Table of Content

10 September 2024, Volume 32 Issue 9

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Professional Forum

Dietary therapy and challenges for familial chylomicronemia syndrome

WANG Qiao, GONG Chunxiu

2024, 32(9):  934-936.  DOI: 10.11852/zgetbjzz2024-0894

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Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive genetic disorder caused by variations in the LPL gene, which codes for lipoprotein lipase, or in genes coding for proteins that regulate lipoprotein lipase activity. Markedly elevated plasma triglyceride (TG) levels (typically >10mmol/L), along with the resulting rash yellow tumor, retinal hyperlipidemia, splenomegaly, recurrent abdominal pain, and pancreatitis attacks are the main clinical manifestations of FCS. Among them, pancreatitis is the primary life-threatening complication and the main cause of reduced quality of life, with its incidence and severity clearly related to plasma TG levels. Conventional lipid-lowering drugs are typically ineffective in FCS patients. Currently, a long-term strict very low-fat diet is the main treatment for this disease. This usually involves reducing dietary fat intake to 10% - 15% of total energy needs while ensuring adequate intake of essential fatty acids. Dietary management can rapidly lower plasma TG levels and effectively prevent complications related to hypertriglyceridemia. However, maintaining and adhering to such a strict very low-fat diet regimen over the long term remains challenging. Surveys have shown that a large part of patients face psychological and social support issues. Therefore, the treatment of FCS requires interdisciplinary collaboration in pharmacology, genetics, nutrition, psychology, and other fields.

Practice and prospects of integrating nurturing care and family interventions for autism spectrum disorder

LI Tingyu, WEI Qiuhong, LI Yan, WEI Hua, DAI Ying, CHEN Li

2024, 32(9):  937-940.  DOI: 10.11852/zgetbjzz2024-0682

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Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with increasing prevalence, posing significant challenges on families and society. As the number of children with mild symptoms and normal intellectual abilities rises, new opportunities for rehabilitation and intervention have emerged. In this context, it is crucial to explore ways to enhance parental caregiving skills to promote the recovery of ASD children. This editorial introduced a novel model that integrated caregiving into family-based interventions, particularly suited for early intervention in economically underdeveloped regions of China for children with ASD. Additionally, it provided valuable insights for resource-limited developing regions.

Original Articles

Moderating effects of toddlers' temperament between responsive feeding and toddlers' obesity-related eating behaviors

LIU Yan, WANG Pei, KONG Yan, YU Guiling, ZHANG Guanghua

2024, 32(9):  941-946.  DOI: 10.11852/zgetbjzz2023-0874

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Objective To analyze the influence of adaptive feeding on obesity related dietary behaviors in toddlers,and to examine the moderating effects of children's temperament in this process,in order to provide reference for improving obesity related dietary behaviors in young children. Methods From May 2021 to February 2023,a questionnaire survey was conducted among 650 caregivers of overweight/obese young children from four maternal and child healthcare centers in Shandong Province.The survey included caregivers' responsive feeding,children's obesity related dietary behaviors (food responsiveness,emotional overeating),and children's temperament (effort control,negative emotions). Results The score for responsive feeding of caregivers was 65.58±8.73,and the scores for food responsiveness and emotional overeating of toddlers were 3.65±0.84 and 3.37±0.76,respectively.Responsive feeding negatively predicted food responsiveness and emotional overeating (β=-0.451,95%CI:-0.521 - -0.393;β=-0.522,95%CI:-0.591 - -0.468,P<0.01).The moderating effect of effort control between responsive feeding and food responsiveness was significant (β=-0.155,95%CI:-0.231 - -0.087,P<0.01),indicating the impact of responsive feeding on food response in high effort control individuals (β=- 0.657,95%CI:-0.743 - -0.484,P<0.01) were greater than individuals with low effort control(β=- 0.401,95%CI: -0.525 - -0.312,P<0.01). Conclusions There is room for improvement in dietary behaviors related to responsive feeding and childhood obesity.Responsive feeding has a negative effect on food responsiveness and emotional overeating,the process by which responsive feeding affected food resonsivenpss was influenced by toddlers' effortl control.Therefore,for reducing toddlers' emotional overeating,emphasis should be placed on improving caregivers' responsive feeding.To maximize the improvement of food responsiveness in toddlers,the combined effects of toddlers' effort control and caregivers' responsive feeding should be considered.

