Chinese Journal Of Contemporary Pediatrics

CJCP

	中文版
	English Version

	2021 Vol. 23 No. 12
	Published: 2021-12-16


	RARE DISEASE RESEARCH STANDARD·PROTOCOL·GUIDELINE CLINICAL RESEARCH EXPERIMENTAL RESEARCH

STANDARD·PROTOCOL·GUIDELINE

	1191	Pediatric Disaster Branch of Chinese Pediatric Society of Chinese Medical Association Pediatric Branch of Chinese People's Liberation Army
		Expert consensus on the prevention and first-aid management of burns in children ^Hot!
		Burns are the second leading cause of unintentional injuries in children and are one of the major causes of disability in children. Timely and effective first-aid management of burns can have a major impact on the prognosis, but there is still a lack of the knowledge on burn management in the general public. With reference to expert opinions and related literature, this consensus summarizes the causes of burns, preventive measures, first-aid methods for common types of burns, and the prevention and treatment of serious complications of burns. It also provides recommendations on the most appropriate pre-hospital treatment. This consensus aims to emphasize the importance of burn prevention, improve the ability of first-aid treatment among witnesses and rescuers, avoid further injury caused by inappropriate treatment, and reduce the mortality and disability rates of burns and the harm to family and society. It can be used as guidance for pre-hospital treatment of childhood burns by first responders, parents, and passers-by.
		2021 Vol. 23 (12): 1191-1199 [Abstract] ( 2598 ) [HTML 1KB] [PDF 676KB] ( 1100 )

	1200	Qi-Ying SONG Xiao-Li ZHAO Yu-Qin GUO Bi-Lan DING Qiong-Ling PENG Li-Ya MA
		Assessment of growth pattern of preterm infants up to a corrected age of 24 months ^Hot!
		Objective To assess the growth of preterm infants up to a corrected age of 24 months, and to understand the growth trend and pattern of preterm infants. Methods A preterm infant follow-up database was established based on the Internet Plus follow-up system. A total of 3 188 preterm infants who were born from April 2018 to April 2021 were enrolled. Their length, weight, and head circumference were recorded at birth and at the corrected ages of 1, 3, 6, 12, 18, and 24 months. The preterm infants were grouped by perinatal factors. The growth curves of these infants were plotted and compared with the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standard and World Health Organization (WHO) standard. Results The weight, length, and head circumference curves of each group of preterm infants grouped by various perinatal factors all rose rapidly within the corrected age of 6 months, but the growth rate slowed down after the corrected age of 6 months. Based on the actual age for the groups of preterm infants with different gestational ages (<28 weeks, 28-31+6 weeks, 32-33⁺⁶ weeks, and 34-36⁺⁶ weeks), the length curve gradually coincided with the WHO curve after the actual age of 9 months (P=0.082), while for the preterm infants with a gestational age of <32 weeks, the weight and head circumference curves were significantly lower than the WHO curves (P<0.001). Based on the corrected age, the physical growth curve of preterm infants with different gestational ages (<28 weeks, 28-31+6 weeks, 32-33⁺⁶ weeks, and 34-36⁺⁶ weeks) basically coincided with each other (P>0.05). For the infants with extremely low birth weight and the small-for-gestational-age infants, the length,weight, and head circumference curves were significantly lower than those of the INTERGROWTH-21st standard and the WHO standard (P<0.05). Conclusions The physical growth rate of preterm infants is faster within the corrected age of 6 months, and the growth rate slows down after the corrected age of 6 months. Preterm infants with a smaller gestational age need longer time to catch up in weight and head circumference. More attention should be paid to the physical growth of extremely preterm infants, extremely low birth weight infants, and small-for-gestational-age infants.
		2021 Vol. 23 (12): 1200-1207 [Abstract] ( 536 ) [HTML 1KB] [PDF 1600KB] ( 573 )

