Table of Content

10 December 2024, Volume 32 Issue 12

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Professional Forum

Emphasizing the neurobiological mechanisms of autism spectrum disorder

XIAO Le, YE Xiaoshan

2024, 32(12):  1277-1281.  DOI: 10.11852/zgetbjzz2024-1362

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Autism spectrum disorder (ASD) is a common neurodevelopmental disorder in children characterized by impairments in social interactions and repetitive, stereotyped behaviors, with a globally increasing incidence rate. Its etiology is complex, involving both genetic and environmental factors. This article systematically summarizes the research progress on the neuropathological mechanisms of ASD, encompassing synaptic function, neurotransmitter imbalance, neural circuit abnormalities, neuroanatomical changes, and neuroinflammation. A deep understanding of the pathological mechanisms of ASD can provide scientific evidence and guidance for the development of related clinical treatment strategies.

Original Articles

Association between maternal dietary polyunsaturated fatty acids during pregnancy and neuropsychological development in 2-year-old children in a cohort study

GUAN Litian, LI Xiuxiu, LU Shaomin, ZENG Xiaoling, XU Sha, LAN Minyan, ZENG Jingjing, WANG Zhen, PENG Kangwei, CAI Li

2024, 32(12):  1282-1287.  DOI: 10.11852/zgetbjzz2024-0493

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Objective To explore the association between maternal dietary polyunsaturated fatty acid (PUFA) intake during pregnancy and neuropsychological development in 2-year-old children, in order to provide a scientific basis for promoting children's neuropsychological development. Methods Based on a prospective birth cohort established at the Yuexiu District Maternity and Child Health Care Hospital in Guangzhou from March 2017 to November 2018, a food frequency questionnaire with good reliability and validity was used to investigate the dietary intake and nutrient supplement use of women in the second trimester of pregnancy over the past month. Based on this information, the intake of PUFAs during pregnancy was calculated. The Ages and Stages Questionnaires, Third Edition (ASQ-3) was used to assess the neuropsychological development of 2-year-old children. Multivariable Logistic regression models were used for association analysis. Results A total of 261 mother-child pairs were included. The average intake of n-6 and n-3 PUFAs during pregnancy was 17.59g/d and 1.10g/d, respectively, with an n-6/n-3 PUFA ratio of 20.21. After adjusting for confounding factors, compared with the lowest quartile group (Q1), higher maternal intake of eicosapentaenoic acid (EPA) during pregnancy was associated with a reduced risk of abnormalities in the fine motor skills domain (OR=0.21, 95%CI: 0.06 - 0.72, P<0.05), and higher docosahexaenoic acid (DHA) intake was associated with reduced risks of abnormalities in the communication domain (OR=0.36, 95%CI: 0.13 - 0.99) and the personal-social domain (OR=0.26, 95%CI: 0.09 - 0.75), respectively (P<0.05). Higher total n-6 PUFA (OR=3.19, 95%CI: 1.09 - 9.31) and linoleic acid (LA) intake (OR=3.28, 95%CI: 1.13 - 5.85) during pregnancy were associated with an increased risk of abnormalities in the problem-solving domain (P<0.05). High n-6/n-3 PUFA ratios (OR=2.81, 95%CI: 1.02 - 7.71; OR=3.83, 95%CI: 1.18 - 12.50) and high LA/α-linolenic acid (ALA) ratios (OR=3.04, 95%CI: 1.10 - 8.42) were associated with an increased risk of abnormalities in the gross motor and fine motor skills domains (P<0.05). No statistical associations were found between other PUFAs and neuropsychological development in 2-year-old children(P>0.05). Conclusion Increasing maternal dietary intake of DHA and EPA during pregnancy and reasonably controlling the intake of n-6 PUFAs and LA, as well as the ratios of n-6 to n-3 PUFAs and LA to ALA, are of great significance for improving children's neuropsychological development.

Relationship between family functioning and reading ability in children with developmental dyslexia