Impact of histological chorioamnioitis on complications and neurodevelopment in premature infants at 1 year of age

XIE Haixia, LUO Hongxia, LIU Haixia, SHAO Qinnan, FENG Guojun, WEN Yalan

2024, 32(9):  947-952.  DOI: 10.11852/zgetbjzz2023-1378

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Objective To investigate the impact of histological chorioamnioitis (HCA) on complications and neurodevelopment in premature infants at 1 year of age,in order to provide reference for perinatal management and early intervention. Methods A total of 342 premature infants born at Jiangyou People's Hospital from January 2017 to December 2022 were selected as study subjects.Then the participants were divided into a control group(n=214),a mild HCA group(n=38),a moderate HCA group(n=56),and a severe HCA group(n=34) based on their exposure to HCA and severity.The complications of premature infants and the neurological development status at corrected gestational age of 1 year were compared among the four groups,and the effects of different degrees of HCA on the neurological development of premature infants were analyzed. Results There were statistically significant differences in gestational age(F=6.546),birth weight(F=14.780),the rates of cesarean section(χ²=5.427) and premature rupture of membranes (χ² =6.215)among the four groups of premature infants (P＜0.05).In terms of complications,there was significant difference in the incidence of early onset sepsis (EOS) and >grade Ⅱ intraventricular hemorrhage (IVH) among four groups of premature infants (χ²=1.273,2.457,P<0.05).There were significant differences in gross and fine motor development at 1 year of corrected gestational age among four groups of premature infants (P<0.05).Further pairwise comparison between groups showed that compared with the control group,the severe HCA group had delayed adaptability,gross and fine motor development (P<0.05),while the moderate HCA group had delayed gross and fine motor development (P<0.05);compared with the mild HCA group,the severe HCA group lagged behind in adaptability and gross motor development (P<0.05),moderate HCA group lagged behind in gross motor development (P<0.05);compared with moderate HCA group,severe HCA group had lower score of gross motor (P<0.05).Multivariate Logistic regression analysis showed that compared with the control group,the severe HCA group had a relatively higher risk in adaptability (OR=1.559,95%CI: 1.084 - 2.869) and gross motor development delay(OR=2.958,95%CI: 1.824 - 4.662),while the moderate HCA group had an increased risk of gross motor development delay(OR=1.428,95%CI: 1.014 - 3.752,P＜0.05). Conclusion HCA is associated with the occurrence of EOS and IVH above grade Ⅱ in premature infants,and may increase the risk of neurodevelopmental abnormalities in premature infants at 1 year old,especially moderate to severe HCA.

Association of overweight and obesity with blood pressure in children and adolescents aged 7 - 17 years in Xinjiang

WANG Wenlei, ZHANG Jun, HOU Lei, ZHANG Rong, Shamusye Muyiduli, DONG Yan, ZHE Wei, Shawulasi Rejiafu, FANG Ping, Adilah Sulidan

2024, 32(9):  953-957.  DOI: 10.11852/zgetbjzz2023-0996

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Objective To understand the prevalent status of overweight, obesity, and hypertension among children and adolescents in Xinjiang, and to investigate the associations between these conditions, so as to provide scientific basis for formulating targeted prevention and control strategies. Methods By means of stratified cluster random sampling, body measurement and questionnaire survey were carried out in 6 schools from urban areas and 5 schools from suburban areas in 14 prefectures and cities of Xinjiang in 2019. Overweight, obesity and high blood pressure in children and adolescents were determined according to Screening for Overweight and Obesity in School-age Children and Adolescents(WS/T 586-2018) and Screening Cut-off Value for High Blood Pressure in Children and Adolescents aged 7 - 18(WS/T 610-2018). Analysis of variance(ANOVA) was employed for comparing measurement data, while the chi-square test was used for group comparisons of categorical data. Multivariate Poisson regression was utilized to calculate the overweight/obesity ratio(PRR) alongside its 95%confidence interval(95%CI). Results A total of 41 005 children and adolescents aged 7 - 17 years were investigated. The prevalence of overweight and obesity was 15.8% and 12.2%, respectively. Males exhibited higher rates of overweight(17.4%) and obesity(15.1%) compared to females(14.3% and 9.4%, χ²=133.23, 744.99, P<0.01). Han ethnicity children and adolescents had higher rates of overweight(18.5%) and obesity(17.8%) than other ethnic groups(14.2% and 8.7%, χ²=75.61, 301.76, P<0.01). Urban areas reported higher rates of overweight(16.3%) and obesity(13.3%) than rural areas(15.1% and 10.3%, χ²=10.56, 80.40, P<0.01), with obesity rates decreasing with age(χ²_trend=707.65, P_trend＜0.01). The detection rate of hypertension was 13.2%, with Han ethnicity children and adolescents showing a higher rate(14.9%) than other ethnic groups(12.2%, χ²=61.08, P<0.01). The detection rate of high blood pressure was higher in rural areas(14.6%) than that in urban areas(12.4%, χ²=37.07, P<0.01), and it increased with age(χ²_trend=2.05, P_trend<0.01). The prevalence of hypertension was 10.9%in the normal BMI group, 15.9%in the overweight group, and 23.3% in the obese group. Adjusting for age, ethnicity, and urban/rural residence, the prevalence of hypertension in the overweight group was 1.50 times higher than in the normal group(95%CI: 1.45 - 1.55), and in the obese group, it was 2.24 times higher than that in the normal group(95%CI: 2.09 - 2.40). Conclusions The study highlights the need for comprehensive interventions and management should be highlighted to address overweight and obesity in boys, particularly younger children, regardless of whether they reside in urban or rural areas. Control of blood pressure should be a priority, and early intervention is crucial to mitigate metabolic risk factors for cardiovascular health and reduce the risk of future cardiovascular diseases.