CLINICAL RESEARCH

	1200	SONG Qi-Ying, ZHAO Xiao-Li, GUO Yu-Qin, DING Bi-Lan, PENG Qiong-Ling, MA Li-Ya
		Assessment of growth pattern of preterm infants up to a corrected age of 24 months ^Hot!
		Objective To assess the growth of preterm infants up to a corrected age of 24 months, and to understand the growth trend and pattern of preterm infants. Methods A preterm infant follow-up database was established based on the Internet Plus follow-up system. A total of 3 188 preterm infants who were born from April 2018 to April 2021 were enrolled. Their length, weight, and head circumference were recorded at birth and at the corrected ages of 1, 3, 6, 12, 18, and 24 months. The preterm infants were grouped by perinatal factors. The growth curves of these infants were plotted and compared with the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standard and World Health Organization (WHO) standard. Results The weight, length, and head circumference curves of each group of preterm infants grouped by various perinatal factors all rose rapidly within the corrected age of 6 months, but the growth rate slowed down after the corrected age of 6 months. Based on the actual age for the groups of preterm infants with different gestational ages (<28 weeks, 28-31⁺⁶ weeks, 32-33⁺⁶ weeks, and 34-36⁺⁶ weeks), the length curve gradually coincided with the WHO curve after the actual age of 9 months (P=0.082), while for the preterm infants with a gestational age of <32 weeks, the weight and head circumference curves were significantly lower than the WHO curves (P<0.001). Based on the corrected age, the physical growth curve of preterm infants with different gestational ages (<28 weeks, 28-31⁺⁶ weeks, 32-33⁺⁶ weeks, and 34-36⁺⁶ weeks) basically coincided with each other (P>0.05). For the infants with extremely low birth weight and the small-for-gestational-age infants, the length, weight, and head circumference curves were significantly lower than those of the INTERGROWTH-21st standard and the WHO standard (P<0.05). Conclusions The physical growth rate of preterm infants is faster within the corrected age of 6 months, and the growth rate slows down after the corrected age of 6 months. Preterm infants with a smaller gestational age need longer time to catch up in weight and head circumference. More attention should be paid to the physical growth of extremely preterm infants, extremely low birth weight infants, and small-for-gestational-age infants.
		2021 Vol. 23 (12): 1200-1207 [Abstract] ( 1808 ) [HTML 69KB] [PDF 1600KB] ( 1102 )

	1208	LIU Chun-Hua, WANG Hui, PENG Si-Cong, WANG Wen-Xiang, JIAO Rong, PAN Sha, ZHU Tian-Jiao, LUAN Xiao-Ying, ZHU Xiao-Fang, WU Su-Ying, WEI De-Guo, FU Bing-Feng, YAN Rui-Hong, YANG Shu-Jie, LUO Ya-Hui, LI Gui-Ping, YANG Min, JIA De-Zhao, GAO Chuang, XIAO Xiong-Fei, XIONG Li, SUN Jie, XIAO Jia-Peng, LI Bo-Wen, LI Yan-Ni, ZHANG Lian-Hong, LI Tian-Guo, CHENG Min, XIA Jian-Xin, XIA Shi-Wen
		Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China ^Hot!
		Objective To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. Methods A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. Results Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, P<0.05) or with severe asphyxia (19.8% vs 8.1%, P<0.05) or hypothermia therapy (4.8% vs 1.5%, P<0.05), as well as a significantly higher incidence rate of disorder of glucose metabolism (18.8% vs 12.5%, P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly higher incidence rate of disorder of glucose metabolism at 1, 2, and 6 hours after birth (P<0.05). The multivariate logistic regression analysis showed that recurrent hyperglycemia (adjusted odds ratio=2.380, 95% confidence interval: 1.275-4.442, P<0.05) was an independent risk factor for poor prognosis in neonates with asphyxia. Conclusions Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.
		2021 Vol. 23 (12): 1208-1213 [Abstract] ( 1640 ) [HTML 1KB] [PDF 581KB] ( 647 )

	1214	LIU Yun-Feng, HUANG Chun-Ling, TONG Xiao-Mei, ZHANG Yang, ZENG Lin, YUAN Jin-Fang
		Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus ^Hot!
		Objective To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. Methods A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis. Results Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups. Conclusions Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.
		2021 Vol. 23 (12): 1214-1220 [Abstract] ( 1518 ) [HTML 1KB] [PDF 783KB] ( 631 )