YIN Feifei, GAO Shan, LI Juan, ZUO Pengxiang, XIAO Xinyu

2024, 32(12):  1288-1293.  DOI: 10.11852/zgetbjzz2024-0162

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Objective To analyze the relationship and internal mechanism between family functioning and reading ability in children with developmental dyslexia (DD), in order to provide reference for family support and intervention measures for DD children. Methods From March to June 2023, a multistage random cluster sampling method was used to screen out 451 children with DD and 451 typically developed(TD) children from the 3rd to 6th grade students in 9 primary schools in a certain region of Xinjiang. A questionnaire survey was conducted using the General Information Questionnaire, Family Functioning Scale, Simple Coping Styles Questionnaire, Social Adaptation Inventory for Children and Adolescents, and Elementary School Children's Language Reading Ability Measurement Inventory. The Stroop program, 2-Back program, and digit span program were used to evaluate executive function. Amos 26.0 was used to construct a structural equation model and test the mediating effects. Results 1) The total score of family functioning in the DD group was higher than that in the TD group (t=3.501, P<0.001); the reading ability, social adaptation ability, and parental coping style scores of children in the DD group were significantly lower than those in the TD group (t=-26.375, -11.309, -2.341, P<0.05); the accuracy of the 2-Back task, Stroop task, and number conversion task in children of the DD group were all significantly lower than those in the TD group (t=-4.107, -7.336, -6.114, P<0.001); 2) The family functioning score in DD children was negatively correlated with reading ability, social adaptation, positive coping, 2-Back accuracy, Stroop accuracy, and number conversion accuracy (r=-0.64~-0.32, P<0.01), and positively correlated with negative coping (r=0.62, P<0.01); 3) Family functioning had a significant direct effect on the reading ability of DD children (β=-0.144, P<0.05) ,and it also had an indirect effect on reading ability through the mediating of executive function, social adaptation, and parental coping style (β=-0.552, P<0.001). Conclusion The level of family functioning is an important factor affecting the reading ability of DD children, with executive function, social adaptation, and parental coping styles playing multiple mediating roles.

Mediating role of responsive caregiving in the association between maternal reflective functioning and toddlers' social-emotional competence

YU Haiyan, WANG Ruiling, ZHENG Shuo, MA Wenbo

2024, 32(12):  1294-1299.  DOI: 10.11852/zgetbjzz2024-0309

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Objective To explore the relationship among maternal reflective functioning, responsive caregiving, and toddlers' social-emotional competence, so as to provide a theoretical basis for promoting toddlers' social-emotional development. Methods From December 2023 to January 2024, 479 mothers of 12- to 36-month-old toddlers from four municipal childcare institutions in Weifang City were selected by convenience sampling method. A self-designed socio-demographic questionnaire, Parental Reflective Functioning Scale (PRFQ), Responsive Caregiving Rating Scale, and the Chinese version of Urban Infant-Toddler Social and Emotional Competence Assessment Scale were used in this survey. The effects of maternal reflective functioning and responsive caregiving on young children's social-emotional competence were analyzed, and Amos 28.0 software was used to construct a structural equation model to verify the mediating role of responsive caregiving. Results 1) The influence of children's gender (t=-3.783), age in months (t=-4.585), being an only child (t=2.324), and family's average monthly income (F=3.643) on young children's social-emotional competence was statistically significant (P<0.05). 2) Pearson correlation analysis showed a significant positive correlation among maternal reflective functioning scores, responsive caregiving, and young children's social-emotional competence (r=0.326 - 0.503, P<0.01). 3) Mediation analysis revealed that maternal reflective functioning significantly predicted young children's social-emotional competence (β=0.590, P<0.001), and responsive caregiving partially mediated the relationship between maternal reflective functioning and young children's social-emotional competence, with a mediating effect of 0.157, accounting for 21.02% of the total effect. The model fit well (χ²/df=2.908, RMSEA=0.063, NFI=0.926, IFI=0.950, TLI=0.934, CFI=0.950, GFI=0.953, and AGFI=0.926). Conclusion Maternal reflective functioning and responsive caregiving have significant effects on young children's social-emotional competence, and responsive caregiving partially mediates the relationship between maternal reflective functioning and young children's social-emotional competence.

Clinical efficacy and influencing factors of positional brachycephaly treated with cranial remolding orthoses

WU Xiaoyan, SHANG Meichen, LIU Hua, DAI Na, ZHU Hongjing, YANG Ming

2024, 32(12):  1300-1303.  DOI: 10.11852/zgetbjzz2023-1277

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Objective To evaluate the efficacy and influencing factors of cranial remolding orthoses (CRO) in the treatment of infant positional brachycephaly (PB),in order to provide scientific basis for optimizing the treatment strategy of CRO. Methods A total of 63 infants with PB who received CRO treatment at the Beijing United Family Hospital from September 2018 to February 2022 were collected.Three-dimensional laser scanning technology was used to measure the Cephalic Ratio (CR),calculate the rate of head shape change.The efficacy and influencing factors of CRO treatment were analyzed. Results After CRO treatment,the CR value of infants with PB improved significantly (t=16.97,P<0.001).There was a significant difference in the treatment time among different groups of CRO onset months,with the 4- to 5-month-old age group being significantly shorter than the 8-month-old and above group (H=9.611,P<0.05).There was a negative correlation between the age of initial treatment and the rate of head shape change (r=-0.592,P<0.001).The severity of PB at the beginning of treatment was positively correlated with the rate of head shape change (r=0.498,P＜0.001).Comorbidity with plagiocephaly was correlated with the rate of head shape change (Z=-2.115,P＜0.05).Prematurity was not significantly correlated with the rate of head shape change (Z=-1.424,P>0.05). Conclusions CRO has a significant effect on the treatment of infant PB.The younger the age,the shorter the treatment time,and the more severe the PB,the higher the treatment efficiency.The treatment efficiency of infants with concurrent plagiocephaly is affected.It is recommended that pediatricians diagnose the PB as early as possible and recommend wearing CRO for treatment,especially for severe PB,to achieve better treatment outcomes.

