Table of Content

10 December 2025, Volume 33 Issue 12

Previous Issue   

Professional Forum

Impact of social and natural environmental exposure on healthy development of adolescents and preventive strategies

SONG Yi

2025, 33(12):  1281-1286.  DOI: 10.11852/zgetbjzz2025-1232

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Adolescence is a critical stage marked by rapid intellectual and cognitive development, as well as the formation of behavioral and health patterns.In recent years, academic consensus has shifted from viewing adolescence as the "healthiest stage" to recognizing it as a sensitive period of dramatic changes in health determinants, harboring immense investment potential for the "triple dividend".Research in adolescent health and puberty development has expanded from biological factors to social and natural environmental factors.Social environmental exposures, such as socioeconomic development, accelerated urbanization, digital transformation, and commercial factors, alongside natural environmental exposures, including environmental pollution, climate change, artificial light at night, and built environments, have emerged as novel research hotspots.However, most of those factors might have double-edged sword effect, presenting both risks and opportunities.Deepening our understanding of their impacts, underlying mechanisms, and intervention pathways, while developing effective policies or strategies, has become a critical research priority in child and adolescent health.

Identification of phenotypes in short stature with genetic variation

WANG Yirou, WANG Xiumin

2025, 33(12):  1287-1290.  DOI: 10.11852/zgetbjzz2025-1185

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Short stature is a common reason for consultation in the field of pediatric endocrinology and genetic metabolism, and its genetic etiology has garnered increasing attention in recent years.Defects in any genes involved in the process of height growth can lead to short stature, primarily by disrupting the normal proliferation and differentiation of growth plate chondrocytes.While dysfunction of the growth hormone-insulin-like growth factor (GH-IGF) axis represents a classic mechanism, multiple other factors—such as nutritional status, inflammatory cytokines, paracrine signaling, extracellular matrix, and intracellular signaling pathways—are also jointly involved in its regulation.Affected children often present clinically with abnormal body proportions, a positive family history, multisystem malformations or functional impairments, with specific genetic variants frequently correlating with distinct phenotypic profiles.Therefore, the systematic collection of phenotypic information combined with genetic testing has become a core strategy for achieving precision diagnosis and treatment of genetic-related short stature.

Original Articles

Correlation of SPOCK and TMEM38B gene polymorphisms with age at menarche in girls from the Sunan region

ZHANG Zongcui, MA Wei, ZHANG Hongxiao, WANG Ling, LIU Jinying, MA Wenyuan, SHI Rui, ZHANG Yu

2025, 33(12):  1291-1297.  DOI: 10.11852/zgetbjzz2025-0112

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Objective To investigate the association between single nucleotide polymorphisms (SNPs) in the SPOCK1 and TMEM38B genes and early age at menarche (AAM) in girls from the Sunan region of Gansu Province, so as to provide evidence for the prevention of early AAM. Methods From January to July 2023, 159 menstruated girls aged 9 - 18 from Yugur Autonomous County, Zhangye City, Gansu Province were recruited. Participants were divided into an early AAM group (AAM<12.8 years, n=75) and a normal AAM group (n=84) based on the 25th percentile(12.8 years old)of their AAM. TagSNPs for the candidate genes SPOCK1 and TMEM38B were selected from public NCBI and the shared resources of the 1 000 Genomes Project. Haploview software was used to screen out loci with a minimum allele frequency (MAF) of >0.05, and linkage disequilibrium analysis was performed to finalize the TagSNP. Multivariate logistic regression was used to analyze the association between SNPs and the risk of early AAM under different genetic models. Results After adjusting for confounders, significant associations with early AAM risk were found for SPOCK1 gene SNPs rs1859345 (overdominant model: TC vs. TT+CC, OR=2.10, 95%CI: 1.01 - 4.42, P=0.046) and rs7701979 (overdominant model: GT vs. GG+TT, OR=2.18, 95%CI: 1.02 - 4.65, P=0.040). Significant associations were also identified for TMEM38B gene SNPs rs10453225 (codominant model: GT vs. GG, OR=2.83, 95%CI: 1.29 - 6.20, P=0.024; dominant model: GT+TT vs. GG, OR=2.38, 95%CI: 1.13 - 4.98, P=0.020; overdominant model: GT vs. GG+TT, OR=2.30, 95%CI: 1.21 - 4.40, P=0.011), rs4452860 (recessive model: AA vs. GG+GA, OR=0.43, 95%CI: 0.20 - 0.94, P=0.033; overdominant model: GA vs. GG+AA, OR=2.13, 95%CI: 1.12 - 4.07, P=0.021), and rs12684013 (overdominant model: CT vs. TT+CC, OR=1.96, 95%CI: 1.04 - 3.73, P=0.037). Conclusion The rs1859345 and rs7701979 loci of SPOCK gene, and the rs10453225 locus, rs4452860 locus and rs12684013 locus of TMEM38B gene are all correlated with AAM in girls in Sunan region, suggesting these genes may play a role in the genetic regulation of menarche and providing potential genetic markers for the early screening of early AAM.