Weight status of primary school students and the effect of dietary behavioral interventions in western poverty alleviation areas in China

WU Yan, LIU Sha, GAO Liwang, LI Chao, WEI Wei, LONG Yu, ZHANG Yonghong, YIN Guangling, BAI Jing, ZHAO Li, WANG Youfa

2024, 32(9):  958-963.  DOI: 10.11852/zgetbjzz2023-1095

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Objective To assess the effect of a comprehensive school-based intervention on weight status and eating behaviors among primary school students in poverty alleviation areas in western China,in order to provide reference for improving the nutritional preoblems of children in impoverished area. Methods Six primary school students in grades 2 - 5 were selected from three poverty alleviation counties in Shaanxi and Sichuan province,and a baseline survey and whole-cluster randomised controlled intervention study were conducted from November 2020 to June 2022,with 18-month malnutrition prevention and control and unhealthy lifestyle behavior improvement in the intervention group and myopia prevention and control education in the control group.A total of 1 160 students were included at baseline and 1 079 were followed up at the end,with 602 and 477 participants in the intervention and control groups,respectively.Physical examination and frequency of eating behavior questionnaires were administered to the students,and mixed-effects models were used to assess the effect of the intervention. Results After the intervention,the risks of overweight/obesity (OR=0.60) and wasting (OR=0.47) in the intervention group were reduced compared with those in the control group(P＜0.05).Regional stratified analysis showed that the risk of overweight/obesity (OR=0.54) and wasting (OR=0.31) was reduced in the intervention group in Shaanxi compared with that in the control group (P＜0.05).The results of dietary behavior showed that the average weekly frequency of egg (β=0.41),milk (β=0.84) and fruit (β=0.43) intake in the intervention group was higher than that in the control group after the intervention(P＜0.05).The results in the two provinces were different,with an increase in the frequency of egg (β=0.36 and 0.54,respectively) and milk (β=0.96 and 0.64,respectively) intake in the intervention group compared with that in the control group in both Shaanxi and Sichuan(P＜0.05);the frequency of fried food (β=0.50) and candy (β=0.64) intake increased in the Sichuan intervention group compared with the control group(P＜0.05). Conclusions Comprehensive school-based interventions can reduce the risk of obesity and wasting,and improve the weight status and dietary intake of students in rural poverty alleviation areas in China,but there are regional differences in the effectiveness of interventions.

Effects of mother-infant skin-to-skin contact on breastfeeding and neurobehavioral development of premature infants after discharge from hospital

SUN Yu, LIU Wan, HONG Xinmin, LIU Guoqin, LI Peipei, LI Weidong, GUO Feng, SHAO Ziyu

