Table of Content

10 October 2022, Volume 30 Issue 10

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Professional Forum

Effects of hyperglycemia exposure during pregnancy on offspring neurodevelopmental outcomes

LI Zhan-kui, BAI Rui-miao

2022, 30(10):  1045-1048.  DOI: 10.11852/zgetbjzz2022-1061

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With the increasing incidence of pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), the number of infants of diabetic mothers (IDMs) is also increasing year by year. Due to the abnormal metabolism in the intrauterine environment of pregnant women with GDM, their offspring have different degrees of short-term or long-term neurological abnormalities. There are relatively few studies on the short-term or long-term neurobehavior of offspring exposed to hyperglycemia during pregnancy. Therefore, this article summarizes the short-term and long-term neurodevelopmental outcomes of offspring under hyperglycemia exposure during pregnancy.

Association of perinatal ureaplasma urealyticum infection with adverse pregnancy outcomes and neonatal related disorders

LI Qiu-ping

2022, 30(10):  1049-1052.  DOI: 10.11852/zgetbjzz2022-1127

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Perinatal ureaplasma spp. infection is associated with adverse pregnancy outcomes such as infertility, premature rupture of membranes, chorioamnionitis, miscarriage, preterm delivery and even stillbirth, as well as many diseases in neonatal period. This paper will focus on the epidemiological characteristics of ureaplasma spp. infection in perinatal period, the association of ureaplasma spp. exposure with adverse pregnancy outcomes, neonatal and especially preterm related diseases such as sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing enterocolitis, as well as the diagnosis and prevention measures of ureaplasma spp., so as to provide reference for the prevention and treatment of clinically relevant diseases.This paper will focus on the epidemiological characteristics of perinatal Mycoplasma solani infections, the association of perinatal Mycoplasma solani exposure with adverse maternal outcomes, neonatal and especially preterm related diseases such as sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing small bowel colitis, and the diagnostic and preventive measures of Mycoplasma solani for clinical control.

Original Articles

Motor development of children under 3 years old in 15 provinces of China in 2020

PAN Hong-di, ZHANG Yue, LI Yi-chen, NIU Ting-ting, HU You-fang, HU Yan, HUANG Yan, SUN Quan-chao, ZHU Ling, CHEN Wei, HUANG Yong-ling, KUANG Xiao-ni, GE Fei, HE Li, ZHANG Lian-xun, TANG Rui-xia, LIU Yun-fen, XU Tao, LI Zhi-xin

2022, 30(10):  1053-1057.  DOI: 10.11852/zgetbjzz2022-0342

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Objective To investigate the population distribution of gross motor milestones in children under 3 years old in China, and to map the development process of major indicators of gross motor development, so as to provide evidence for individualized assessment and intervention for infants and toddlers. Methods From September to December 2020, a cross-sectional survey was conducted on the development of normal children aged 1 to 36 months in 30 districts/counties of 15 cities in 15 provinces (autonomous regions/municipalities) of China. The developmental process map was drawn according to 10 categories of motor abilities, including "head control", "sitting", "turning over", "crawling", "standing", "walking/running", "upper limb strength", "squatting/jumping", "walking up stairs" and "single-foot use", and the 50th percentile age of each indicator was described. Results A total of 8 010 normal children aged 1 to 36 months were included in this study. The milestone curves of gross motor development showed the achievement of 30 indicators of gross motor development in Chinese infants. The median age of "lifts head 90°(prone)" was at 3.2 months, "supine turning prone" was at 4.6 months, "sit without hand support" was at 6.3 months, "hands-and-knees crawling" was at 7.6 months, "stand alone" was at 11.4 months,"walk alone" was at 13.1 months, "run with good balance" was at 15.8 months, "balance on each foot(≥1 s)" was at 18.7 months, "jump up with both feet together" was at 20.4 months. The curves reflected the attainment of milestones at different ages and suggested that the rate of attainment of each milestone increased rapidly over a certain age range of months. For example, infants' head control ability developed mainly within 6 months of age. The rate of turning over at 3 months was less than 15%. It took a certain amount of time for infants to transform their gross motor ability and develop proficiency. The median switching time between "sit without hand support" and "stand alone" was about 5.1 months. It took about 2.2 months from "sit with support" to "sit without hand support". Conclusion The milestone curve of gross motor development reflects the development trajectory of 30 gross motor development indicators of infants in China, providing basis for clinical evaluation, early intervention and development prediction of children's health care in China.

Correlation between head circumference and neurobehavioral development of low birth weight infants in Shanghai