Influencing factors and combined effects in children with tic disorder and comorbid attention-deficit/hyperactivity disorder

CHEN Rong, CAI Yingying, LI Qinyu, CHEN Liangliang, LIU Xiumei

2025, 33(12):  1298-1302.  DOI: 10.11852/zgetbjzz2025-0314

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Objective To explore the main influencing factors and their combined effects on tic disorder (TD) comorbid with attention-deficit/hyperactivity disorder(ADHD) in children, in order to provide a theoretical basis for developing prevention and treatment strategies for TD with ADHD (TD+ADHD). Methods A total of 80 new cases of TD+ADHD treated in the Department of Developmental and Behavioral Pediatrics of Fujian Children′s Hospital from January 2023 to April 2024 were included as the observation group, and 178 new cases of TD-only treated in the same department matched by gender and age frequency of the observation group were included as the control group. A questionnaire survey was administered. Results Univariate analysis showed that there were statistically significant differences in family history of TD (χ²=4.093), parental allergic disease (χ²=7.912), corporal punishment (χ²=10.393), criticism (χ²=19.457) and keeping pets (χ² =5.142) (P<0.05) between the TD+ADHD group and the TD-only group. Multivariate unconditional logistic regression analysis showed that the risk of ADHD comorbidity in TD children whose parents had allergic diseases and who experienced corporal punishment was 4.485 times that of TD children whose parents had no allergic diseases and who experienced no corporal punishment (95%CI: 1.915 - 10.505,P<0.01). The risk for TD children whose parents had allergic diseases and kept pets was 5.006 times that of those whose parents had no allergic diseases and did not keep pets (95%CI: 1.815 - 13.807,P<0.01). The risk for TD children whose parents had allergic diseases and who experienced both corporal punishment and pet ownership was 18.693 times that of those whose parents had no allergic diseases, experienced no corporal punishment, and did not keep pets (95%CI: 3.862 - 90.488,P<0.001). Conclusions TD comorbid with ADHD in children Results from the interaction of genetic and environmental factors. Parental allergic diseases combined with corporal punishment and pet ownership significantly increase the risk of ADHD comorbidity in children with TD.

Item response theory model for the home toy inventory assessment in infants

HUA Jing, CHI Xia, SONG Jun, RUI Hongxin, ZHOU Jianyong, LIN Feng

2025, 33(12):  1303-1309.  DOI: 10.11852/zgetbjzz2025-0183

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Objective To apply item response theory (IRT) to develop a tool for assessing home toy inventory, so as to provide a quantitative basis for guiding families in the scientific arrangement of infants′ physical activity toys. Methods A cross-sectional study was conducted using a convenience sample of infants aged 18 - 42 months and their parents recruited between January and October 2023 from the Department of Child Health Care of Nanjing Women and Children′s Healthcare Hospital. Items from the toy dimension (including gross and fine motor toys) of the Affordances in the Home Environment for Motor Development-Self Report (AHEMD-SR) were selected. IRT modeling was performed using R software to calculate person ability, goodness of fit, item difficulty, and intervention benefit, alongside reliability and validity analysis. Results The sample included 250 infants and their parents. Mokken scale analysis screened 23 items for Rasch model construction. The resulting model demonstrated good fit (M₂ statistic＝377.917, df＝252, P＞0.05), high reliability (latent class reliability coefficient＝0.898) and good validity (r＝0.60, P<0.01). Among these, 22 items showed significant intervention benefit (P＜0.05).The person-item map indicated good matching between item difficulty and individual ability, presenting a normal distribution. Conclusions The Home Toy Inventory Assessment, constructed based on IRT, fits well with the Rasch model and can effectively evaluate home toy support related to children′s motor development. The person-item map serves as a decision-making tool to assist parents in developing individualized home intervention plans tailored to their capability levels.