Neurodevelopmental prognosis of preterm infants with severe retinopathy of prematurity

HE Lu, SUN Huiqing

2024, 32(12):  1304-1309.  DOI: 10.11852/zgetbjzz2023-1350

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Objective To investigate the neurodevelopmental prognosis of premature infants with severe retinopathy of prematurity (ROP), and to assess whether ROP is associated with neurodevelopmental delay, so as to provide evidence for early identification and intervention. Methods A retrospective cohort study was conducted to analyze premature infants with a gestational age of 25 - 32 weeks admitted to the Children's Hospital Affliated to Zhengzhou University from January 1, 2019 to August 31,2021. Infants with severe ROP were assigned to the ROP group, while those with similar gestational ages but without ROP served as the control group.The cranial magnetic resonance imaging (MRI) results of both groups were compared at corrected full-term age, 3 months, and 6 months of corrected age. The Neonatal Behavioral Neurological Assessment (NBNA) scores at corrected full-term age, and the mental development index (MDI) and psychomotor development index (PDI) outcomes at 3, 6, 12, 18, and 24 months of corrected age were statistically analyzed. Results At 18 and 24 months of corrected age, the MDI and PDI scores of the ROP group were lower than those of the control group (MDI: t=2.344, 2.529, P<0.05; PDI: t=2.043, 2.378, P<0.05).The incidence of visual abnormalities (primarily ametropia) was significantly higher in the ROP group compared to the control group at the same time points (χ²=9.297, P=0.002).Logistic regression analysis revealed that oxygen therapy duration was a risk factor for later psychomotor developmental delay (OR=1.031, 95%CI: 1.005 - 1.058, P=0.021). Conclusions After treatment, visual impairment in premature infants with severe ROP is primarily manifested as refractive errors.At 18 - 24 months of corrected age, their MDI and PDI scores lag behind those of age-matched premature infants without ROP. Further research is recommended to investigate whether older children with ROP experience neurodevelopmental delays compared to preterm infants with the same age.

Epidemiological investigation and prediction model construction of malocclusion in children aged 3 - 14 in Shijiazhuang City

ZHANG Liming, SONG Peng, ZHAO Yue, TIAN Man, WANG Yu

2024, 32(12):  1310-1315.  DOI: 10.11852/zgetbjzz2023-1334

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Objective To investigate the prevalence of malocclusion among children aged 3 - 14 years in Shijiazhuang City, and to construct a predictive model for malocclusion. Methods Using cluster sampling, a total of 6 591 children aged 3 - 14 years from kindergartens, primary schools, and junior high schools in eight districts of Shijiazhuang City were selected as subjects for examination of dental development from May to October 2023. Children were divided into malocclusion and normal groups. Univariate analysis were conducted on information collected regarding children's demographic data, feeding practices, dietary habits, and presence of oral maladaptive behaviors. Multivariate analysis identified factors influencing malocclusion, based on which a predictive model was developed. The model's predictive performance was evaluated using the area under the ROC curve (AUC), calibration curves, and decision curves. Results Among the 6 591 children surveyed, 4 342 cases of malocclusion were identified, yielding a prevalence rate of 65.88%. The primary types of malocclusion were deep overbite, deep overjet, and crowded teeth, with rates of 26.61%, 19.60%, and 15.73%, respectively. Logistic regression analysis revealed that risk factors for malocclusion in children aged 3 - 14 years included a family history of malocclusion, bottle-feeding duration >12 months, high food fineness, lip-sucking, object-biting, unilateral chewing, mouth breathing, and presence of dental caries(P<0.05). Internal validation showed an AUC of 0.818 (95%CI: 0.763 - 0.873), good calibration curve fit, and a Hosmer-Lemeshow goodness-of-fit test (χ²=9.904, P=0.275). The prediction model demonstrated satisfactory net benefit rates when the threshold probability ranged from 3% to 81%. Conclusion A nomogram constructed based on the presence or absence of a family history of malocclusion, bottle-feeding duration, food fineness, and oral maladaptive behaviors (lip-sucking, object-biting, unilateral chewing, mouth breathing), as well as the presence or absence of dental caries, can predict the risk of malocclusion occurrence reasonably well among children aged 3 - 14 years in Shijiazhuang City.