2024, 32(9):  964-968.  DOI: 10.11852/zgetbjzz2023-1159

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Objective To evaluate the effect of skin-to-skin contact (SSC) post-discharge on breastfeeding practices and neurobehavioral development among premature infants, in order to provide reference for promoting breastfeeding. Methods A cohort of 103 premature infants was established between June 1st and December 31st, 2021, at maternal and child health institutions in Hefei. SSC was implemented following discharge. Participants were categorized into continuous SSC group if SSC was maintained for one month post-discharge with completed follow-ups, and intermittent SSC group if SSC was not consistently practiced but follow-ups were completed. Breastfeeding self-efficacy and neurobehavioral development were monitored and assessed at corrected ages of 1, 3, and 6 months based on the intervention protocol. Results Among the 103 premature infants, 40 were in the continuous SSC group, 60 in the intermittent SSC group, and 3 were lost to follow-up. At the corrected age of 1 month, the continuous SSC group scored significantly higher on breastfeeding self-efficacy compared to the intermittent SSC group (Z=3.390, P=0.001). By corrected ages of 3 and 6 months, the exclusive breastfeeding rates were significantly higher in the continuous SSC group (χ²=5.627, 4.931, P<0.05); specifically, 47.5%in the continuous SSC group maintained exclusive breastfeeding until 6 months, compared to 26.7%in the intermittent group (χ²=4.579, P=0.032). Multivariate Logistic regression analysis identified post-discharge continuous SSC as a factor for promoting sustained breastfeeding (OR=0.27, 95%CI: 0.09 - 0.80, P<0.05). No statistically significant differences were found in neurobehavioral development scores across domains between the groups at 3 and 6 months (P>0.05). Conclusion Sustained SSC post-discharge enhances breastfeeding self-efficacy among mothers of premature infants and increases the rate of continued breastfeeding. No significant effect of prolonged SSC on the neurobehavioral development of premature infants post-discharge is observed.

Association between blood arsenic levels and physical growth of children aged 0 - 6 years in Shanghai

LIN Yin, LIU Junxia, ZHANG Lin, YAN Chonghuai

2024, 32(9):  969-973.  DOI: 10.11852/zgetbjzz2024-0612

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Objective To obtain a cross-sectional data of children in Shanghai on blood arsenic levels, influencing factors, and to evaluate the relationship between arsenic exposure and children's physical growth, in order to provide reference for the prevention and intervention of health problems caused by arsenic exposure. Methods A total of 2 263 children aged 0 - 6 years in Shanghai, recruited between 2013 and 2015, with available blood samples, anthropometric growth indicators, and baseline demographic data were selected as study subjects. Total arsenic levels in whole blood were measured using inductively coupled plasma mass spectrometry (ICP-MS/MS). Associations between arsenic exposure and children's physical growth were analyzed using univariate linear regression and multivariable linear regression. Results The median blood arsenic level in Shanghai children was 1.57μg/L. Girls had higher blood arsenic levels than boys (1.67μg/L vs. 1.47μg/L, Z=510 794.50, P<0.05); children whose primary caregivers smoked had higher blood arsenic levels than those whose caregivers did not smoke (1.83μg/L vs. 1.52μg/L, Z=275 783.00, P<0.05); children who frequently consumed sea fish and freshwater fish had higher blood arsenic levels than those who occasionally consumed sea fish (1.69μg/L vs. 1.34μg/L, Z=417 778.00, P<0.05) and freshwater fish (1.69μg/L vs. 1.37μg/L, Z=443 342.00, P<0.05). After adjusting for parental height, weight, and household income, arsenic exposure level was significantly negatively associated with age-specific height-for-age Z-score (β=-0.08, 95%CI:-0.12 to -0.03, P<0.01), weight-for-age Z-score (β＝-0.07, 95%CI:-0.11 to -0.03, P<0.01), and body mass index (BMI)-for-age Z-score (β＝-0.05, 95%CI:-0.10 to 0.00, P=0.03). Conclusion There are sex differences in blood arsenic levels among 0- to 6-year-old children in Shanghai, which are related to dietary factors and have a negative correlation with physical growth in children.

Basic Experimental Articles

Effect of milk tea consumption on glucose and lipid metabolism in young mice

LI Fan, YANG Kexin, ZHANG Xutong, CHEN Lingbo, LIU Chunhao, XU Pengcheng, HU Hao, SUN Xiaoming