Assessment oflongitudinal changes in motor function in children with Duchenne muscular dystrophy using motor function measurement and timed function tests

WANG Yating, HUANG Meihuan, CUI Ruiqing, ZHOU Chunming, ZHONG Jiamin, YUN Guojun

2025, 33(12):  1310-1315.  DOI: 10.11852/zgetbjzz2024-1221

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Objective To investigate longitudinal changes in motor function outcomes in children with Duchenne muscular dystrophy (DMD) under corticosteroid treatment, in order to provide evidence for clinical management. Methods This longitudinal study included 46 male DMD patients (aged 3 - 14 years) treated at Rehabilitation Department of Shenzhen Children′s Hospital from October 2017 to July 2024.Participants were stratified into preschool and school-age groups.Assessments included basic information, Motor Function Measure-32 (MFM-32) and Timed Function Tests (TFTs).TFTs included the 10-meter walk/run test (10MWR), rise from floor (RFF), and four-step climb (4SC).Spearman′s correlation and paired t-tests were used to analyze the relationships between MFM-32 domains and TFTs at baseline and 12-month follow-up. Results MFM-D1 domain scores showed a strong negative correlation with TFTs (r =-0.665 to -0.614, P < 0.01).In the preschool group, statistically significant differences were observed in the MFM-D1 (t=2.782), D3 (t=2.963), total score (t=3.639), 10MWR (t=-2.138) and 4SC (t=-2.381) (all P<0.05).School-age group demonstrated significant changes in MFM-D1 (t=-4.433), total score (t=-3.427), 10MWR (t=3.15) and RFF (t=2.128) (all P<0.05). Conclusions After 12 months,motor function in the preschool children with DMD shows an overall upward trend, while the school-age children with DMD exhibited a decline. MFM-32 and TFTs are sensitive tools for monitoring motor function progression in DMD.Combined implementation is recommended for comprehensive clinical assessment.

Genetically predicted causal effects between cytomegalovirus infection and neurodevelopmental disorders

LAI Qiankun, LI Yinzhi, HUANG Qi, GUO Jingmin, YAO Qingshan

2025, 33(12):  1316-1322.  DOI: 10.11852/zgetbjzz2025-0416

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Objective To investigate the causal relationship between cytomegalovirus (CMV) infection and neurodevelopmental disorders (NDDs) in children,in order to provide evidence for targeted intervention. Methods Using genome-wide association study (GWAS) data, a two-sample Mendelian randomization (TSMR) approach was employed to analyze causal associations between four CMV antibodies and autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), developmental intellectual disability (DID), and tic disorder (TD). The inverse variance weighted (IVW) method was primarily used for causal effect estimation, with Bonferroni correction applied to determine significance thresholds. Robustness of Results was validated via Cochran′s Q test, MR-Egger regression intercept, MR-PRESSO, and leave-one-out analysis. Reverse MR was conducted to exclude reverse causality. Results TSMR analysis under Bonferroni correction revealed a significant positive causal relationship between anti-CMV IgG and ASD risk (OR=1.333, 95%CI:1.103 - 1.611, P=0.003), indicating that CMV infection significantly increased ASD risk. No causal associations were found between CMV antibodies and ADHD, DID, or TD. Cochran′s Q test confirmed no heterogeneity, MR-Egger regression indicated no horizontal pleiotropy, MR-PRESSO detected no outliers, and leave-one-out analysis supported result reliability. Reverse MR excluded reverse causality. Conclusion This Mendelian randomization study confirms a genetically predicted positive causal link between CMV infection and ASD risk, suggesting that perinatal CMV prevention may hold potential value for reducing ASD risk.