Basic Experimental Articles

Activation and mechanism of microglia in Tourette syndrome

ZHANG Xiaoling, LIU Xiumei

2024, 32(12):  1316-1321.  DOI: 10.11852/zgetbjzz2023-1161

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Objective To investigate the activation and mechanism of microglia (MG) in Tourette syndrome (TS) rats induced by 3,3'-aminodipropionitrile (IDPN). Methods Thirty six male Sprague Dawley rats were randomly divided into a TS group and a Sham group (Sham group),with 18 rats in each group.The TS group received intraperitoneal injection of IDPN for 7 days,with the dose of 300mg/(kg·d),while the Sham group received intraperitoneal injection of physiological saline for 7 days,with the dose of 5mL/(kg·d).Double immunofluorescence staining was used to detected the expression of inducible nitric oxide synthase (iNOS),a marker protein of M1 type microglia,and its co-localization with Iba-1(a specific marker for microglial activation) in rat striatum,as well as the expression of arginase 1 (Arg-1) and its co-location with Iba-1 in M2 microglia.The expression levels of iNOS,Arg-1 in rat striatal tissues were quantified by enzyme-linked immunosorbent measurement (ELISA),real-time PCR (qRT-PCR),meanwhile the expression levels of inflammatory cytokines tumor necrosis factor α (TNF-α),interleukin-6(IL-6),and interleukin-10(IL-10) were detected. Results Immunofluorescence double staining showed that the positive expressions of Iba-1 and iNOS in striatum of TS group were enhanced and co-located compared with Sham group,while the positive expression of Iba-1 and Arg-1 in striatum of TS group decreased and showed co-localization.The ELISA results showed that compared with the Sham group,the TS group had a significant increase in the content of M1 type MG marker protein iNOS (t=5.796,P<0.001),a significant decrease in the content of M2 type MG marker protein Arg-1 (t=4.348,P<0.01),and a significant increase in inflammatory factors,including TNF-α,IL-6 and IL-10 (t=5.654,5.748,8.231, P<0.001).The qRT-PCR results showed that compared with the Sham group,the mRNA expression level of iNOS,a M1 type MG marker protein,was significantly increased in the TS group (t=9.914,P<0.001),while the mRNA expression level of Arg-1,a M2 type MG marker protein,was significantly reduced (t=4.390,P<0.01),and the mRNA expression levels of inflammatory factors in the TS group,including TNF-α,IL-6 and IL-10 were significantly increased (t=12.056,14.147,13.350,P<0.001). Conclusion TS rats induced by IDPN exhibit MG activation,with M1 type MG upregulated and M2 type MG downregulated,thereby mediating neuroinflammation.

Review

Genetic advances in the fetal ventriculomegaly

ZHAO Chenyue, ZHANG Lixue, JIANG Jinsong, GUO Min, GAO Jingbo, GUO Rong, CAO Guizhi, XUE Huiqin

2024, 32(12):  1322-1327.  DOI: 10.11852/zgetbjzz2024-0019

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Ventriculomegaly (VM) is a common fetal ultrasound abnormality in prenatal screening,with an incidence of about 1%,and is closely related to the intellectual and psychomotor development of children,which can be evaluated by prenatal ultrasound or MRI that can assess its size and morphology.VM can be caused by central nervous system malformations,chromosomal aberrations,gene mutations,genetic syndromes and potential fetal anomalies,with genetics etiology accounting for a large portion of the cases and has become a concern for many families.This review combs genetic advances in fetal VM,including the genetics etiology and its associated molecular mechanisms,as well as the diagnosis and identification of genetic etiologies.

Research process on family therapy in attention deficit hyperactivity disorder

HUANG Meilin, WANG Haifei, DU Yasong

2024, 32(12):  1328-1332.  DOI: 10.11852/zgetbjzz2023-1330

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Attention deficit hyperactivity disorder (ADHD) has emerged as one of the widely recognized significant social concerns,impacting both children and their families.Currently,family therapy for ADHD children in China is still in its developmental stage,yet various forms of family therapy have played essential roles in ADHD intervention in recent clinical practice.This paper reviews the evidence-based research related to family therapy for ADHD,considering the familial relationship characteristics of ADHD patients,evaluated the different forms of family therapy and their treatment efficacy in ADHD intervention.

Advances in the possible mechanisms of tic disorders comorbid with allergic diseases in children

ZHANG Panpan, CAO Fan, XIAO Xuwu

2024, 32(12):  1333-1338.  DOI: 10.11852/zgetbjzz2023-1327

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In the past few decades,the incidence rate of children's allergic diseases in the world has been gradually increasing worldwide,and its impact on children has exceeded the condition of allergy itself.There is evidence suggesting a correlation between allergic diseases and the different of tic disorder (TD) in children,and allergies may be an important risk factor of TD.The underlying mechanism may be related to intestinal microbiota disorders,changes in immunological characteristics,and DNA methylation.Further exploration of the relationship between allergic diseases and TD will be of great significance for the prevention and treatment of TD.