	1221	JIANG Ren-Hui, SHEN Yu-Jie, LIU Xiao-Chen, LI Lu-Quan, CHENG Qian
		Long-term effect of active parenteral nutrition support regimen in preterm infants with a gestational age of <34 weeks ^Hot!
		Objective To study the long-term effect of active parenteral nutrition support regimen in preterm infants with a gestational age of <34 weeks. Methods According to the different doses of fat emulsion and amino acids used in the early stage, the preterm infants with a gestational age of <34 weeks, who were admitted to the hospital within 24 hours after birth from May to December 2019, were divided into an active parenteral nutrition group and a conventional parenteral nutrition group (n=50). Physical indices and the measurements of the Gesell Development Scale were collected at the age of 6 months and 13 months. Results At the age of 6 months, the active parenteral nutrition group (n=46) had higher developmental quotients of gross motor, fine motor, and personal-social behavior than the conventional parenteral nutrition group (n=34) (P<0.05). At the age of 13 months, the active parenteral nutrition group (n=25) had higher developmental quotients of adaptive behavior, gross motor, and personal-social behavior than the conventional parenteral nutrition group (n=19) (P<0.05). There were no significant differences in the physical development indices such as body weight, body height, and head circumference between the two groups during follow-up (P>0.05). Conclusions For preterm infants with a gestational age of <34 weeks, an active parenteral nutrition support strategy with high doses of fat emulsion and amino acids within 24 hours after birth can improve their long-term neurodevelopment.
		2021 Vol. 23 (12): 1221-1227 [Abstract] ( 1838 ) [HTML 1KB] [PDF 560KB] ( 641 )

	1228	ZHANG Xue-Fei, HE Xiao-Ri, LI Wen, WANG Tao, HU Jin-Tao, DONG Qing-Yi, CHEN Ping-Yang
		The timing of withdrawal from caffeine citrate in very preterm infants ^Hot!
		Objective To study the clinical features and outcome of very preterm infants withdrawn from caffeine citrate at different time points. Methods A retrospective analysis was performed on the medical data of the preterm infants with a gestational age of <32 weeks, who were hospitalized in the Division of Neonatology, the Second Xiangya Hospital of Central South University, from January 1, 2016 to November 30, 2020. According to the time of withdrawal from caffeine citrate, the infants who met the study criteria were divided into the group with withdrawal before the last week of hospitalization and the group with withdrawal within the last week of hospitalization. The two groups were compared in terms of clinical features, features of citric caffeine use, length of hospital stay and hospital costs, change in the intensity of respiratory support, and preterm complications. Results A total of 403 preterm infants were enrolled, with 285 infants in the group with withdrawal before the last week of hospitalization and 118 infants in the group with withdrawal within the last week of hospitalization. There were no significant differences in clinical features between the two groups (P>0.05). Compared with the group with withdrawal before the last week of hospitalization, the group with withdrawal within the last week of hospitalization had a significantly longer duration of the use of caffeine citrate, a significantly shorter length of hospital stay, a significantly lower rate of increased intensity of respiratory support after withdrawal, and a significantly lower incidence rate of moderate or severe bronchopulmonary dysplasia (P<0.05). Conclusions A relatively long course of caffeine citrate treatment is more beneficial to the short-term clinical outcome of very preterm infants.
		2021 Vol. 23 (12): 1228-1233 [Abstract] ( 1837 ) [HTML 1KB] [PDF 538KB] ( 708 )

	1234	LI Feng-Chao, DUAN Jian-Ying, ZHANG Yin-Hong, HAN Si-Qi, MA Xiao-Lin, CAI Shi-Yan, LI Li
		Follow-up study of preterm infants with thyroid dysfunction after medication ^Hot!
		Objective To study the effect of levothyroxine sodium tablets on the growth and development and thyroid function in preterm infants with thyroid dysfunction. Methods A retrospective analysis was performed for 82 preterm infants who were born in the Department of Obstetrics of the First People's Hospital of Yunnan Province, from January 1, 2013 to December 31, 2017, and these infants were hospitalized after birth in the Department of Neonatology of the hospital. They were regularly followed up to observe growth and development and thyroid function at the outpatient service of the Department of Neonatology. According to thyroid function test results, they were divided into an abnormal thyroid function group (observation group; n=31) and a normal thyroid function group (control group; n=51). The infants in the observation group were given oral administration of levothyroxine sodium tablets, while those in the control group were not given any treatment. The two groups were compared in terms of the physical and intelligence development and thyroid function of preterm infants with various gestational ages (28-<32 weeks, 32-<34 weeks, and 34-<37 weeks) after regular follow-up to the corrected age of 12 months. Results There were no significant differences in physical development indices (body length, body weight, and head circumference) between the observation and control groups at various gestational ages after follow-up to the corrected age of 12 months (P>0.05). There were no significant differences between the two groups in the scores of each functional area of the Gesell Developmental Scale among the preterm infants with a gestational age of 28-<32 weeks and 32-<34 weeks after follow-up to the corrected age of 12 months (P>0.05). For the preterm infants with a gestational age of 34-<37 weeks, compared with the control group, the observation group had a significantly lower score of gross motor ability at the age of 3 and 12 months, significantly lower scores of fine motor ability, language ability, and adaptation ability at the age of 12 months (P<0.05), and a significantly lower score of personal-social ability at the age of 3 months (P<0.05). However, the score of personal-social ability in the observation group was not significantly different from the control group at the age of 12 months (P>0.05). After 2-4 weeks of treatment with levothyroxine sodium tablets, the thyroid function of the 31 preterm infants with thyroid dysfunction returned to normal. Among the 31 infants, 21 (68%) achieved complete drug withdrawal, with normal results of neonatal screening (100%); 10 infants (32%) failed to achieve drug withdrawal, and only 2 (20%) out of the 10 infants had normal neonatal screening results (P<0.05). Conclusions Early diagnosis and reasonable treatment can reduce the impact on growth and development in preterm infants with thyroid dysfunction. Most preterm infants tend to have transient thyroid dysfunction, while those with positive results of neonatal screening are more likely to develop permanent thyroid dysfunction.
		2021 Vol. 23 (12): 1234-1241 [Abstract] ( 1586 ) [HTML 1KB] [PDF 635KB] ( 781 )