Relationship between parental empathy and responsive caregiving for infants and young children

LU Lin, SONG Yang, YIN Keli, REN Geng, XI Lili

2025, 33(12):  1323-1327.  DOI: 10.11852/zgetbjzz2025-0205

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Objective To investigate the relationship between parental empathy and responsive caregiving for infants and young children, in order to provide a theoretical evidence for improving the quality of parenting in China by enhancing the level of parental responsive caregiving. Methods A cross-sectional study was conducted among parents of 304 children aged 0 - 3 years from three childcare institutions in Shaanxi Province between January and February 2025. A total of 304 valid data were collected online (via Questionnaire Star) using a general information questionnaire, the Chinese version of the Interpersonal Reactivity Index (IRI-C), and the Responsive Caregiving Rating Scale. Results Differential tests revealed statistically significant differences in responsive caregiving levels based on the different guardian role (t=3.915) and whether the parent was the primary caregiver (t=2.631) (P<0.01). Hierarchical multiple linear regression analysis showed that the overall level of parental empathy significantly and positively predicted the level of responsive caregiving (β=0.257, P<0.001). Further analysis indicated that empathic concern (β=0.207), personal distress (β=-0.164), and perspective-taking (β=0.307) all had significant predictive effects on the level of responsive caregiving (P<0.01). Conclusions Other-oriented parental empathy (empathic concern and perspective-taking) positively influences responsive caregiving, whereas self-oriented parental empathy (personal distress) has a negative impact. Parenting guidance should focus on cultivating parents′ other-oriented empathic concern and perspective-taking abilities to effectively improve the quality of responsive caregiving.

Association between birth weight and neuropsychological development among children aged 0 - 6 months

GE Jingjing, WANG Weikai

2025, 33(12):  1328-1332.  DOI: 10.11852/zgetbjzz2024-1189

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Objective To analyze the association between birth weight and neuropsychological developmental outcomes in children aged 0 - 6 months, in order to provide a reference for early clinical intervention. Methods A total of 2 572 children who visited the Child Health Care Clinic of Gansu Provincial Maternal and Child Health Hospital from January 2021 to December 2023 were enrolled.Neuropsychological development was assessed using the Developmental Behavior Assessment Scale for Children Aged 0 - 6 Years, and the relationship between birth weight and developmental outcomes was analyzed using binary logistic regression. Results The rate of overall developmental abnormality(developmental delay or borderline impairment was 7.8%(201/2 572).Significant differences were observed in the overall developmental quotient (DQ), gross motor DQ, and adaptive DQ among children with different birth weights (P<0.05).The abnormal development rates in overall (χ²=57.271), gross motor (χ²=22.037), fine motor (χ²=12.400), adaptive ability (χ²=20.828), language (χ²=14.570), and social behavior (χ²=28.267) domains also varied significantly by birth weight (P<0.05).Compared to low birth weight, below-average (OR=0.48, 95% CI: 0.30 - 0.76), average (OR=0.38, 95%CI: 0.24 - 0.60), and above-average birth weight (OR=0.34, 95%CI: 0.18 - 0.62) were protective factors against developmental delay or borderline impairment (P<0.01).Average birth weight was protective against gross motor delay (OR=0.66, 95%CI: 0.48 - 0.90, P < 0.01), while above-average birth weight reduced the risk of adaptive ability delay (OR=0.61, 95%CI: 0.41 - 0.91, P<0.05).Additionally, average (OR=0.62, 95%CI: 0.42 - 0.91; OR=0.47, 95%CI: 0.26 - 0.86) and above-average birth weight (OR=0.61, 95%CI: 0.39 - 0.96; OR=0.47, 95%CI: 0.22 - 0.99) were protective against language and social behavior delays (P<0.05).However, high birth weight showed no significant effect on any developmental domain compared to low birth weight (P>0.05). Conclusion Clinical follow-up should prioritize children with low, below-average, and high birth weight, implementing timely management and interventions to optimize neuropsychological development.

Review

Research progress on the exercise intervention for children and adolescents with developmental coordination disorder

HOU Yaoqi, LEI Zonghan, WANG Yan, LU Wanjing, LIU Hong, SONG Xiangqin

2025, 33(12):  1333-1337.  DOI: 10.11852/zgetbjzz2025-0116

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This paper aims to explore the effects of exercise interventions on children with developmental coordination disorder (DCD) and their underlying physiological mechanisms, while systematically reviewing recent experimental studies on the impact of exercise interventions on children with DCD. Research indicates that exercise interventions can significantly improve motor coordination in children with DCD, with intervention Methods showing increasing diversity, ranging from fundamental movement training to specialized sports training (such as taekwondo, table tennis), as well as innovative training approaches combining cognitive tasks. Exercise interventions can promote brain physiological changes through inducing synaptic plasticity, restructuring neural circuits, increasing gray matter volume, and regulating neurotransmitter systems, thereby enhancing motor control abilities. These changes are achieved through the activation of multiple signaling pathways, ultimately optimizing functional connectivity in motor-related brain regions.