LI Min-ming, ZHOU Ting-ting, ZHANG Jing, PENG Yong-mei

2022, 30(10):  1058-1062.  DOI: 10.11852/zgetbjzz2021-1521

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Objective To investigate the correlation between head circumference and neurobehavioral development of low birth weight(LBW) infants 18-month in Shanghai, so as to provide evidence for early recognition of LBW neurobehavioral retardation. Methods A prospective cohort study was conducted. Children registered and managed in Maternal and Child Health Care Hospitals of 16 districts in Shanghai from March 2016 to October 2018 were selected into this study. Questionnaire survey, head circumference measurement and Gesell developmental diagnosis were conducted on the enrolled subjects. Results A total of 758 LBW infants [329 boys(43.4%) and 429 girls(56.6%)] were included in this study, with an average birth weight of (2 223±231.13)g and an average gestational age of(35.78±1.92) weeks. Logistic regression analysis showed that the risk of abnormal development in LBW fine motor significantly increased in (head circumference-for-age Z-score,HCZ)_1-month, HCZ_3-month,HCZ_6-month<-1 groups(OR=6.97, 3.07, 2.96, P<0.05). The risk of abnormal development in LBW adaptive behavior significantly increased in HCZ <-1 group at all follow-up months(OR=3.39, 3.28, 2.65, 3.25, 3.29, 2.67, P<0.05). The risk of abnormal development in LBW language significantly increased in HCZ_1-month, HCZ_3-month,HCZ_6-month, HCZ_9-month, HCZ_12-month<-1 groups(OR=4.28, 3.32, 2.62, 3.95, 2.90, P<0.05). Multiple linear regression analysis showed that HCZ_1-month was a good predictor to the dysplasia of LBW fine motor and language, and HCZ_6-month could predict the dysplasia of LBW adaptive behavior to a certain extent(R²=0.052, 0.063, 0.046). Standardized regression coefficients showed that HCZ had significant contribution to the prediction of abnormal language development at each follow-up month(β=0.180, 0.165, 0.158, 0.139, 0.136, 0.113). Conclusions Head circumference has a predictive effect on the outcome of neurobehavioral development of low birth weight infants within 18 months old. Focusing on the follow-up of head circumference in LBW is important for early identification and intervention of neurobehavioral developmental delay.

Reliability and validity test of Chinese version of the Child Riding Risk Behavior Diagnostic Scale

SUN Ya-ru, LIU Ting, YIN Cui-yan, WANG Xin, NIU Yu-shuo, LI Kui-nan, YANG Xiu-ling

2022, 30(10):  1063-1067.  DOI: 10.11852/zgetbjzz2021-1640

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Objective To translate and revise Child Riding Risk Behavior Diagnostic Scale(CRRBDS), and to evaluate the reliability and validity test of Chinese version of CRRBDS. Methods After obtaining the authorization of the original author of RBDS, the English version of CRRBDS was translated, retranslated and cross-culturally adjusted by using Brislin translation mode to form the Chinese version of CRRBDS. Then the Chinese version of CRRBDS was used to investigate the parents of child healthcare department in a triple A hospital in Qingdao and the parents of children in a kindergarten in Qingdao, so as to evaluate its reliability and validity. Results The CRRBDS contained 16 items divided into 5 dimensions, including type selection cognition, response efficacy, self-efficacy, perceived severity and perceptual susceptibility, with the cumulative variance contribution rate of 72.939%. The correlation coefficient between the scores of each item and the total score ranged from 0.550 to 0.697. The content validity index(I-CVI) of the Chinese version of CRRBDS items ranged from 0.800 to 1.000, and the content validity index(S-CVI) of the scale level was 0.950. The Cronbach's α coefficient of the scale was 0.886, the split-half reliability coefficient was 0.931 and the test-retest reliability coefficient was 0.862. Conclusion The Chinese version of the CRRBDS has good reliability and validity, which can be used to measure parents' diagnosis of children's riding risk behavior.

Influence of childhood trauma and perceived stress in adolescents with anxiety depression disorder

LIU Chuan-yong, HOU Rui, WANG Ping

2022, 30(10):  1068-1072.  DOI: 10.11852/zgetbjzz2022-0364

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Objective To explore the influence of childhood trauma and perceived stress in adolescents with anxiety depression disorder(ADD), in order to provide evidence for clinical psychotherapy of adolescents with ADD. Methods From January 2020 to January 2021, a total of 120 adolescents with ADD, who were first hospitalized in Hangzhou Seventh People's Hospital, were divided into ADD group and non-ADD group according to the anxiety/somatization factor score of Hamilton Depression Scale-17(HAMD₁₇), with 60 patients in each group. HAMD₁₇, Childhood Trauma Questionnaire (CTQ-SF) and Chinese Perceived Stress Scale (CPSS) were used to measure the level of depression, childhood trauma and perceived stress. Then the differences of the two groups were compared, and the relationship model among the level of anxiety depression, childhood trauma and perceived stress in ADD group was analyzed. Results 1) There were no significant differences between ADD group and non-ADD group in age, gender, only child or not, years of education and course of depression (P>0.05). 2) The total scores of HAMD₁₇, emotional abuse, emotional neglect, physical abuse, the total score of childhood trauma, tension, loss of control and the total score of perceived stress in the ADD group were significantly higher than those in non-ADD group (t=3.558, 11.374, 5.333, 4.080, 7.796, 8.829, 11.854, 13.276, P<0.01). 3) The total score of HAMD₁₇ in ADD group was positively correlated with the total score of childhood trauma, tension, loss of control and the total score of perceived stress (r=0.415 - 0.590, P<0.01); the total score of childhood trauma in ADD group was positively correlated with tension, loss of control and the total score of perceived stress (r=0.306 - 0.390, P<0.01). 4) Perceived stress had a direct pathway effect on anxiety depression in ADD group (β=0.81, P<0.001), and childhood trauma had an indirect pathway effect on anxiety depression through perceived stress in ADD group (β=0.567, P<0.001). Conclusions Adolescents with anxiety depression disorder have more traumatic experiences in childhood and higher perceived stress level. Perceived stress not only has a direct effect on anxiety depression, but also completely mediates the influence of childhood trauma on anxiety depression.