	1242	YE Chang-Xiang, CHEN Sheng-Bao, WANG Ting-Ting, ZHANG Sen-Mao, QIN Jia-Bi, CHEN Li-Zhang
		Risk factors for preterm birth: a prospective cohort study ^Hot!
		Objective To investigate the incidence of preterm birth and risk factors for preterm birth. Methods A prospective cohort study was performed for the pregnant women in early pregnancy and their spouses, who underwent prenatal examination for the first time in Hunan Provincial Maternal and Child Health Care Hospital from May 2014 to December 2016 and decided to be hospitalized for delivery. A questionnaire survey was performed to collect exposure information possibly related to preterm birth. The hospital's medical record system was used for information verification and to record the pregnancy outcome. A multivariate logistic regression analysis was used to investigate the risk factors for preterm birth. Results A total of 6 764 pregnant women with complete data were included, and the incidence rate of preterm birth was 17.09%. The multivariate logistic regression analysis showed that a history of adverse pregnancy outcomes, eating areca nut before pregnancy, a history of pregnancy complications, a history of hepatitis, no folate supplementation during pregnancy, medication during pregnancy, active smoking and passive smoking during pregnancy, drinking during pregnancy, unbalanced diet during pregnancy, high-intensity physical activity during pregnancy, and natural conception after treatment of infertility or assisted conception as the way of conception were risk factors for preterm birth (P<0.05). Additionally, the pregnant women whose spouses were older, had a higher body mass index or smoked had an increased risk for preterm birth (P<0.05). A higher level of education of pregnant women or their spouses and lower gravidity were protective factors against preterm birth (P<0.05). Conclusions There are many risk factors for preterm birth. Special attention should be paid to the life behaviors of pregnant women during pregnancy, and health education should be strengthened for pregnant women and their spouses to develop good living habits and reduce the incidence of preterm births.
		2021 Vol. 23 (12): 1242-1249 [Abstract] ( 5725 ) [HTML 1KB] [PDF 629KB] ( 2613 )

	1250	KANG Qian-Qian, LI Xu, TONG Guang-Lei, FAN Ya-Lan, SHI Lei
		Magnetic resonance spectroscopy features of the thalamus and the cerebellum and their association with clinical features in children with autism spectrum disorder: a prospective study ^Hot!
		Objective To study the changes in biochemical metabolites in the thalamus and the cerebellum and their association with clinical features in children with autism spectrum disorder (ASD). Methods In this prospective study, magnetic resonance spectroscopy (MRS) with point-resolved spatial selection was used to analyze the thalamus and the cerebellum at both sides in 50 children with ASD aged 2-6 years. Creatine (Cr) was as the internal standard to measure the relative values of N-acetylaspartate (NAA)/Cr, choline (Cho)/Cr, myoinositol (MI)/Cr, and glutamine and glutamate complex (Glx)/Cr, and the differences in metabolites and their association with clinical symptoms were compared. Results In the children with ASD, NAA/Cr in the left thalamus was positively correlated with the scores of hearing-language and hand-eye coordination in the Griffiths Development Scales-Chinese (P<0.05). Cho/Cr in the right cerebellum was positively correlated with the scores of personal-social competence, hearing-language, and hand-eye coordination (P<0.05). NAA/Cr and Glx/Cr in the left thalamus were positively correlated with those in the left cerebellum (P<0.05). There was no significant difference in metabolites between the left and right sides of the thalamus and the cerebellum in the children with ASD (P>0.05). Conclusions There are metabolic disorders in the cerebellum and the thalamus in children with ASD, and there is a correlation between the changes of metabolites in the left cerebellum and the left thalamus. Some metabolic indexes are related to the clinical symptoms of ASD. MRS may reveal the pathological basis of ASD and provide a basis for diagnosis and prognosis assessment of ASD as a noninvasive and quantitative detection method.
		2021 Vol. 23 (12): 1250-1255 [Abstract] ( 1797 ) [HTML 1KB] [PDF 730KB] ( 697 )