2024, 32(9):  974-979.  DOI: 10.11852/zgetbjzz2023-0941

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Objective To investigate the effect of milk tea consumption on glucose and lipid metabolism in young mice, so as to provide reference for the prevention and treatment of metabolic disorders in young individuals. Methods Twenty male ICR mice were randomly divided into the control group and milk tea group, with 10 mice in each group. Mice in the control group drank water normally, while mice in the milk tea group were given both water and milk tea for 12 hours each day. After 2 weeks, the blood glucose and lipids of mice were detected. The protein levels of peroxisome proliferator-activated receptor-γ coactivator-1α(PGC-1α) in different tissues were detected. Results Compared with the control group, the body weight of mice in the milk tea group increased significantly at the end of the second week(t=2.402,P<0.05), the fasting blood glucose level increased but there was no significant difference(P>0.05), the glucose tolerance was significantly impaired(P<0.05), and total cholesterol(T-CHO) and low-density lipoprotein cholesterol(LDL-C) levels significantly increased(t=3.253,5.490,P<0.05). Correlation analysis showed that there was a significant positive correlation between body weight and blood glucose(R²=0.71,P<0.05). The expression levels of PGC-1α in liver, skeletal muscle and white adipose tissues of milk tea group were obviously inhibited(P<0.05). Conclusion The consumption of milk tea can induce glucose and lipid metabolism dysfunction in young mice, which may be related to the inhibition of PGC-1α expression in liver, skeletal muscle and white adipose tissues.

Review

Assessment and influencing factors of bone health in children and adolescents

WANG Ai, ZHOU Bingqian, YU Jian, CAO Hong

2024, 32(9):  980-983.  DOI: 10.11852/zgetbjzz2023-0932

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Osteoporosis begins in childhood, and the accumulation of bone strength and bone mass during growth and development is essential for the prevention of osteoporosis and fragility fractures. Dual energy X-ray absorptiometry, as the preferred bone mass assessment technique for children and adolescents with osteoporosis, can be combined with clinically significant fractures to make a diagnosis of osteoporosis. Peak bone mass and bone mineral density(BMD) can be increased through intervention of factors such as physical activity, nutritional intake, medication, and lifestyle. Hospitals, families, schools, the internet and other parties should join forces to strengthen the popularization of osteoporosis knowledge and promote the disease cognition and bone protection behavior of children and adolescents. This article reviews the definition, assessment tools and influencing factors of osteoporosis in children and adolescents, so as to provide reference for promoting the prevention and intervention of osteoporosis in children and adolescents.

Research progress on family food environment of children

XIA Jialing, GUAN Ji, FANG Yue, HUANG Yingchun, LIU Ying, LI Fan, Jimu Ergamu

2024, 32(9):  984-988.  DOI: 10.11852/zgetbjzz2023-0998

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Children's family food environment, influenced by the naturally built environment, political and economic environment, and sociocultural environment, is closely linked to children's health. It has a shaping and regulating effect on children's eating behavior. This article reviews the research status, assessment tools, influencing factors, and nursing strategies of family food environment to raise the attention of medical staff to children's family food environment, so as to provide reference for solving children's eating behavior problems.

Research progress on the prevention and treatment of cow's milk protein allergy with probiotics, prebiotics, synbiotics and postbiotics

CHENG Shuang, WANG Ju

2024, 32(9):  989-993.  DOI: 10.11852/zgetbjzz2023-1023

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Cow's milk protein allergy(CMPA) is one of the most common food allergies in childhood, with non-specific symptoms that can affect multiple organ systems, posing a threat to children's health. One of the mechanisms of CMPA is the inability of the intestinal mucosa to establish normal immune tolerance to milk protein antigens, which may be closely related to intestinal dysbiosis. Probiotics, prebiotics, synbiotics and postbiotics play a role in influencing the intestinal microbiota and immune system, making them potential new strategies for prevention and treatment of CMPA. This article briefly introduces the characteristics of the intestinal microbiota of children with CMPA, reviews the research progress of probiotics, prebiotics, synbiotics, and postbiotics in prevention and treatment of CMPA, and aims to provide evidence for making strategies in preventing and treating CMPA.

Effects of postpartum depression on infant growth and development

WU Shanhong, WANG Yan, YUAN Yiming, ZHAO Mingyue, GONG Zihan, ZHANG Ziwei, LI Tianyi, PEI Fei

2024, 32(9):  994-998.  DOI: 10.11852/zgetbjzz2023-1015

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Backward growth and development of infants and young children are closely related to a variety of factors.Postpartum depression,as a type of mental-emotional disorder that is highly prevalent among women after pregnancy,not only endangers physical and mental health of postpartum mothers,but also negatively affects the growth and development of infants and young children,such as height,weight,development of motor,cognition,language,and behavior.This paper reviews the adverse impact of maternal postpartum depression on the growth and development of infants and young children,as well as non-pharmacological interventions for maternal postpartum depression,in order to provide new perspectives on the development and health care of clinical children.