Progress on the impact of gestational diabetes mellitus on offspring neuropsychological development and its mechanisms

HUO Yunfeng, WU Juanjuan, WANG Hua

2025, 33(12):  1338-1342.  DOI: 10.11852/zgetbjzz2024-0899

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Gestational diabetes mellitus (GDM) is a common pregnancy-related disorder that often leads to adverse pregnancy outcomes and may have long-term health implications for both mothers and their offspring.Neuropsychological studies on GDM-exposed offspring indicate an increased incidence of developmental delays, attention-deficit/hyperactivity disorder (ADHD), learning disabilities, and autism spectrum disorder (ASD).The mechanisms underlying GDM′s impact on offspring development involve multiple factors, including placental alterations during pregnancy, intrauterine oxidative stress, postnatal growth patterns, and changes in gene expression.Preconception and antenatal health management, along with regular developmental screening and early intervention after delivery, are essential measures for mothers with GDM and their children.This review summarizes the effects of GDM on offspring neuropsychological development, explores potential mechanisms, and proposes management recommendations.

Advances in the assessment and intervention of selective motor control in upper limb among children with spastic cerebral palsy

ZHONG Jiamin, ZHOU Chunming, HUANG Meihuan, CHEN Yijing, WANG Yating, CAO Jianguo

2025, 33(12):  1343-1347.  DOI: 10.11852/zgetbjzz2024-1060

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Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder of movement and posture caused by early-life brain injury, with spastic CP being the most prevalent subtype.Impaired selective motor control(SMC) is a hallmark of this condition, significantly impacting motor function and daily activities in affected children.However, current assessment and intervention approaches for upper limb SMC remain inadequate, lacking systematic and standardized integration.This review synthesizes recent advances in the evaluation and management of upper limb SMC in children with spastic CP, aiming to inform future research and clinical practice for optimizing rehabilitation strategies.

Research progress on the mechanism of perinatal depression′s impact on offspring neurofunctional development

ZHI Jincao, XU He, CHANG Qing, WU Shanhong, QIN Huan, WANG Yan

2025, 33(12):  1348-1352.  DOI: 10.11852/zgetbjzz2024-1297

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Early life is a critical period for neurodevelopment in children. Perinatal depression (PND) has been demonstrated to profoundly affect various aspects of offspring development, including motor skills, language, cognition, and social abilities. This article reviews the impact of PND on offspring neurofunctional development and its potential underlying mechanisms, such as epigenetic regulation, impaired mother-infant attachment, alterations in brain structure and function, hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, immune inflammation, abnormal gut microbiota, and multi-omics regulation. It also proposes preventive measures for PND, aiming to promote maternal mental health during the perinatal period and mitigate the negative effects of PND on offspring neurofunctional development.

Research progress on the effects of different whole-body vibration parameters on motor function of children with cerebral palsy

GUO Hongjie, CHANG Wanpeng, LIU Shuai, HUANG Yan

2025, 33(12):  1353-1357.  DOI: 10.11852/zgetbjzz2025-0054

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As a non-invasive rehabilitation method, whole-body vibration (WBV) training can improve the motor function of children with cerebral palsy (CP) by adjusting the parameters of vibration type, frequency, amplitude and duration. However, there are many parameters and the mechanism of action is complex, and different parameters and training postures produce different effects. Therefore, the optimal vibration scheme of WBV has not yet reached a consensus. This paper analyzes the actual effects of different vibration parameter schemes in the treatment of children with CP from multiple vibration parameter dimensions, so as to provide more accurate and scientific guidance for clinical practice.