	1256	ZHANG Ya-Ru, TAO Hong-Mei, YANG Guang, WANG Yi, SHA Lin, SHAO Zhi
		Efficacy of family rehabilitation treatment performed by parents under the guidance of professionals in children with autism spectrum disorder: a prospective study ^Hot!
		Objective To study the efficacy of family rehabilitation treatment performed by parents under the guidance of professionals in children with autism spectrum disorder (ASD). Methods In the prospective study, 60 children with ASD, aged 24-60 months, were randomly divided into an observation group and a conventional group. The parents of the children in the conventional group received an online training on basic knowledge and rehabilitation training of ASD alone, and those in the observation group received the online training and performed family rehabilitation treatment under the guidance of a professional team. Psycho-Education Profile Third Edition (PEP-3) and Childhood Autism Rating Scale (CARS) were used to evaluate the changes in related abilities after intervention. Results After 6 months of intervention, the scores of all dimensions of the PEP-3 scale in the observation group and most dimensions of the conventional group significantly increased (P<0.01); the CARS scale scores of the two groups significantly decreased (P<0.05). Compared with the conventional group, the observation group had significant increases in the scores of the dimensions of language understanding, language expression, gross motor, fine motor, self-care ability of daily living (P<0.05), and adaptive behavior (P<0.05), as well as a significant reduction in the CARS score (P<0.05). Conclusions An online training on basic knowledge and rehabilitation training of ASD for parents can improve the abilities and core clinical symptoms of children with ASD. The family rehabilitation treatment model with a team of professionals as the resource platform and parents as the performer has a more significant efficacy on improving the language, sports, and other abilities and alleviating the severity of the symptoms in children with ASD.
		2021 Vol. 23 (12): 1256-1261 [Abstract] ( 2098 ) [HTML 1KB] [PDF 555KB] ( 907 )

	1262	ZHANG Ni-Si, ZHANG Zhan-Hui, LIN Wei-Xia, ZHANG Meng, LI Bing-Xiao
		Physical and neuropsychological development of children with Citrin deficiency ^Hot!
		Objective To study the physical and neuropsychological development of children with Citrin deficiency (CD). Methods A total of 93 children, aged 1.9-59.8 months, who were diagnosed with CD by SLC25A13 gene analysis in the First Affiliated Hospital of Jinan University from August 2010 to August 2015, were enrolled as subjects. A retrospective analysis was performed for their birth condition and physical growth and neuropsychological development indices. Among these children, 7 underwent physical measurement and neuropsychological development assessment within 1 year old and after 1 year old, and therefore, a total of 100 cases were included for analysis. Results For the 93 children with CD, the incidence rate of failure to thrive was 25% (23 children) and the proportion of small for gestational age was 47% (44 children). For the 100 cases of CD, the incidence rates of growth retardation, underweight, emaciation, overweight, and microcephalus were 23% (23 cases), 14% (14 cases), 4% (4 cases), 8% (8 cases), and 9% (9 cases), respectively. The incidence rate of neuropsychological developmental delay was 25% (25 cases), and the incidence rates of development delay in the five domains of adaptability, gross motor, fine motor, language, and social ability were 7% (7 cases), 15% (15 cases), 7% (7 cases), 9% (9 cases), and 7% (7 cases), respectively. Conclusions Physical and neuropsychological developmental delay can be observed in children with CD, and physical and neuropsychological development should be regularly assessed.
		2021 Vol. 23 (12): 1262-1266 [Abstract] ( 1691 ) [HTML 1KB] [PDF 569KB] ( 623 )

	1267	SHENG Jun-Feng, SHAO Lan, WANG Yu-Lin
		Clinical features of children with coronavirus disease 2019 caused by Delta variant infection ^Hot!
		Objective To study the epidemiological and clinical features of children with coronavirus disease 2019 (COVID-19) caused by Delta variant infection and their differences from children with ordinary COVID-19 (non-Delta variant infection). Methods Eleven children aged <14 years, who were diagnosed with COVID-19 caused by Delta variant infection from August to September 2021 were enrolled (variant group). