⁶ weeks, and the overall survival rate was 60.5%.There were significant differences between the survival group and the death group in 13 indicators, including birth weight, gestational age, twins, antenatal corticosteroids, using pulmonary surfactant, invasive ventilation, non-invasive ventilation, duration of non-invasive ventilation, total oxygen therapy time, complicated with neonatal respiratory distress syndrome, intraventricular hemorrhage, early-onset sepsis, neonatal necrotizing enterocolitis (P＜0.05). Multivariate Logistic regression analysis showed intraventricular hemorrhage was risk factors for poor prognosis(OR=5.518, 95%CI:1.186 - 25.685,P=0.029),and non-invasive ventilation was protection factor(OR=0.006, 95%CI:0.001 - 0.051, P＜0.001).Conclusions The survival rate of EPI is improving, but there is still a gap from the developed countries. Intraventricular hemorrhage is an important risk factor for the prognosis of EPI. So it is suggested to treat complications effectively in early stage, thereby improving the survival rate of EPI.

Association between screen time and sleep duration and the moderating effect of outdoor activity among preschoolers

MA Ying, JIAO Ting, HUANG Ya-shen, SHU Guan-yu, SONG Yan-yan, JIANG Lin

2022, 30(6):  664-668.  DOI: 10.11852/zgetbjzz2021-1587

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Objective To examine the association between electronic screen time and sleep duration among preschoolers in Guangzhou, and to explore the moderate effect of outdoor activity, in order to provide reference for facilitating sleep health of children.Methods Using a random cluster sampling method, a total of 166 preschoolers in 3 kindergartens in Guangzhou were selected into this study from October to December 2020. Data on electronic screen time, outdoor activities, and sleep duration of children were collected by parental questionnaire. General linear regression models were used to analyze the association of electronic screen time and outdoor activities with sleep duration, and the moderating test was used to explore the moderating effect of outdoor activity. Results Totally 138 preschoolers (83.1%) had a sleep duration less than 10 hours per night, and the daily screen time of 86 preschoolers (51.8%) was more than 1 hours. The mobile electronic screen time was prominently associated with sleep duration (β=-0.298,95%CI:-0.603 - -0.021), while the TV screen time has no relation with sleep duration (β＝-0.144, 95%CI :-0.382 - 0.089). The moderating test demonstrated a null moderating effect of outdoor activity on the association between screen time and sleep duration (P>0.05). Conclusion Exposure to mobile electronic screen is adversely associated with the sleep duration among preschoolers, and outdoor activitiesplay no moderating role on this association.

Longitudinal study on the birth outcome and cognitive development of singleton preterm infants conceived by assisted reproduction technology

HU Dan, WANG Xiao-xia, CUI Yi-fan, LIU Pu, LIANG Qian, XIAO Xu-wu

2022, 30(6):  669-672.  DOI: 10.11852/zgetbjzz2021-1276

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Objective To compare the birth outcome and cognitive development level of singleton preterm infants conceived by assisted reproductive technology (ART) with those of healthy infants naturally conceived, so as to provide scientific basis for the early comprehensive development of ART preterm infants.Methods A total of 28 ART singleton preterm infants and 34 NC singleton preterm infants were enrolled in this study from January 1st, 2019 to July 31st, 2021, and their relevant information were collected. Children's Neuropsychological Behavioral Development Assessment (2016 version) was conducted in all subjects at 6 and 12 months old.Results Maternal and paternal age for childbearing(t=2.536,2.055), the rates of pregnancy complications(χ²=11.442), cesarean section(χ²=6.115) and low birth weight(χ²=4.736) of ART preterm infants were all significantly higher than those of NC infants (P＜0.05). ART group and NC group had similar physical development levels and trends at birth, 6 months old and 12 months old (P＞0.05). The total development quotient, the scores of fine motor development and language development at 6 months old of ART preterm infants were 92.23±8.15, 88.38±7.64, 89.95±12.35, significantly lower than those in NC group, while the score of warning behavior(3.57±3.12) was significantly higher (t=2.376, 2.163, 2.142, 2.467, P＜0.05). But the cognitive development levels of the two groups were similar at the age of 12 months (P＞0.05).Conclusions ART singleton preterm infants have more adverse high-risk factors during the fetal period, but the physical development reaches the level of naturally conceived infants. The health promotion of fine motor and language skills should be strengthened, as well as the behavior screening for autism in the early infancy of ART infants, so as to promote their early and comprehensive development.