Meta Analysis

Meta-analysis on the efficacy of family interventions for children with cerebral palsy

FANG Enhui, GUAN Hui, TIAN Jinxin, ZHANG Hao, MA Lihong

2025, 33(12):  1358-1366.  DOI: 10.11852/zgetbjzz2024-1104

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Objective To systematically evaluate the efficacy of home-based interventions in improving gross motor function and activities of daily living (ADL) in children with cerebral palsy (CP), so as to provide evidence for developing effective intervention strategies. Methods Literature on home-based interventions for children with CP were searched across databases including CNKI, VIP, Wanfang, CBM, PubMed, Embase, Web of Science, and Cochrane Library from inception to June 2024.Meta-analysis was performed using Review Manager 5.4 and Stata 17.0. Results A total of 28 studies were included.Meta-analysis revealed statistically significant differences between the home-based intervention group and conventional rehabilitation group in GMFM-88 scores (MD=10.87, 95% CI: 8.51 - 13.23), GMFM-88 E dimension scores (MD=4.71, 95% CI: 3.82 - 5.61), and ADLs scores (MD=7.63, 95% CI: 4.68 - 10.57) (P<0.001).However, no significant difference was observed in GMFM-66 scores (MD=4.43, 95% CI: －1.56 - 10.42, P=0.15)between the two groups. Conclusion Home-based interventions can effectively improve gross motor function and ADL performance in children with cerebral palsy.

Clinical Research

Effect of whole-body vibration therapy at different frequencies on upper extremities motor function in children with spastic cerebral palsy

ZHANG Qiu, ZHANG Chi, LI Weiping, YU Jihua, DU Xinping, WANG Jianxiong

2025, 33(12):  1367-1371.  DOI: 10.11852/zgetbjzz2024-1250

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Objective To compare the effects of whole-body vibration training (WBVT) at different frequencies on upper limb motor function and activities of daily living (ADL) in children with spastic cerebral palsy (CP), in order to provide evidence for rehabilitation strategies. Methods A total of 91 children with spastic CP (aged 6 - 12 years) from the Affiliated Hospital of Southwest Medical University were enrolled between December 2023 and October 2024.Participants were randomly assigned to four groups: control group (n=23), 10Hz group (n=22), 15Hz group (n=24), and 20Hz group (n=22).All groups received conventional rehabilitation training, while the 10Hz, 15Hz, and 20Hz groups additionally underwent WBVT at their respective frequencies for 6 weeks.Outcomes were assessed pre- and post-intervention using the Modified Ashworth Scale (MAS), Carroll Upper Extremity Function Test (UE-FT), and Functional Independence Measure for Children (WeeFIM). Results After 6 weeks of treatment, significant differences were observed among the four groups in MAS scores (F=8.014), UE-FT scores (F=15.737), and WeeFIM scores (F=17.525) (P<0.05).Post-hoc LSD tests revealed that the 10Hz, 15Hz, and 20Hz groups showed superior outcomes compared to the control group, with the 20Hz group demonstrating the most significant improvements (P<0.05). Conclusions Conventional rehabilitation combined with WBVT can reduce upper limb muscle tone, improve motor function, and enhance ADL in children with spastic CP.Notably, WBVT at 20Hz appears to be the most effective frequency.

Clinical study of bone mineral density and related factors of bone metabolism in 3 024 children aged 1 to 6 years

XU Yanfen, DONG Wenhong, LU Wei, SHEN Ying

2025, 33(12):  1372-1375.  DOI: 10.11852/zgetbjzz2024-1103

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Objective To analyze the relationship between bone mineral density (BMD) in children and factors including sex, age, body mass index (BMI), blood calcium, blood phosphorus, serum alkaline phosphatase (ALP), and serum 25-hydroxyvitamin D[25-(OH)D], in order to provide a scientific basis for promoting pediatric bone health. Methods A total of 3 024 children aged 1 - 6 years who underwent health examinations at the Child Health Care Center of the Children′s Hospital Affiliated to Zhejiang University School of Medicine from June 2018 to September 2022 were included.BMI, serum ALP, calcium, phosphorus, and 25-(OH)D levels were measured, and BMD was assessed using ultrasound bone densitometry. Results Among the3 024 participants, 578 children (19.11%) had low BMD.Male children exhibited higher BMD Z-scores than females (t=3.132, P<0.01).Significant differences in BMD Z-scores were observed across age groups (F=54.493, P<0.001).The normal BMD group had lower BMI than the low BMD group (t=7.083, P<0.001).Children with low BMD showed lower serum calcium, phosphorus, and 25-(OH)D levels compared to those with normal BMD (t=8.659, 3.479, 16.440, P<0.01).Correlation analysis revealed that BMD Z-scores were positively associated with serum calcium, phosphorus, and 25-(OH)D levels (r=0.146, 0.051, 0.240, P<0.05), negatively correlated with BMI (r=-0.128, P<0.05), and not correlated with ALP (P=0.684).Multivariate logistic regression identified BMI (OR=1.259), calcium (OR=0.025), phosphorus (OR=0.426), and 25-(OH)D (OR=0.954) levels as significant influencing factors of BMD (P<0.05). Conclusions Pediatric BMD is associated with sex, age, serum calcium, phosphorus, BMI, and 25-(OH)D, but not with serum ALP.Maintaining relatively high levels of serum calcium, phosphorus, and 25-(OH)D is crucial for sustaining normal BMD in children.