Advances in clinical characteristics,diagnosis and treatment of children with developmental language delay

SUN Yanhui, LI Yangfang

2024, 32(9):  999-1003.  DOI: 10.11852/zgetbjzz2023-1386

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Language delay is the most common developmental disorder in childhood,and as children grow older,it will have a lasting impact on their daily life and learning ability,and the impact on children's health can last into adulthood.Early active intervention and treatment will greatly improve the short-term and long-term adverse effects of abnormal language development on children,effectively promote the recovery of children's language ability.Language delay of children has been the current research hotspot.This article reviews the clinical characteristics,diagnosis and treatment of language retardation in children.

Application of music therapy in children's rehabilitation

XIE Tingting, PEI Ziyi, ZHANG Yue

2024, 32(9):  1004-1007.  DOI: 10.11852/zgetbjzz2024-0844

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Music, as an art form of expressing people's thoughts, feelings and social reality, plays an indispensable role in human life. Music therapy is an interdisciplinary field integrating musicology, medicine, psychology and other disciplines. With the rapid development of society, music therapy has gained increasing application in the treatment and rehabilitation of child diseases. This article aims to review the application of music therapy in pediatric clinical practices.

Clinical Research

Genetic etiology analysis of children with developmental delay and intellectual disabilities in Ningxia region

WANG Yu, MA Xiaoping, YAO Rui, DU Tianju, LI Hua, LIU Li

2024, 32(9):  1008-1013.  DOI: 10.11852/zgetbjzz2023-1167

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Objective To understand the genetic etiology of children with global developmental delay(GDD)/ intellectual disability (ID) in Ningxia region,in order to provide a basis for early diagnosis and intervention of the disease. Methods A total of 239 children with GDD/ID who met the standards and were treated in the Children's Rehabilitation Department of the First People's Hospital of Yinchuan City from January 2018 to February 2023,aged 0 - 14 years,were selected for testing using WES.Clinical data of positive and partially negative children were collected for summarization and statistical analysis. Results A total of 62 positive children were screened out,with an overall detection rate of 25.97%,including 12 cases of CNV and 50 cases of SNV/indel.Among them,there were 57 cases of GDD and 5 cases of ID,with a male to female ratio of 32∶30.Significant differences were observed in the main clinical phenotypes between positive and partially negative patients(P<0.05),including facial deformities (χ² =26.07),epilepsy (χ²=6.61),delayed motor development (χ²=42.43),abnormal muscle tone (χ²=17.90),and autism (χ²=15.49).Totally 98.39% of positive children had delayed motor development.There was no significant difference in the degree of intellectual disability between the positive CNV group and the positive SNV/indel group (P>0.05). Conclusions The etiology of GDD/ID is complex,with a high proportion of genetic factors.WES testing can improve the detection rate for children with facial deformities,epilepsy,delayed motor development,and abnormal muscle tone,while the detection rate decreases for children with autism.

The influence factors of vitamin D and its correlation with vitamin K1 and K2 in children aged 0 - 6 years

CHEN Xiujin, JIANG Xiaolan, CHEN Hongyi, WANG Qi, CHEN Junlin

2024, 32(9):  1014-1018.  DOI: 10.11852/zgetbjzz2023-0964

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Objective To investigate the factors influencing vitamin D status in children aged 0 - 6 years and its correlation with vitamins K1 and K2, in order to provide scientific grounds for promoting the healthy development of children in this area. Methods A total of 1 447 children aged 0 - 6 years, who underwent pediatric health follow-ups at Jianyang Maternal and Child Health Hospital between January 2021 and December 2022, were selected as study subjects. Serum levels of 25-(OH)D, vitamin K1, and vitamin K2 were obtained through laboratory tests. The current status of vitamin D, influencing factors, and its correlations with vitamins K1 and K2 were analyzed. Results Vitamin D was found to be correlated with both vitamins K1 and K2 (r=0.349 - 0.656, P<0.001). Protective factors against insufficient serum 25-(OH)D levels in children aged 0 - 6 years included mothers being under 35 years at childbirth (OR=0.467, 95%CI:0.318 - 0.823), mothers having education levels of junior college or above (OR=0.321, 95%CI: 0.253 - 0.373), children having a birth weight over 2 500g (OR=0.518, 95%CI: 0.377 - 0.672), and children regularly taking VD supplementation (400U/day) (OR=0.425, 95%CI: 0.341 - 0.613,P<0.05). Conclusions Greater emphasis is needed on the regular administration of vitamin D supplements by parents, accompanied by intensified health education efforts targeting low-birth-weight infants, older mothers, and those with lower educational backgrounds. For children deficient in vitamin D, closer attention should also be paid to their serum levels of vitamins K1 and K2.