Catch-up growth and cognitive development in small for gestational age infants

ZHU Jiang, HUO Yanyan, CHEN Jinjin

2024, 32(12):  1339-1342.  DOI: 10.11852/zgetbjzz2024-0039

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Small for gestational age (SGA) infants often experience poor cognitive development outcomes, particularly those who fail to achieve catch-up growth. Research has demonstrated an association between catch-up growth in SGA infants and their cognitive development outcomes. Understanding the patterns of catch-up growth in SGA infants and its relationship with cognitive outcomes is crucial for timely identification of abnormal growth trajectories and early intervention to improve their cognitive development. This article elucidates the relationship between catch-up growth and cognitive development in SGA infants from three dimensions of weight, length (height), and head circumference, in order to provide reference for postnatal physical growth in these infants and facilitate optimal catch-up growth, thereby ultimately improving their overall health and quality of life.

Meta Analysis

Evolution path and research hotspots in the field of 24-hourmovement behavior among children and adolescents

ZHAO Hanhua, WANG Di, GAO Ying

2024, 32(12):  1343-1348.  DOI: 10.11852/zgetbjzz2024-0070

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Objective To visualize the research hotspots and emerging trends in the field of international research on 24-hour(24h) movement behavior among children and adolescents, in order to provide reference for their healthy development. Methods Literature on 24h movement behavior of children and adolescents was searched in the Web of Science core collection from January 2002 to September 2022. The CiteSpace software was used to visualize the network analysis of keyword co-occurrence, cluster analysis, and citation burst for 1 616 articles. Results The evolutionary trajectory of 24-hour activity patterns among children and adolescents internationally can be categorized into three phases: the "Transformation Period" characterized by understanding the differential impacts of behaviors on health; the "Formation Period" marked by epidemiological surveys of 24-hour activity behaviors; and the "Development Period", highlighted by the release of guidelines for 24-hour activity behaviors. Conclusions In comparison with international experiences, domestic research in this area started later and faces limitations, including insufficient epidemiological evidence, a lack of unified standards for Objective measurement tools, and inadequate evidence supporting physical activity guidelines. It is recommended that future studies prioritize large-scale epidemiological investigations, standardization of measurement instruments, and refinement of physical activity guidelines to foster healthy development among children and adolescents.

Prevalence analysis and trend prediction of the burden of autism spectrum disorder

HAI Yang, JIN Meiyu, ZHANG Te, CUI Yu, WU Lijie

2024, 32(12):  1349-1353.  DOI: 10.11852/zgetbjzz2024-0006

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Objective To compare and analyze the current burden status of autism spectrum disorders (ASD) in China and globally, to extract the epidemiological characteristics and to predict the burden in 2030, based on the analysis of the global burden of disease (GBD) database, so as to provide reference for the prevention and control of the disease burden caused by ASD. Methods Prevalence and disability-adjusted life years (DALYs) data from 1990 to 2019 for ASD in China and globally were retrieved from the GBD database. Joinpoint regression model was used to analyze the changes in ASD disease burden and calculate average annual percentage change (AAPC) over time. Auto regressive integrated moving average model(ARIMA) was constructed to predict the trend of ASD disease burden in China and globally from 2020 to 2030. Results The age standardized prevalence rate and age standardized DALYs rate in China showed an upward trend from 1990 to 2019, with an average annual increase of 0.14% and 0.15%, respectively, and the increase was higher than the global average level (AAPC=-0.03%, P<0.001, AAPC=-0.03%, P<0.001). It is predicted that the age standardized prevalence rate and age standardized DALYs rate of ASD in China will both show an upward trend by 2030, reaching 376.08/10⁵ and 57.90/10⁵, respectively. In comparison, the global age standardized prevalence rate and age standardized DALYs rate of ASD, which are 369.47/10⁵ and 56.28/10⁵, respectively, and the trend is relatively stable. The burden of ASD is biggest for male children under the age of 5 in China and globally. Conclusion Over the past three decades, the burden of ASD in China has persistently escalated and may exceed the global average in the future, making it particularly urgent to implement targeted prevention and control measures.

Clinical Research

Developmental characteristics and risk factors in children with delayed language development