Effect of different types of hypertensive disorders during pregnancy on the birth status of the offspring

ZHONG Zhi-hong, LUO Qiao-yan, SHI Bi-jun, WEI Jian-wei, ZHONG Xin-qi, CUI Qi-liang

2022, 30(6):  673-676.  DOI: 10.11852/zgetbjzz2021-0592

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Objective To explore the effects of different types of hypertensive disorders in pregnancy (HDP) on the birth conditions of their offspring, so as to provide scientific basis for improving the prognosis of their offspring.Methods A retrospective analysis was performed for the parturients with HDP and their newborns (n=1 004) who were born from January 2016 to December 2019 in the Third Affiliated Hospital of Guangzhou Medical University. Besides, they were divided into four types according to diagnosis, including gestational hypertension (group A, n=256), preeclampsia-eclampsia (group B, n=577), chronic hypertension(group C, n=55) and chronic hypertension with superimposed pre-eclampsia (group D, n=116). For comparison, 1 107 normal parturients and newborns were randomly selected into the control group. The birth conditions were compared between the two groups and among the four types of HDP.Results 1) Compared with the control group, the rates of fetal distress, fetal growth restriction, placental abruption, preterm, low birth weight, small for gestational age, neonatal asphyxia, transferring to neonatology department or other hospitals in the HDP group were significantly higher(P<0.05). 2) In terms of fetal growth restriction, placental abruption and small for gestational age, the prevalence rates in group B was significantly higher than those of group A (P<0.05). 3)The rates of preterm infants, very preterm infants, extremely preterm infants, low birth weight infants, very low birth weight infants, extremely low birth weight infants, transferring to neonatology department or other hospitals among group A, group C, group B, group D were increased in order. Pairwise comparison showed that, except for groups A and C, the differences between any two groups were statistically significant (P<0.05). 4) The prevalence rate of neonatal asphyxia in group A was significantly lower than that in any other groups (P<0.05).Conclusions Chronic hypertension with superimposed pre-eclampsia is associated with a higher risk of adverse fetal and neonatal outcomes, which could be caused by the longer course of the disease and more serious condition. It is suggested that early diagnosis and treatment of HDP should be carried out to improve the prognosis of their offsprings.

Influencing factors of optimal score of Hammersmith Infant Neurological Examination in infants aged 3 to 6 months

SHEN Jia-jian, SHAN Ling, JIA Fei-yong, LI Hong-hua

2022, 30(6):  677-679.  DOI: 10.11852/zgetbjzz2021-1214

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Objective To analyze the related factors affecting the optimal score of Hammersmith Infant Neurological Examination (HINE) of 3- to 6-month-old infants, so as to provide basis for early intervention.Methods A total of 145 infants aged 3 to 6 months who received HINE evaluation in the Department of Developmental Behavior Pediatrics, the First Hospital of Jilin University from August 2019 to February 2021 were selected, including 70 infants in normal group and 75 infants in abnormal group. A total of 22 related factors that may affect the optimal score of HINE during pregnancy and perinatal period were investigated.Results The prevalence rates of intrauterine distress, amniotic fluid abnormality, birth asphyxia, intracranial hemorrhage and neonatal convulsion in abnormal group were significantly higher than those in normal group (χ²=6.24, 6.05, 5.51, 12.91, P<0.05). Multiple Logistic regression analysis showed that amniotic fluid abnormality(OR=3.38, 95%CI:1.38 - 8.29), intracranial hemorrhage(OR=4.09, 95%CI:1.59 - 10.49) and neonatal convulsion(OR=11.62, 95%CI:2.43 - 55.55) were independently risk factors for the optimal score of Hammersmith Infant Neurological Examination (HINE) (P＜0.05). Conclusion Early screening and intervention should be given to infants with amniotic fluid abnormality, intracranial hemorrhage and neonatal convulsion.

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Study on the umbilical cord milking during delivery of premature infants born at less than 34 weeks of gestation

LUO Bei, ZHANG Xue-feng

2022, 30(6):  680-684.  DOI: 10.11852/zgetbjzz2021-0819

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Objective To analyze the differences of hemoglobin, bilirubin and related complications between umbilical cord milking (ICM) and immediate cord clamp (ICC), in order to provide clinical evidence for cord-cutting in premature infants born at less than 34 weeks of gestation.Methods The clinical data of 115 cases of premature infants born at less than 34 weeks of gestation and delivered via vaginal were analyzed retrospectively. The infants were divided into UCM group (n=59) and ICC group (n=56) according to cord milking method. Hemoglobin change trend, blood transfusion volume, percutaneous bilirubin value and phototherapy time during hospitalization were compared between infants in UCM group and ICC group. Besides, the prevalence rates of intracranial hemorrhage, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were also compared.Results The hemoglobin level of infants in the UCM group were higher than that in the ICC group within 1 h after birth, about 1 week after birth and before discharge (t=2.246, 2.123, 1.886, P＜0.05). The frequency and volume of blood transfusions for premature infants in the ICC group were higher than those in the UCM group during hospitalization (χ²=2.145, t=2.160, P＜0.05). The peak time of transcutaneous bilirubin in the two groups both ranged from 3 to 6 days. During this period, the value of transcutaneous bilirubin of infants in the UCM group was significantly higher than that in the ICC group(t=2.231, 2.654, 2.686, 2.038, P＜0.05), but there was no significant difference in the duration of phototherapy between the two groups (P＞0.05). The occurrence of complications such as intracranial hemorrhage, ROP, BPD and NEC during the hospitalization was all no significantly different between the two groups (P＞0.05).Conclusions Compared with conventional umbilical cord amputation, umbilical cord milking can increase the blood volume and hemoglobin content, reduce the frequency and volume of blood transfusions during hospitalization, and do not increase pathological jaundice and complications in preterm infants with gestational age ＜34 weeks. Therefore, umbilical cord milking can be used as the first choice for premature infants with gestational age ＜34 weeks.