High-risk factors for brain injury in neonates with congenital diaphragmatic hernia

MA Yingjun, WANG Huiping, XI Zhaoxia, GOU Weina, WANG Mei

2025, 33(12):  1376-1380.  DOI: 10.11852/zgetbjzz2024-1197

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Objective To analyze the risk factors and prognosis of brain injury in neonates with congenital diaphragmatic hernia (CDH), in order to provide evidence for clinical prediction and intervention. Methods A retrospective analysis was conducted on 83 full-term CDH neonates who underwent surgical treatment at the Second Affiliated Hospital of Xi′an Jiaotong University from October 2019 to August 2023.Based on diagnostic criteria for brain injury syndrome, patients were divided into a brain injury group (n=36) and a control group (n=47).General neonatal data, perinatal records, comorbidities, and examination Results were compared between the two groups.Logistic regression analysis was used to identify high-risk factors for brain injury. Results Significant differences were observed between the brain injury and control groups in lung-to-head ratio (LHR) (t=4.335), open surgery (χ²=4.196), and pulmonary hypertension (χ²=5.397) (P<0.05).Logistic regression identified the following independent risk factors for brain injury: lung-to-head ratio <1.5 (OR=8.171, 95%CI: 2.893 - 23.079, P<0.001), pulmonary hypertension (OR=4.069, 95%CI: 1.129 - 14.674, P=0.032), and open surgery (OR=3.517, 95%CI: 0.952 - 12.987, P<0.1).Among the 36 brain injury cases, 1 died, 2 were lost to follow-up, 24 had favorable outcomes, and 9 had poor prognosis. Conclusions Lung-to-head ratio <1.5, pulmonary hypertension, and open surgery significantly increase the risk of brain injury in CDH neonates.Intensive monitoring and targeted interventions should be implemented for high-risk patients to improve prognosis.

Cohort study of birth outcomes and early neurobehavioral developmentin twins conceived via assisted reproductive technology

XU Yuhong, GAO Xueting, ZHANG Huiping, BAI Feng, WANG Duan, HE Yuying, BU Jingyu, ZHANG Yi, CHEN Yanni

2025, 33(12):  1381-1385.  DOI: 10.11852/zgetbjzz2024-1446

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Objective To compare birth outcomes and early neurobehavioral development between preterm twins conceived via assisted reproductive technology (ART) and those conceived naturally, in order to provide evidence-based recommendations for the health management of in vitro fertilization (IVF) infants. Methods This retrospective cohort study included 147 twin pairs (n=294) of preterm infants who underwent regular health examinations at the Child Health Clinic of Xi′an Children′s Hospital between January 2017 and January 2022.Participants were divided into two groups: 78 ART-conceived twin pairs (observation group, n=156) and 69 naturally conceived twin pairs (control group, n=138).Data on maternal gestational complications and neonatal clinical conditions were collected.Neurodevelopmental outcomes were assessed using the Gesell Developmental Schedules (GDS) at corrected ages of 6 and 12 months. Results No significant differences were observed in the incidence of maternal gestational complications between the two groups (P>0.05).The observation group exhibited a higher prevalence of congenital heart disease (CHD) compared to the control group (χ²=12.05, P < 0.05).However, no significant differences were found in GDS scores at 6 or 12 months of corrected age (P>0.05). Conclusions ART-conceived preterm twins have an increased risk of common CHD, but no cases of severe or complex CHD are identified.Early neurobehavioral development do not differ significantly between ART and naturally conceived preterm twins, suggesting that ART does not elevate the risk of neurodevelopmental abnormalities in this population.