GUO Niya, ZHAO Yun, WEI Fang

2024, 32(12):  1354-1358.  DOI: 10.11852/zgetbjzz2024-0343

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Objective To investigate the prevalence of language delay among children aged 18 - 36 months in Urumqi and analyze the risk factors contributing to it, thereby providing a scientific basis for promoting early language development in children. Methods Children aged 18 to 36 months who underwent health check-ups at the Department of Child Health Care, Urumqi Children's Hospital, between January and June 2023 were selected as subjects. The outcome variables were assessed using the Neuro-Psychological Development Assessment Scale for Children Aged 0 - 6 Years and the Early Language Development Progress Scale. Risk factors influencing language developmental delay were obtained through questionnaires. Results A total of 703 children were included in the study, among whom 118 (16.8%) had language delay. Children in the language delay group lagged behind those in the normal language group in the domains of language, gross motor, fine motor, adaptability, and social skills (t=28.29, 5.23, 6.33, 7.74, 13.07, P<0.05). Statistically significant differences were observed between the two groups in terms of gender, parental education level, parental relationship, maternal hypertension during pregnancy, maternal emotional status during pregnancy, feeding mode, daily screen exposure time of children, types of daily play activities, and types of games (χ²:4.202 - 40.063,P<0.05). Multivariate Logistic regression analysis revealed that being male (OR=2.534, 95%CI: 1.571 - 4.089), maternal emotional distress during pregnancy (OR=1.779, 95%CI: 1.048 - 3.019), artificial feeding (OR=2.598, 95%CI: 1.457 - 4.636), daily screen exposure time >1h (OR=3.244, 95%CI: 1.966 - 5.354), solitary play (OR=2.168, 95%CI: 1.323 - 3.553), and playing mainly sensory motor games (OR=1.902, 95%CI: 1.157 - 3.126) were risk factors for language delay in children (P<0.05). Conclusions Children's language development is influenced by multiple factors such as gender, maternal emotional status during pregnancy, feeding mode, screen exposure time, gaming methods, and gaming content. Therefore, in areas with relatively backward conditions for children's health care in the western region, priority should be given to conducting health education on the above factors, guiding parents to adopt scientific parenting methods, and promoting early language development in children.

Construction and evaluation of the Children Motor Development Assessment Scale for infants aged 0 - 3 years in six cities of China

FAN Zhaoyang, TAI Xuelong, HE Shousen, GU Guixiong, WU Kangmin, LI Li, ZHANG Yanyan, XIE Lu, ZHANG Ruifang, LU You, YANG Yanhui, GUOJI Erti, WANG Hongyuan, SONG Tingting, DAI Yaohua

2024, 32(12):  1359-1363.  DOI: 10.11852/zgetbjzz2024-0687

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Objective To develop a Motor Development Scale (MDS) for infants aged 0 - 3 years, and to evaluate its reliability and validity, so as to provide a convenient and effective practical tool for the scientific and effective assessment of motor development among infants in China. Methods From July 2019 to April 2021, infants aged 0 - 3 years from six cities nationwide were assessed for motor development using the MDS. The Cronbach's α coefficient was used to evaluate the internal consistency reliability. Two different evaluators conducted two MDS assessments within two weeks on 25 children to determine the test-retest reliability. The validity evaluation was performed using the Gross Motor and Fine Motor Subscales of the Gesell Scale as the gold standard for Pearson correlation analysis. Statistical analysis was conducted on the scale scores. Results A total of 1 019 valid samples were collected, including 512 boys and 507 girls. The Cronbach's α coefficients for the fine motor, gross motor subscales, and the total scale were all >0.9, indicating good internal consistency of the scale. The test-retest reliability for the fine motor subscale and gross motor subscale was 0.997 and 0.995, respectively (P<0.01). The validity test results showed a correlation between the Gesell fine motor developmental quotient (DQ) and the MDS fine motor DQ (r=0.71, P<0.05), as well as between the Gesell Gross Motor DQ and the MDS Gross Motor DQ (r=0.73, P<0.05). The MDS scores showed an increasing trend with the age of infants (P<0.01). Conclusions The MDS developed in this study has a motor development screening efficiency comparable to the Gesell Motor Subscales. The content validity of the scale meets standard levels, with a reasonable structure, strong applicability, simplicity, and ease of operation, and has a good ability to screen for children with developmental abnormalities, meeting the needs of motor development screening and motor rehabilitation assessment in children.

Relationships between family rearing environment and responsivecaregiving for children aged 1 - 3 years

XU Yuying, GUO Chenming, ZHANG Xi, WANG Suqing, LU Yaping, YU Liping

2024, 32(12):  1364-1368.  DOI: 10.11852/zgetbjzz2024-0034

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Objective To understand the current status and correlation of family rearing environments and responsive caregiving for children aged 1 to 3 years, in order to provide theoretical basis for the implementation of responsive caregiving guidance services for infants and young children. Methods From March to September 2023, a cross-sectional survey was conducted among parents of children aged 1 - 3 years in Wuhan. General demographic information and responsive caregiving practices for infants and young children were collected. Child Home Nurture Environment Scale and the Responsive Caregiving Evaluation Scale were used to assess the family nurturing environments and responsive caregiving status of infants and young children. Relevant influencing factors were also analyzed. Results A total of 244 children were included, with 126 males (51.6%) and 118 females (48.4%). The mean age of the infants and young children was (2.52±0.71) years old. Statistically significant differences were found in responsive caregiving abilities across the following factors: Primary caregiver (F=18.705), feeding method (F=6.248), medical insurance status (F=54.252), maternal education level (F=18.834), paternal education level (F=33.149), family registration status (t=11.363), mother's full-time employment status (t=-5.394), average monthly income of parents (F=16.067), marital relationship (F=10.299), number of children (F=7.114), and family nurturing environment (t=6.521,P<0.05). A significant positive correlation was observed between family nurturing environments and responsive caregiving abilities for infants and young children (r=0.422, P<0.01). Linear regression analysis revealed that the language and cognition dimension (β=0.206, 95%CI: 0.06 to 1.20) and the neglect and punishment dimension (β=-0.117, 95%CI: -0.86 to -0.08) in the family nurturing environment had statistically significant effects on responsive caregiving abilities (P<0.05). Conclusions There is a close relationship between family nurturing environments and responsive caregiving for infants and young children. Pediatric healthcare providers should enhance the knowledge and skills of primary caregivers in responsive caregiving, fostering optimal family nurturing environments to support early childhood development.