Reliability, validity and norms of the ChineseInfants Sleep Assessment Scales

FENG Wei-wei, WANG Hui-shan, ZHANG Tong, YANG Yu-feng, XU Zhi-fei, PAN Xiao-ping, WANG Guang-hai, XU Tao, Working Group on Norms Establishment of Chinese Infants and Todders Sleep Assessment Scales

2022, 30(10):  1073-1077.  DOI: 10.11852/zgetbjzz2022-0641

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Objective To verify the reliability and validity of the Chinese Infants Sleep Assessment Scales (ISAS), and to establish national norms and cut-off scores of poor sleep and abnormal sleep. Methods Using multistage random sampling, an investigation was conducted among 5 855 urban and rural infants' caregivers (including 2 943 infants aged 0 to 3 months and 2 912 infants aged 4 to 11 months) from 14 cities in 7 provinces. The internal consistency reliability, split-half reliability and confirmatory factor analysis were used to verify the reliability and validity of the scales. Then the percentile norms were established, and the total ISAS scores exceeding P₈₅ and P₉₅ were used as the cut-offs for identifying poor sleep and abnormal sleep. Results The Cronbach's α coefficients of ISAS (for infants aged 0 to 3 months) and ISAS (for infants aged 4 to 11 months) were 0.68 and 0.69, the split-half reliability were 0.78 and 0.75, respectively. The factor structure models were stable, which showed good reliability and validity. The age norm of ISAS (for infants aged 0 to 3 months) and the gender-specific age norm of ISAS (for infants aged 4 to 11 months) were established. The cut-off values of ISAS score for poor sleep were 31 and 32 in the two scales, respectively, which were 34 and 35 for abnormal sleep, respectively. Conclusions ISAS (for infants aged 0 to 3 months) and ISAS (for infants aged 4 to 11 months) have stable reliability and validity. Their norms and cut-offs can be used to quantitatively evaluate infants' sleep, in order to provide an quantitative basis for their promotion and application.

Current status of neuropsychological development and its influencing factors in children with congenital heart disease

WANG Ruo-si, ZHOU Jin-yan, WANG Yan, ZHANG Jun-xia, LI Cong-mei, LI Jing, FENG Yan, YANG Shu

2022, 30(10):  1078-1082.  DOI: 10.11852/zgetbjzz2022-0547

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Objective To investigate the current situation and related influencing factors of neuropsychological development in children with congenital heart disease (CHD), so as to provide scientific basis for enhancing the neuropsychological development. Methods A 1:1 case-control study was designed matched by age, gender and residential type. From January 2019 to December 2021, a total of 348 pairs of infants aged 12 to 36 months were enrolled in this study from the Department of Preventive Healthcare, Yan'an Hospital Affiliated to Kunming Medical University. Cases and controls were interviewed face to face with a uniformed questionnaire to collect their socio-demographic data. Developmental Screening Test (DST) for children under six was used to conduct neuropsychological test among these children. The neuropsychological development status of children in the two groups was compared. Factors related to the neuropsychological development of children with CHD were then analyzed. Results The scores of development quotient (DQ) and mental index (MI) among children with CHD were lower than those in the control group (P＜0.001). The neuropsychological development of children with atrial septal defect was better than that of children with other types of CHD. Multivariate Logistic regression analysis showed that male children (OR=4.505, 95%CI:1.171 - 17.241), premature (OR=9.091, 95%CI: 1.538 - 47.121) and only children (OR=3.802, 95%CI: 1.051 - 13.889) were risk factors for delayed DQ of CHD children, while flexible working arrangement of mothers (OR=0.118, 95%CI: 0.029 - 0.487), regular healthcare (OR=0.233, 95%CI: 0.098 - 0.553) were associated with lower risk of DQ retardation. Premature (OR=3.906, 95%CI: 1.346 - 11.364) were significantly associated with MI delays, while flexible working arrangement of mothers (OR=0.219, 95%CI: 0.052 - 0.923), regular healthcare (OR=0.224, 95%CI: 0.089 - 0.560) were related to lower risk of MI retardation. Conclusions The neuropsychological development of CHD children is still unsatisfactory. Further studies are warranted in order to make neurodevelopmental evaluation strategies for children with CHD.

Basic Experimental Articles

Protective effect and mechanism of delayed mild hypothermia on white matter injury inoxygen-glucose deprivation and restoration newborn rats

LIANG Sui-xin, TI Yun-xing, HUANG Jun-rong, LI Xiu-hong, ZHOU Wen-jia

2022, 30(10):  1083-1087.  DOI: 10.11852/zgetbjzz2022-0036

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Objective To analyze the protective effect and possible mechanism of delayed mild hypothermia on white matter injury in oxygen-glucose deprivation and restoration newborn rats. Methods The models of whole brain perfusion and oxygen glucose deprivation were established in 40 neonatal rat pups. Forty neonatal rats were randomly divided into four groups and treated with mild hypothermia (32 ℃) for 0 h, 24 h, 48 h, 72 h, with 10 rats in each group. The expression of myelin basic protein (MBP) was detected by Western Blot.The expression of microglia was identified by immunofluorescence.The concentrations of TNF-α and IL-6 were determined by ELISA. Results The level of MBP protein expression at 32 ℃ for 24 h, 48 h and 72 h was significantly higher than that at 0 h in the control group (F=478.007, t=-18.180、22.940,-29.670,P＜0.001), and there was a significant positive correlation between the protein expression level and the duration of delayed mild hypothermia.With the extension of delayed mild hypothermia time, the activation degree of microglia was inhibited. The number of Iba-1 positive cells at 24 h, 48 h and 72 h was significantly lower than that at 0 h in control group (F=99.892, t=5.879, 9.295, 18.760,P＜0.001), showing that increased fluorescence expression level was negatively correlated with delayed mild hypothermia time. The concentrations of TNF-α and IL-6 were significantly lower than those of the control group at 0 h (TNF-α:F=454.197, t=2.184, 15.300, 15.000, P＜0.05;IL-6:F=123.995, t＝5.650,13.120, 13.910, P＜0.001), indicating that the concentrations of IL-6 was negatively correlated with the time of delayed hypothermia. Conclusion Delayed mild hypothermia can protect the white matter injury of oxygen-glucose deprivation and reoxygen-glucose newborn mice, and its mechanism may be related to inhibiting microglial cell activation and down-regulating inflammatory response.