Investigation and analysis of sleep status of 2- to 6-year-old children in Zhongshan City

HUANG Lian-hong, ZHANG Cui-mei, WANG Gui-lan, LI De-geng, LIU Nan, CHEN Ang, LI Jian, ZHU Jian-ping

2022, 30(6):  685-688.  DOI: 10.11852/zgetbjzz2021-0895

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Objective To investigate the sleep status of children aged 2 to 6 years in Zhongshan City, and to analyze the common sleep problems of children with different characteristics.Methods A total of 1 880 children from 6 kindergartens in 5 districts of Zhongshan City were randomly selected from March 2018 to February 2019 by stratified cluster random sampling. The questionnaire was designed based on the Clinical Questionnaire of Sleep Center of Sydney Children's Hospital and cultural background.Finally 1 799 valid questionnaires were collected.Results The average daily sleep time of 2-year-old children in Zhongshan City was 11.37 h, and that of 3- to 6-year-old children was 10.26 to 10.99 h, and it gradually decreased with age in terms of daytime, nighttime and the overall sleep(F=14.285, 28.408, 40.635, P<0.05). The detection rates of insufficient sleep, delayed bedtime, and difficulty in falling asleep were 17.01% (306/1 799), 88.2% (1 587/1 799) and 41% (738/1 799). The outdoor activities and screen time of 2- to 6-year old children were (2.27±1.11) h and (1.25±0.94) h, respectively, which reached the recommended standard for children in China. Children had more sleep problems, mainly manifested as fear of going to bed(64.0%), sweating(50.9%), molars(44.8%), snoring(40.1%), nightmares(39.4%), night terrors(39.1%) and drooling(25.3%), sleepwalking(3.2%) and apnea(0.7%). Conclusion At present, the sleep time of children in Zhongshan City is inadequate, so parents and pediatricians should pay more attention to children's sleep health care to promote their sleep health.

Exploration of early screening model for infants with autism spectrum disorders

CONG Yan,XU Xia, WANG Hao, WANG Dong, YU Lu-ting, DONG Chen-qing, JIANG Li, ZHENG Ting-ting, JI Jia-yi

2022, 30(6):  689-693.  DOI: 10.11852/zgetbjzz2021-1307

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Objective To evaluate the screening efficacy of autism spectrum disorder (ASD) by the Bayley Scales of Infant Development-Ⅰ(BSID Ⅰ) combined with Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT-R/F), in order to provide clinical basis for early ASD screening in primary child care system.Methods Infants aged 6 to 12 months, who participated in Early Developmental Risk and Abnormality Screening Program for 0 - 3 Years Old Children in Yiwu Maternal and Child Health Hospital using BSID Ⅰ evaluation from January to December 2019 were enrolled in this for a prospective cohort study.BSID Ⅰ were conducted in the children with positive autism alert indexin Autism Diagnosis and Rehabilitation Guide issued by the Ministry of Health in 2010.Infants with abnormal mental development index (MDI) and psychomotor development index (PDI) (MDI or PDI<80) were followed up. M-CHAT-R/F assessment was performed at 18 months of age, then further diagnosis of ASD was made based on DSM-5 by a specialist.Results Totally 3 096 cases were included in the study, of whom 535 cases with positive autism alert index and421 cases (13.60%) had abnormal BSID Ⅰ results. At 18 months of age, a total of 38 (9.97%) children were screened positive by M-CHAT-R/F evaluation, and 16 children were finally diagnosed with ASD. When taking BSID Ⅰ MDI<80 as a predictor, its proportion was significantly different between ASD group and non-ASD group (χ²=10.28, P<0.01). The positive predictive value of BSID Ⅰ for ASD screening was 0.076, which increased to 0.42 when combined with M-CHAT-R/F.Conclusions BSID Ⅰ combined with M-CHAT-R/F can improve the positive predictive value of ASD screening in infants. It is suggested that m-CHAT-R /F screening at 18 months of age should be performed in infants with BSID Ⅰ MDI<80, thus to provide a new method for early screening of ASD.