Death trends of congenital heart disease in children under 5 years old in China from 2008 to 2021

LI Changlan, YANG Junli, LIU Ling, LI Xiaoyi, CHANG Yue

2025, 33(12):  1386-1391.  DOI: 10.11852/zgetbjzz2024-1168

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Objective To examine the mortality trends of congenital heart disease (CHD) among children under 5 years old in China from 2008 to 2021, in order to provide critical evidence for developing health policies to reduce CHD mortality. Methods Data were collected from China′s cause of death monitoring system spanning the years 2008 to 2021.The annual percentage change (APC) and average annual percentage change (AAPC) of congenital heart disease mortality rates among children under 5 years old were assessed using JoinPoint regression analysis. Results From 2008 to 2021, both infants (<1 year: AAPC=-8.65, P<0.001) and children (1-<5 years: AAPC=-9.01, P<0.001) showed significant declining trends in CHD mortality, though infant mortality remained substantially higher.Male infants exhibited greater mortality reduction (AAPC=-9.11, P<0.001) than females (AAPC=-7.91, P<0.001), yet maintained higher absolute rates.Urban areas demonstrated steeper declines in infant mortality (AAPC=-10.69, P<0.001) compared to rural areas (AAPC=-7.69, P<0.001), with rural rates surpassing urban after 2018.Western China showed slower mortality reduction in children aged 1-<5 years (AAPC=-6.02, P<0.001) compared with eastern (AAPC=-11.42, P<0.001) and central regions (AAPC=-8.71, P<0.001). Conclusions While CHD mortality among childrenunder 5 years has significantly declined since 2008, rates remain concerningly high, particularly for infants.These findings underscore the need for enhanced nationwide CHD prevention and early screening programs to further reduce disease burden and mortality.

Case-control study on the association between maternal factors during pregnancy and neonatal congenital heart disease in the Guangxi region

WEI Jishan, WEI Ping, HUANG Xuhua, ZHANG Yuxing, LIU Xianghong, MO Jingyuan, YU Qun

2025, 33(12):  1392-1396.  DOI: 10.11852/zgetbjzz2025-0191

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Objective To investigate the clinical characteristics of neonatal congenital heart disease (CHD) and its association with maternal factors during pregnancy in the Guangxi region, so as to provide evidence for developing CHD prevention strategies. Methods A 1∶2 matched case-control study was conducted. A total of 2 277 neonates diagnosed with CHD born in Guangxi maternity institutions in 2021 were selected as the case group, and 4 554 healthy neonates matched by gender and region served as the control group. Maternal antenatal and delivery information was collected for both groups. Univariate and multivariate logistic regression analysis were used to identify risk factors for CHD. Results The most common type of CHD in the case group was patent ductus arteriosus (34.34%), followed by atrial septal defect (14.27%) and ventricular septal defect (11.73%). Birth weight (t=23.383) and length (t=27.121) in the case group were significantly lower than those in the control group (P<0.001). Multivariate analysis revealed that maternal age at delivery ≥35 years (OR=1.21, 95%CI: 1.10 - 1.34), gestational age <37 weeks (OR=3.09, 95%CI: 2.43 - 3.92), neonatal birth weight <2 500g (OR=2.73, 95%CI: 2.12 - 3.51), pre-pregnancy BMI ≥ 28kg/m² (OR=2.69, 95%CI: 1.92 - 3.34), no folic acid supplementation during pregnancy (OR=2.23, 95%CI: 1.96 - 2.55), history of adverse pregnancy (OR=2.95, 95%CI: 2.47 - 3.52), multiple pregnancy (OR=6.85, 95%CI: 4.49 - 10.47), and anemia during pregnancy (OR=3.63, 95%CI: 2.99 - 4.41) were independent risk factors for neonatal CHD(P<0.01). Conclusions Neonatal CHD in the Guangxi region is closely associated with various maternal factors during pregnancy. Enhanced perinatal monitoring and intervention for pregnant women of advanced age, those with multiple pregnancies, anemia, no folic acid supplementation, or a history of adverse pregnancy are crucial to reduce the risk of CHD.

Case Report

A case of autoimmune polyendocrine syndrome type 1

Dilareyi·Dawulietihan, Luo Yanfei, Mayila·Abudureyimu, Mireguli·Maimaiti

2025, 33(12):  1397-1400.  DOI: 10.11852/zgetbjzz2024-1394

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