Review

Exploration of the concept and connotation of early learning opportunities in nurturing care

ZHANG Yue

2022, 30(10):  1088-1090.  DOI: 10.11852/zgetbjzz2021-1295

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Promoting nurturing care is a coring intervention of early child development,and early learning opportunity is an important strategic action of nurturing care. However, child health care providers are not very familiar with the concept and content of early learning. So it is necessary to understand this term, which influences what kind of curricula are provided for parenting and health services.

Research progress in the risk factors of fetal intrauterine growth retardation and the intervention effect of exercise during pregnancy

GUO Chang-sheng, WU Yun-ta na, WANG Yan, DAI Jian-yang, YANG Nan, PEI Fei

2022, 30(10):  1091-1094.  DOI: 10.11852/zgetbjzz2021-1499

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A good intrauterine environment is closely related to fetal health and development, but a variety of risk factors can lead to intrauterine growth retardation. As an effective intervention, exercise is widely used in pregnancy. Appropriate exercise can prevent the adverse outcome of the fetus and promote the development of the fetus. The risk factors of intrauterine growth retardation and the intervention effect of exercise during pregnancy are summarized in this review, so as to provide reference for further researches.

Research advances in the association between parental insightfulness and early childhood development

ZHANG Chang, ZHOU Ting

2022, 30(10):  1095-1098.  DOI: 10.11852/zgetbjzz2021-1479

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Parental insightfulness is defined as the capacity of caregivers to consider motives and emotions underlying their children's behaviors from the perspective of children. Based on attachment theory, parental insightfulness plays an important role in the establishment of secure attachment and early childhood development. Previous studies have indicated that parental insightfulness is associated with positive parenting behaviors and improved quality of parenting, which plays an important role in the early child socio-emotional development. Parental insightfulness is mainly influenced by characteristics and experience of caregivers, and could be improved through parental interventions. The present study focuses on parental insightfulness and aims to provide basis for further research and child health care practices on child development and early rehabilitation of special need children such as children with autism spectrum disorder.

Research progress in the pain-specific assessment scales and its application in preterm infants

HUANG Wen-qi, QING Yan-bing, MA Li-fang, LI Zhang-qi, SU Chun-xiang

2022, 30(10):  1099-1103.  DOI: 10.11852/zgetbjzz2021-1134

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This paper reviews six pain specific assessment scales for preterm infants, discusses the application, and takes comparative analysis, so as to provide reference for the pain management of premature infants as well as the localization development of the pain specific scales for premature infants.

Advance of goals-activity-motor enrichment in early intervention of high-risk children with cerebral palsy

HAO Chao-li, WU Xi-xi, HAN Qing-mei, ZENG Pei, GUO Jin

2022, 30(10):  1104-1107.  DOI: 10.11852/zgetbjzz2021-1545

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Goals-activity-motor enrichment is a new early intervention therapy for children at high risk of cerebral palsy, which has been gradually applied in clinical practice. It focuses on early intervention for children at high risk of cerebral palsy through continuous enrichment of the peripheral environment with the active participation of the parents, using motor target as the main orientation. This paper discusses the main content of goals-activity-motor enrichment and the application of early intervention in children at high risk of cerebral palsy through literature review.

Research progress in the correlation between maternal vitamin D status and offspring food allergy

ZHANG Xu-dong, LIU Yang

2022, 30(10):  1108-1111.  DOI: 10.11852/zgetbjzz2021-1425

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The prevalence of children's food allergy is increasing year by year, which has become an important health problem that has attracted the attention of all sectors of society. Recent studies have found that vitamin D can affect the regulation of human immune system from fetal stage, and maternal low levels of vitamin D will increase the risk of allergic diseases in offspring. However, there are few studies on maternal vitamin D status and offspring food allergy at home and abroad. Therefore, this paper reviews related studies on this topic.

Meta Analysis

Knowledge map analysis of domestic infant cry research field based on CiteSpace

YANG Han, WANG Miao-qin, LI Yan-xi, YANG Chong-yao, CHEN Mao-qing, LI Yu-jun

2022, 30(10):  1112-1117.  DOI: 10.11852/zgetbjzz2022-0103

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Objective To analyze the status quo of research in the field of domestic infant crying, to explore the domestic research hotspots in this field, so as to provide certain ideas and basis for scientific research in infant crying. Methods Relevant papers on infant crying published from 1980 to December 2021 on the CNKI database were selected as the data source. CiteSpace software was used to visualize and analyze the related literature from the following five aspects:The quantity of articles, scholars, research institutions, research focuses, cutting-edge research topics. Results A total of 190 papers were included, with an overall upward trend in the number of articles published in the field from 1980 to 2021. The topic of infant cry has not yet been extensively examined in China, and cooperation among different scholars and institutions in this field was inadequate. The highest number of articles was issued by Hangzhou Medical College and its affiliated hospitals. The hot topics of researches contained nursing of crying babies (touch intervention, skin-to-skin contact, and breastfeeding), recognition of babies' emotional cry, and deep learning. "Nursing", "neonates", "infant crying" and "deep learning" were the frontiers of researches in this field. Research trends shifted from neonatal pathological crying to targeted interventions for infant crying and deep learning. Conclusions The field of domestic infant crying is receiving more attention. Further studies are warranted to strengthen cooperation and communication among different authors and institutions, to integrate multidisciplinary development, and to expand scope from infant emotional needs analysis, intelligent medicine and monitoring and new nursing intervention methods.