Influencing factors of congenital heart disease in some areas of Xinjiang Uygur Autonomous Region

ZHANG Nian, LI Hongna, WANG Xiaoli

2024, 32(12):  1369-1373.  DOI: 10.11852/zgetbjzz2023-1257

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Objective To analyze the prevalence and associated factors of congenital heart disease (CHD) among newborns in some areas of northern Xinjiang, China, in order to provide theoretical foundations for prevention and control strategies in the region. Methods From January 1st to December 31st, 2021, 145 neonates diagnosed with CHD at Altay Regional People's Hospital and Ili Prefecture Maternal and Child Health Hospital were selected as the case group. Maternal prenatal examination data and delivery records were collected through the Xinjiang Maternal and Child Health Cloud Monitoring System. Based on maternal age during pregnancy, 290 healthy neonates born during the same period were matched at a ratio of 1∶2 as the control group. Univariate and multivariate analysis were conducted using a case-control study design to explore the influencing factors of CHD in the Xinjiang region. Results Among the cases, patent ductus arteriosus was the most prevalent (73.10%, 106 cases). Univariate analysis showed statistically significant differences in pre-pregnancy BMI, gravidity, parity, presence of anemia, Rh blood type, history of diabetes, newborn gender, gestational age, birth weight, and mode of delivery between the case and control groups (P<0.05). Multivariate analysis revealed that pre-pregnancy overweight or obese (OR=1.919, 95%CI: 1.174 - 3.427), gravidity ≥ 2 times (2 times:OR=4.449, 95%CI:2.380 - 8.318,≥3 times:OR=15.716,95%CI:5.680~43.487), anemia (OR=6.073, 95%CI: 2.193 - 16.813), Rh-negative blood type (OR=2.748, 95%CI: 1.210 - 11.788), history of diabetes (OR=2.463, 95%CI: 1.693 - 8.760), female newborn gender (OR=1.753, 95%CI: 1.141 - 2.694), low birth weight (OR=3.685, 95%CI: 1.086 - 12.497), macrosomia (OR=10.062, 95%CI: 2.667 - 37.959), and cesarean delivery (OR=2.491, 95%CI: 1.515 - 4.097) were risk factors for CHD (P<0.05). Full-term neonates served as a protective factor (OR=0.484, 95%CI: 0.272 - 0.861) against CHD (P<0.05). Conclusions CHD is associated with pre-pregnancy BMI, gravidity, history of diabetes, anemia, birth weight, gestational age, and mode of delivery. Pre-pregnancy testing and genetic counseling services should be strongly promoted to reduce the incidence of CHD.

Analysis of the status and influencing factors of tummy time for infants under 4 months of age

ZHANG Lijin, SHANG Xiaorui, HE Hui, WEI Qianwei, LI Yichen

2024, 32(12):  1374-1378.  DOI: 10.11852/zgetbjzz2023-1399

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Objective To analyze the current status of tummy time among infants in Beijing during early infancy and its influencing factors, in order to provide basis for parental guidance on childcare practices and promote children's growth and development. Methods From June 1st to August 31st, 2021, two streets/township community health service centers from each of two districts in Beijing were selected using cluster sampling, from which 447 resident infants were randomly sampled. Caregivers were surveyed via questionnaire covering demographic information and details of infants' tummy time. Results Among 447 infants, 58.4% started their tummy time within 1 month of birth. Only 15.0% of infants under 4 months spent ≥ 30min on tummy time. Univariate analysis showed that infant tummy time increased with infant age(χ²=0.283,P<0.05). Infants in the 30- to 34-year-old maternal age group had a higher proportion of ≥30-minute tummy time compared to those with mothers younger than 30 or older than 35. Multivariate analysis revealed that being 0-month-old (OR=12.369, 95%CI: 4.056 - 37.723) or 1-month-old (OR=4.751, 95%CI: 1.657 - 13.080), and maternal education levels of college or below (OR=2.670, 95%CI: 1.143 - 6.242) were risk factors for tummy time during infancy (P<0.05), while fathers being under 30 years old acted as protective role in tummy time during infancy (OR=0.135, 95%CI: 0.034 - 0.533, P<0.05). Conclusions The proportion of infants spending ≥30 minutes daily in tummy time during early infancy is not high. Tummy time is influenced by factors including infant age, mother's educational level, and father's age, necessitating enhanced education and guidance for parents regarding the importance of tummy time in early infancy.