Status quo and influencing factors of early catch-up growth in small for gestational age infants

ZHANG Lin, QIN Zhenying, ZHANG Dan, HU Youfang

2024, 32(9):  1019-1023.  DOI: 10.11852/zgetbjzz2023-0793

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Objective To analyze the early growth trajectory of full-term small for gestational age(SGA) infants, and to discuss the influencing factors of catch-up growth, so as to provide scientific basis for clinical management of SGA. Methods Full-term(37 weeks ≤ gestational age <42 weeks) SGA infants who took physical examination and follow-up regularly in the Department of Child Health Care in the First Affiliated Hospital of Nanjing Medical University from January to December 2022 were selected in the study group. Full-term appropriate for gestational age(AGA) infants born in the same period were selected in the control group according to 1∶1 match based on gestational age and gender. Z score was used to calculate growth rate and Logistic regression was used to analyze the influencing factors of catch-up growth. Results A total of 154 infants were included, including 76 SAG cases and 78 AGA cases. There were no statistical differences in gestational age, gender, delivery and feeding mode between the two groups(P＞0.05). No differences in △WAZ and △LAZ were observed between SGA and AGA at 0 months of age(t＝-1.158,-1.149, P＞0.05). The growth accelerated remarkably at 1 - 6 months old and 7 - 12 months old, △WAZ and △LAZ were significantly higher than those of AGA group(t=3.114, 2.494, 4.170, 3.587, P＜0.001). The rate of catch-up growth in SGA group was 81.6%at 12 months of age, which mainly ccurred within 6 months old when the weight growth rate was (0.71±0.16)kg/month and the length growth rate was (3.29±0.33)cm/month, significantly higher than those of the non catch-up group [(0.47±0.06)kg/month,(2.75±0.48)cm/month, t＝-6.790,-2.341, P＜0.05]. No difference was observed in the growth rate of body weight and length at 7 - 12 months of age between the two groups(P>0.05). The proportion of boys was higher in the catch-up group and their bone mass density(BMD) Z score(-1.56±0.87) was lower than that in the non catch-up group at 6 months(0.51±1.13,t=2.071, P=0.046), while no statistical difference existed at 12 months of age(P＞0.05). Conclusions Full-term SGA infants show accelerated catch-up growth and dynamic changes in growth indicators. Catch-up growth occurrs obviously in the first 6 months after birth, more in boys and possibly results in early bone mineral deficiency.

Clinical characteristics of catch-up growth in small for gestational age infants

CHEN Zhuxiu, LI Rong, PENG Luting, LI Xiaonan

2024, 32(9):  1024-1028.  DOI: 10.11852/zgetbjzz2023-0796

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Objectives To analyze the clinical characteristics of catch-up growth in small-for-gestational age(SGA) infants, so as to provide scientific basis for evaluating the growth and development and to promote the healthy growth of SGA infants. Methods SGA infants who initially visited a paediatrician in the Department of the Children's Health Care of Nanjing Children's Hospital between June 2019 to December 2020, whose birth weight met the criteria and/or birth lengths was under the 10th percentile(<P₁₀) were enrolled in this study to took routine physical examinations, and were followed up regularly. Then SGA infants were divided into catch-up growth(CUG) and non catch-up growth(NCUG) groups according to whether Z-scores of weight and/or length increase was greater than 0.67. The neuropsychological development scores was tested by development screen test(DST). Results A total of 169 SGA infants were included in this study, including 69 boys and 100 girls. There were 72 cases(42.6%) in CUG group and 97 cases(57.4%) in NCUG group.Z-score of length in CUG group was significantly higher than that in NCUG group since 6 months old(t=5.523, P＜0.001).Z-score of weight(t=2.206, P＜0.05) and body mass index(BMI) Z-score(t=2.958,P＜0.05) in CUG group was significantly higher than that of NCUG group since 3 months old. Z-score of head circumference for age in CUG group was significantly higher than that of NCUG group from 1 month old(t=5.092, P＜0.001). The growth rate of CUG group reached the peak before 6 months of age, and reached the catch-up growth standard(△Z>0.67). DST scores in the CUG group were higher than those in the NCUG group(DQ t=3.966, P＜0.001; MI t=3.151, P＜0.05). At the age of 3 and 6 months after birth, Z-scores of length(t=2.707, 2.386), the Z-scores of weight(t=2.235, 2.931)and the Z-scores of BMI(t=3.263, 3.824) of infants fed with fortified nutrition formula in the CUG group were significantly higher than those of exclusive breastfeeding(P＜0.05), but there was no significant difference in Z-scores of head circumference(P>0.05). Conclusions The postnatal physical growth rate, neurodevelopment level in SGA infant with catch-up growth are significantly higher than those without catch-up growth. The peak of catch-up growth occurrs at 6 months after birth. In children with catch-up growth, nutritional supplementation formula feeding can promote body length and weight, thus reaching catch-up growth faster and increasing BMI.