Clinical Research

Influencing factors of γδ-T cells in peripheral blood and its predictive value for outcomes in premature infants

JIN Xin-yun, ZHANG Xiao-li, WANG Yin-juan, LIU Jia-xin, WANG Xiao-yang, XU Fa-lin

2022, 30(10):  1118-1122.  DOI: 10.11852/zgetbjzz2021-1011

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Objective To investigate the influence of perinatal risk factors on γδ-T lymphocyte subsets in peripheral blood of preterm infants, and to determine the prognostic value of γδ-T cells for outcomes of premature infants. Methods A total of 112 preterm infants with gestational age from 28 to 37 weeks were enrolled in this study (including 88 cases of early preterm infants, 24 cases of middle to late preterm infants). Meanwhile 15 infants with gestational age of 37 to 42 weeks were selected into the control group. The levels of γδ-T, CD4+, CD8+, CD3+ and total lymphocytes in peripheral blood within 24 hours after birth were tested by flow cytometry. The influence of gestational age and risk factors of preterm birth on the lymphocyte subsets levels, as well as the relationship between outcomes of premature infants and γδ-T cells were analyzed. Results 1)There was significantly difference in the level of γδ-T cell in peripheral blood among the early preterm infants,middle to late preterm infants and term infants(F=8.855,P<0.001),and the proportion of γδ-T cells in early preterm infants was significantly lower than that in the other two groups(P＜0.05). 2) There was no significant difference in lymphocyte subsets among different causes of preterm birth groups (P＞0.05). 3)The levels of γδ-T cells in the four different iatrogenic preterm delivery subgroups were significantly different(F=3.595,P<0.05), andthe proportion of γδ-T cells in the fetal growth restriction group was significantly decreased (P<0.05). 4) There was no significant difference in the proportion of lymphocyte subsets between early-onset infection group and non-early-onset infection group (P>0.05). 5) No significant difference in γδ-T lymphocyte subsets was found among the normal group, the cerebral palsy/developmental delays group and the death group with 6 and 12 months of corrected age (P>0.05). Conclusion γδ-T cells in early peripheral blood of preterm infants are mainly affected by gestational age and are sensitive to fetal growth restriction, but have no correlation with the short-term development level of preterm infants.

Follow-up analysis of physical and neuropsychological development of premature infants within 24 months of corrected age

YANG Yu-lan, SUN Bin-bin, QU Xiao-li, JIANG Wen

2022, 30(10):  1123-1127.  DOI: 10.11852/zgetbjzz2021-1068

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Objective To compare the physical and neuropsychological development of preterm infants with different gestational ages within 24 months of corrected age, so as to provide theoretical basis for further health care of preterm infants. Methods Data on the physical development and neurodevelopment of 4 077 subjects (including 2 283 male infants and 1 794 female infants), who participated in the follow-up management in the clinic of high-risk infants in Shenzhen Maternity and Child Health Hospital from January 2017 to August 2020 at 1, 3, 6,12, 18,24 months of corrected age, were respectively collected and analyzed. According to gestational age, preterm infants were divided into extremely preterm infants (<28 weeks), early preterm infants (28 - 31⁺⁶ weeks), mid-term preterm infants (32 - 33⁺⁶ weeks) and late preterm infants (34 - 36⁺⁶weeks). Physical development of infants was evaluated by the Z-score method, and the neurodevelopment was evaluated by the Bayley Ⅱ scales. Weight for ageZ value (WAZ), length for ageZ value (LAZ), head circumference for age Z value(HCZ), mental development index (MDI) and physical development index (PDI) for each group were analyzed, and the trend lines of physical and neurodevelopment index of each corrected age were drew. Results 1) Differences in the average physical development indicators (including WAZ, LAZ, HCZ) of each gestational age group for each corrected month age were statistically significant (P<0.05), and all physical development indicators of the extremely preterm infants group were less than the others at each corrected month age(P<0.05). Differences in the physical development indicators at 1, 3, 6 months and 12 months of age among early, mid-term and late preterm infants were significant(P<0.05), which were not significant at the corrected age of 18 and 24 months(P＞0.05). There were no significant differences in the scores of physical development indicators between the mid-term preterm infants and late preterm infants(P＞0.05). The WAZ and LAZ of each gestational age group showed an upward trend from corrected age of 40 weeks to 6 months, but showed a downward trend from corrected 6 months to 18 months (F=5.572, 4.867, P<0.001). The HCZ of each gestational age group showed an overall downward trend from corrected age of 40 weeks to 24 months (F=3.095, P=0.006). 2) The MDI and PDI of extremely preterm infants group were lower than those of the others at each corrected month age (F=22.134、31.729, P<0.05), but with no significant differences among early, mid-term and late preterm infants(P＞0.05). The MDI from 6 months to 24 months of age showed a downward trend in the extremely preterm infants group (F=8.972, P<0.001). Conclusion The physical and neuropsychological development of early, mid-term and late preterm infants within 24 months of corrected age is basically appropriate,which is still unsatisfactory in extremely preterm infants within 24 months of corrected age and requires further study and intervention.