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Association of gene mutation degree with initial biochemical indices and therapeutic effect of 21-hydroxylase deficiency in Qingdao area

LIU Tingting, ZHANG Liqin, DU Wei, LI Shuo, LU Weibing, LIU Chang, WANG Yanyan

2024, 32(12):  1379-1383.  DOI: 10.11852/zgetbjzz2024-0055

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Objective To analyze the difference on initial therapeutic responses in patients with congenital adrenal hyperplasia (CAH) due to CYP21A2 gene mutations, stratified by residual enzymatic activity, in order to provide basis for clinical diagnosis, management, and prognosis prediction. Methods A retrospective analysis was conducted on the clinical data of 34 patients who were screened and genetically confirmed at the Qingdao Neonatal Disease Screening Center between January 2010 and July 2023. Multiplex Ligation-dependent Probe Amplification (MLPA) combined with Sanger sequencing was employed to detect pathogenic CYP21A2 mutations. Patients were grouped according to the residual enzymatic activity of mutated CYP21A2 into five genotypic categories: Null (activity=0), Group A (<1%), Group B (2% - 11%), Group C (20% - 50%), and Group D (activity unknown). Differences in diagnostic and treatment indicators among these mutation severity groups were analyzed. Results 1) In addition to the large fragments, mutations were more frequently detected in intron region 2(29.82%), exon 4(28.87%), and exon 10(12.28%), with exon 10 exhibiting the greatest variety of mutations than other areas. 2) Excluding 3 cases in Group D with unknown enzymatic activity, the positive predictive value of genotype-phenotype correlation for the remaining 31 patients was 90.32%.3) All children in the Null group and group A in Qingdao area started treatment within 1 month. Statistically significant differences were observed among Null, A, B, and C groups for the initiation time of treatment (H=11.568), progesterone (H=13.864), testosterone (H=13.249), sodium (H=17.370), potassium levels (H=19.613), and 17-hydroxyprogesterone concentrations (H=10.720) (P<0.05). However, no significant differences were noted in the time to normalization of 17-OHP levels or the initial dose of hydrocortisone among the four genotypic groups (P>0.05). Conclusions The gene mutations of 34 patients in Qingdao are prone to intron 2, exon 4 and exon 10, and there are many kinds of mutations in exon 10. There is a strong correlation between genotype and phenotype, which decreased with the decrease of enzyme activity. Mutation severity significantly influences the timing of treatment initiation and levels of 17-OHP, and rogens, and electrolytes, while having no significant effect on the time to 17-OHP normalization or the initial dosage of hydrocortisone required.

Correlation of serum 25-(OH)D and vitamin B12 levels withseverity of autism spectrum disorder in children

HUANG Tianran, LIU Shurao, ZHANG Yanting, CEN Liting, LU Yanzhen

2024, 32(12):  1384-1388.  DOI: 10.11852/zgetbjzz2023-0020

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Objective To explore the levels of serum 25-(OH)D and vitamin B12 in children with autism spectrum disorders (ASD) and their correlation with disease characteristics,in order to provide a scientific basis for the prevention and treatment of ASD. Methods A total of 100 children with ASD treated in the First People's Hospital of Zhaoqing from June 2019 and June 2021 were retrospectively analyzed,and were selected as observation group.Another 100 healthy children who came to the hospital for physical examination were randomly enrolled as control group.The levels of serum 25-(OH)D and vitamin B12 of the children in two groups were compared,and the differences in supplementation rates of vitamin D and vitamin B12 during childhood and maternal pregnancy were statistically analyzed.Receiver operating characteristic (ROC) curve was used to analyze the differences in levels of serum 25-(OH)D and vitamin B12 of children in both groups.Spearman correlation analysis was adopted to explore the correlation between changes of levels of serum 25-(OH) D and vitamin B12 and severity of ASD. Results The levels of serum 25-(OH)D and vitamin B12 of children,the supplementation rates of vitamin D and vitamin B12 of children and mothers in the observation group were significantly lower than those in control group (t=9.230,7.163, χ²=16.647,23.894,11.524,4.760,P<0.05).The levels of serum 25-(OH)D and vitamin B12 had the value of predicting and evaluating ASD (AUC=0.816,0.761,P<0.05).The levels of serum 25-(OH)D and vitamin B12 of children with mild-to-moderate ASD were higher than those with severe ASD (P<0.05).Spearman correlation analysis found that the severity of ASD children was negatively correlated with levels of serum 25-(OH)D and vitamin B12 (r_s=-0.328,-0.301,P<0.05). Conclusions Children with ASD have abnormal serum 25-(OH) D and vitamin B12.The supplementation rates of vitamin D and vitamin B12 during childhood and maternal pregnancy are related to the incidence of ASD.Vitamin D and B12 supplementation during pregnancy may have a certain effect on preventing the treating of ASD in children.