Body composition analysis in school-age children with attention-deficit/hyperactivity disorder

MAO Guanghui, WANG Dan, LI Lili, JI Yiting, WANG Qiyu, FENG Chenxia, ZHAO Xiaoyan, HE Lu, CAI Shizhong, CHEN Yan

2024, 32(9):  1029-1033.  DOI: 10.11852/zgetbjzz2023-0253

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Objective To analyze the body composition of school-age children with attention-deficit/hyperactivity disorder (ADHD),in order to provide guidance for clinical intervention in children with ADHD. Methods A total of 376 children were recruited as ADHD group from January to December 2022 in the Department of Child Health Care in Children's Hospital of Soochow University.Meanwhile,94 children who took physical examination in this hospital were selected as the control group.The body composition of all children was assessed by bioelectrical impedance analysis. Results The weight,body fat(BF),body mass index(BMI),fat mass index(FMI),percentage of body fat (PBF) and waist hip ratio(WHR) of children in ADHD group were higher than those of children in control group (t=2.400,3.618,3.358,3.901,3.458,2.935,P＜0.05).Furthermore,significant differences were observed in BF,FMI,PBF among children with predominantly inattentive ADHD,predominantly hyperactive/impulsive ADHD and combined ADHD (F=3.295,3.362,4.337,P＜0.05). Conclusions The body composition of ADHD children is different from that of typicallt developed children.Children with ADHD are at a higher risk of obesity,especially in those with predominantly inattentive ADHD.

Appropriate Technology

Application of cardiac auscultation, pulse oximetry combine with oxygen inhalation in screening neonatal congenital heart disease in Guangxi Province

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

2024, 32(9):  1034-1039.  DOI: 10.11852/zgetbjzz2024-0077

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Objective To analyze the accuracy and feasibility of combining cardiac auscultation, pulse oximetry (POX) screening, and oxygen therapy assessment for congenital heart disease (CHD) detection in newborns in Guangxi, China, in order to provide basis for wider implementation of this screening strategy. Methods Live newborns delivered in obstetric institutions in Guangxi between January 1st and December 31st, 2021, were enrolled. Cardiac auscultation and POX screening were performed respectively, and the screening results were evaluated in combination with oxygen inhalation. Neonates positive on any screening parameter were classified as CHD screen-positive and further diagnosed by echocardiography. Sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios, and Youden's index were calculated for individual and combined screening measures, and comparisons were made to assess the accuracy of the CHD screening method. Results A total of 469 261 neonates were screened, with 5 199 identified as positive, among whom 3 459 were confirmed cases of CHD. Multivariate analysis revealed that cardiac murmurs (OR=620.17, 95%CI: 564.18 - 681.72), abnormal POX results (OR=235.52, 95%CI: 214.59 - 258.49), and oxygen therapy for ≥72 hours (OR=333.45, 95%CI: 293.76 - 378.50) were independent risk factors for predicting CHD (P＜0.05). The sensitivities for detecting CHD in the murmur group, POX group, and oxygen therapy group were 53.34% (95%CI: 51.66% - 55.01%), 34.32% (95%CI: 32.74% - 35.93%), and 22.23% (95%CI: 20.86% - 23.66%), respectively. The sensitivity rose to 79.73% (95%CI: 78.35% - 81.05%) when combining cardiac auscultation with POX, and further increased to 91.73% (95%CI: 90.75% - 92.62%) upon incorporating oxygen therapy indicators, with the area under the ROC curve reaching 0.96 (95%CI: 0.95% - 0.96%). Conclusions The combination of cardiac auscultation, POX screening, and assessment of oxygen therapy requirements is non-invasive, simple, and reliable, effectively facilitating early detection of CHD in newborns. These findings support the broader application and promotion of this screening approach.