Temperament characteristics and its influencing factors of infants with cow's milk protein allergy

LI Guo-kai, GAO Xue-jie, YE Hong, ZHANG Rui, LIU Gui-hua

2022, 30(10):  1128-1131.  DOI: 10.11852/zgetbjzz2021-1520

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Objective To explore the temperament type, temperament dimension levels and influencing factors of infants with cow's milk protein allergy (CMPA), so as to provide basis for early family nurturing of infants with CMPA. Methods From January 2019 to December 2020, 102 infants who took typical physical examination in the Child Health Center ofFujiar Provincial Maternity and Children's Hospital were enrolled as the control group, and 102 infants with CMPA aged 4 to 8 months in the allergy specialist clinic were enrolled as the case group. All infants were evaluated by Chinese Infant Temperament Scale (CITS) and Cow's Milk-related Symptom Score (CoMiSS). Vitamin D level was measured in all infants and maternal anxiety was measured using the Self-Rating Anxiety Scale (SAS). Results A significant difference was found in infants' temperament types between the two groups (χ²=51.866, P<0.05). Except persistence and distractibility at the temperament dimension, the scores of activity level, rhythmicity, approach-withdrawal, adaptability, intensity of reaction, mood and threshold of responsiveness of infants in CMPA group were higher than those in control group (t=5.713,4.154,4.844,5.052,5.067,4.138,4.787,P<0.05). The CoMiSS scores of the infants and the maternal SAS scores in the CMPA group were significantly higher than those in the control group (t=49.433, 16.562, P<0.05), while vitamin D level of infants in CMPA group was significantly lower (t＝-16.981, P<0.05). Spearman analysis showed that maternal anxiety and CoMiSS score were correlated with temperament type of infants with CMPA (r=0.191,0.228,P<0.05), and the maternal anxiety level was related to the CoMiSS score and vitamin D level (r=0.762,-0.520,P<0.05). Conclusions The temperament type of CMPA infants has increased in the difficult-to-nurture type and decreased in the easy-to-nurture type. Family parenting should be guided according to the temperament type of the infants, paying attention to the influence of maternal anxiety on the infants' temperament type and family parenting. Moreover, providing health education and standardized diagnosis and treatment can alleviate allergic symptoms and improve nutritional status of infants, thereby improving the health of infants with CMPA.

Relationship between recurrent wheezing and gene prediction model of four-locus asthma in children and risk factors of recurrent wheezing

SHEN Ren, YANG Shan-pu, ZHANG Lin-tao, WU Yue-chao

2022, 30(10):  1132-1135.  DOI: 10.11852/zgetbjzz2021-1443

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Objective To explore the relationship between recurrent wheezing and gene prediction model of four-locus asthma in children, and to analyze the risk factors of recurrent wheezing. Methods A total of 91 asthmatic children who were hospitalized or saw a doctor in outpatient clinics in Yuhuan People's Hospital from January 2019 to March 2021 were selected into this study. According to the asthma predictive index(API) result, children were divided into API positive group(n=55) and API negative group(n=36).Meanwhile, 30 healthy children were selected as the control group. The high-risk rates of four-locus asthma gene prediction model among three groups were compared. The influencing factors of recurrent wheezing were analyzed by univariate and multivariate Logistic regression. Results The high-risk rate of four-locus asthma gene prediction model in API positive group was significantly higher than that in API negative group and control group(χ² =12.487, P<0.05). The risk of the four-locus asthma gene prediction model in the API positive group was 2.54 times higher than that in the API negative group and 5.32 times higher than that in the control group. Univariate analysis indicated that children's recurrent wheezing was associated with high risk type of the four-locus asthma gene prediction model, allergy history, family history of allergic diseases, positive inhaled allergens, positive ingested allergens, passive smoking, elevated eosinophil count and respiratory syncytial virus infection(χ²=13.831, 22.817, 25.475, 20.573, 6.373, 11.487, 10.790, 10.789, P<0.05), but not related to living surroundings(P>0.05). Multivariate Logistic regression analysis showed that the high risk type of four-locus asthma gene prediction model(OR=5.535, 95%CI: 1.928 -15.893), allergy history(OR=4.921, 95%CI:1.661 - 14.577), family history of allergic diseases(OR=4.460, 95%CI:1.560 - 12.749),positive inhaled allergens(OR=13.105, 95%CI:2.436 - 70.503) and passive smoking(OR=3.704, 95%CI:1.304 - 10.521) were independent risk factors for recurrent wheezing. Conclusions The high risk rate of four-locus asthma gene prediction model is significantly increased in children with recurrent wheezing, especially API positive children. Repeated wheezing is caused by multiple factors, among which the high risk type of four-locus asthma gene prediction model is an important reason.

Longitudinal study on the catch-up growth characteristics of preterm infants with different birth weight within 2 years of age

ZHANG Mei, KUANG Xiao-ni, MIAO Dan, MA Qi, HUANG Guang-wen

2022, 30(10):  1136-1140.  DOI: 10.11852/zgetbjzz2021-1568

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Objective To analyze the physical catch-up growth characteristics of preterm infants within 2 years of age, so as to provide data for clinical intervention. Methods Preterm infantswho were born from January 2017 to June 2019 and took regulartook follow-up visits from birth to 24 months of age in Changsha Maternal and Child Health Hospital were enrolled in this study. The Z-score method was used to evaluate the weight, length and head circumference of preterm infants. Z value and the mean increas value of weight, length and head circumference for each month age were calculated by group. The composition ratio of different Z value levels and the catch-up growth rate were analyzed, and the physical catch-up growth characteristics of SGA and AGA preterm infants were analyzed. Results Weight Z value of AGA preterm infants at born, 1, 18, 24 months old, Z value of body length at 1,9,18,24 months and head circumference at 24 months old, were significantly higher than those of SGA preterm infants(t=1.998 - 6.383, P＜0.05). The weight, length and head circumference Z value of AGA and SGA preterm infants all increased with age, while the catch-up speed decreased with age, and the catch-up speed was the highest at the age of 1 to 6 months. The percentage of weight, length and head circumference Z value ＜-2 decreased with age, and the catch-up rate increased with age. The maximum increase was between 1 and 6 months old. The weight of SGA and AGA preterm infants started to catch up at 18 and 12 months old, respectively, while the body length and head circumference started to catch up at 24 months old. The percentages of Z value≥0 showed an upward trend with the increase of months. The proportions of achieving catch-up growth of weight, length and head circumference till 24 months old in SGA preterm infants were 36.1%, 25.0% and 22.2% at 24 months of age, respectively, which were 57.7%, 45.1% and 43.7% for AGA preterm infants. Conclusions Low birth weight preterm infants are characterized by fast growth followed by slow growth and early age of weight catch-up growth within 2 years old, and the fastest catch-up is between 1 and 6 months of age. SGA preterm infants lag behind AGA preterm infants in terms of growth development. By 24 months of age, more than half of AGA preterm infants have not completed catch-up growth in terms of growth indicators except for weight.

Experience Exchange

Consistency between early warning signs of psychological and behavioral development and Gesell Developmental Scale of children aged 0 to 3 years

LIU Chao, LI Cheng-shan

2022, 30(10):  1141-1143.  DOI: 10.11852/zgetbjzz2021-1502

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Objectives To know about the psychological and behavioral development of children aged 0 to 3 years in Shunyi District of Beijing over the past three years, and to evaluate the application effects of early warning signs. Methods From September, 2018 to September, 2021, a total of 1 360 children who received assessment by Gesell Developmental Scale(GDS) in Maternal and Child Health Care Hospital of Beijing Shunyi District were selected, and the results of early warning signs of these children in community physical examination were retrieved. Then the results of two assessment methods were statistically analyzed. Results Among 1 360 children assessed by GDS,the proportion of boys(69.9%) was significantly higher than that of girls(30.1%) (χ² =214.412,P<0.05). The development quotients (DQ) of language and personal-social ability area of boys were significantly lower than those of girls (t＝4.201,2.186, P<0.05). In terms of early warning signs, children under 12 months old were mainly backward in the development of gross and fine movements, while children aged 12 to 36 months were mainly backward in language development.There was statistical difference in the composition ratio of early warning positive items among children in different age groups (χ²=36.750, 5.762, 9.966, 8.895, 57.731, 231.749, 105.385, 56.919, P<0.05). The result of early warning signs was moderately consistent with that of GDS (Kappa=0.559, P<0.05).The DQ value of adaptability in children with two or more positive early warning signs was significantly lower than that of children with one positive warning sign (t=5.718,P<0.05). Conclusion More attention should be paid to the development of boys' psychological and behavioral development, as well as the promotion of early childhood development, especially for the gross and fine movements development of infants, and the language development of young children.

Quality of life of the extremely preterm infants within 2 years old

JIANG Wen, SUN Bin-bin, YANG Yu-lan, QU Xiao-li, HE Hui-jing, ZHANG Shi, ZENG Hui, WANG Hao

2022, 30(10):  1144-1148.  DOI: 10.11852/zgetbjzz2021-1309

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Objective To analyze the physical and neuromotor development characteristics and existing problems of extremely preterm infants in the earlylife stage(0 to 2 years old), so as to provide scientific basis for improving the long-term quality of life of extremely preterm infants. Methods The physical development data of 258 extremely preterm infants followed up in the high-risk infant clinic of Shenzhen Maternity & Child Healthcare Hospital from 2016 to 2019 were analyzed and compared with the physical development data of children aged 0 to 2 years in nine cities of China in 2005. Physical development indicators(weight, length and head circumference), the standard deviation Z and the distribution of each indicator less than the 10th percentile(＜P₁₀) and less than the 3th percentile(＜P₃) were compared among different age groups. The development of infants was evaluated by Bayley Ⅱ Infant Scale at the corrected age of 6, 12, 18 and 24 months. Results 1) At the corrected age of 2 years old, the physical catch-up development of extremely preterm infants was still not ideal, in which the body length was better, followed by the weight, while the head circumference developed most slowly. The Z values of body length, weight and head circumference of boys were -0.31, -0.51, -0.87, and those of girls were -0.22, -0.43, -0.54. 2) The proportions of length, weight and head circumference <P₁₀ and <P₃ in extremely preterm infants within corrected age of 2 years old were significantly higher than the theoretical values for children with the same age. For boys at the corrected age of 2 years old, the corresponding values of body length, weight and head circumference < P₁₀ were 17.78, 22.22 and 28.89, respectively, while the corresponding values of body length, weight and head circumference < P₃ were 2.22, 13.33 and 15.56, respectively. For girls at the corrected age of 2 years old, the corresponding values of body length, weight and head circumference < P₁₀ were 13.04, 26.09 and 21.73, respectively, while the corresponding values of body length, weight and head circumference < P₃ were 8.70, 17.39 and 13.04, respectively. The proportions of body length and weight < P₁₀ decreased with age, and the proportion of head circumference maintained a high level within 2 years old. 3) The intelligence and motor development level of extremely preterm infants at the corrected age of 2 years old had a large gap with that of full-term infants with the same age. There was an upward trend of gradually catching up within the age of 2 years. The development of girls was slightly better than that of boys, but the difference was not significant(P>0.05). Conclusions 1) The physical development within corrected age of 2 years old after preterm birth is still not complete catch-up development. The catch-up of body length is ideal, followed by body weight, while the catch-up of head circumference is the slowest. Early nutrition enhancement should be focused on the improvement of head circumference and body weight. 2) The motor and intellectual development of extremely preterm infants within the corrected age of 2 years old shows a gradual increase, but there is a large gap compared to children of the same age and intensive training should be provided until 2 years old.

Difference in early neuro-motor development between preterm and full-term infants

TANG Meng-yan, LIU Xiao-mei, DU Juan

2022, 30(10):  1149-1152.  DOI: 10.11852/zgetbjzz2021-1477

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Objective To compare the difference in Infant Neurological Motor Assessment 20 Items(INMA20) results between preterm and full-term infants, so as to provide new clues for early detection and early intervention of children with neurodevelopmental abnormalities. Methods Infants born from January 1st to December 31st 2020 and followed up continuously in the Department of Child Health Care, West China Second University were enrolled in this study, and were divided into preterm group and full-term group according to gestational age. The difference in INMA20 results between the two groups was analyzed. Results A total of 349 premature infants and 713 full-term infants were enrolled. Failure rate of visual and auditory response dimension in preterm infants(13.5%) was higher than that in full-term infants(8.4%)(χ²=6.683,P=0.010), and failure rate of muscle tension dimension in full-term infants(50.9%) was higher than that in preterm infants(44.0%)(χ²=4.517, P=0.034), but no differences were found in reflex, posture and final results(P＞0.05). Besides, the results of each item showed that the failure rates of face tracking, adductors angle and dorsalis pedis flexion angle in preterm infants were significantly higher than those in full-term infants(χ²=7.307,3.932,P＜0.05), while the failure rates of continuous fist holding, pull sitting posture and head upright and scarf sign in full-term infants were significantly higher than those in preterm infants(χ²=5.936,11.058,6.669, P＜0.05). Conclusions Preterm infants have weaker audiovisual integration and lower limb muscles, while full-term infants have higher upper limb muscles and weaker head and neck muscles. It is suggested strengthening audiovisual integration training in routine child healthcare so as to promote audiovisual catch-up development in preterm infants, and taking motor interventions in order to promote gross motor development. Meanwhile, early motor development assessments should be conducted to identify infants with developmental abnormalities as early as possible.

Appropriate Technology

Value of serum Tau protein in assessing brain injury in premature infants and the recent prognosis

ZHAO Kai-hong, FU Hong-tao, TIAN Bo, WANG Tong, ZHANG Fang

2022, 30(10):  1153-1157.  DOI: 10.11852/zgetbjzz2021-1042

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Objective To investigate the value of serum Tau protein in assessing brain injury in premature infants (BIPI) and the recent prognosis, so as to provide reference for the prevention and treatment of BIPI. Methods From January to December 2020, 92 premature infants hospitalized in the Neonatology Department of Tangshan Maternal and Child Health Care Hospital were consecutively included. According to the cranial B-ultrasound and MRI diagnosis results in corrected gestational age of 40 weeks, infants were divided into paraventricula-intraventricular hemorrhage(PIVH) group(n=24), periventricular leukomalacia(PVL) group(n=10) and non-brain injury group(n=58). Serum levels of Tau protein, interleukin-6(IL-6), amplitude electroencephalogram (aEEG) score and Neonatal Behavioral Neurological Assessment (NBNA) score were compared among the three groups. Results On the 1st, 3rd and 7th day after birth, serum levels of Tau protein and IL-6 were significantly different among PIVH group, PVL group and non-brain injury group (F=18.227, 20.273, 18.569, 16.375, 17.283, 18.144, P<0.01). Specifically, the levels of above indicators in PIVH group and PVL group were significantly higher than those in non-brain injury group (P<0.05), but the difference between PIVH group and PVL group was not significant (P>0.05). The aEEG scores within 1 week after birth, aEEG score and NBNA score at corrected gestational age of 40 weeks were significantly different among PIVH group, PVL group and non-brain injury group(F=15.352, 14.903, 16.284, P<0.05). In detail, the levels of above indicators in PIVH group and PVL group were significantly lower than those in non-brain injury group (P<0.05), but the difference between PIVH group and PVL group was not significant (P>0.05). Serum level of Tau protein was positively correlated with serum IL-6 level (r=0.822, P<0.05), and negatively correlated with aEEG score in the first week after birth, aEEG score and NBNA score at the corrected gestational age of 40 weeks (r=-0.695,-0.647,-0.682,P<0.05). The optimal threshold value of serum Tau protein in the assessment of BIPI was 183.39 pg/ml, and corresponding AUC, sensitivity and specificity was 0.820, 76.3% and 85.2%, respectively. There was no significant difference in the assessment value when predicting BIPI among serum Tau protein level, aEEG score in 1 week after birth, aEEG score and NBNA score at corrected gestational age of 40 weeks (P>0.05). Conclusions Serum level of Tau protein could reflect BIPI and the recent prognosis of infants. The occurrence of BIPI should be alerted when it exceeds 183.39 pg/ml.

Case Report

Case report of a premature infant with chimeric trisomy 18 syndrome and secondary aldosteronism

GUO Shao-qing, ZHONG Mei-zhen, LI Xiao-zhong, ZHAO Shan-shan

2022, 30(10):  1158-1160.  DOI: 10.11852/zgetbjzz2021-1405

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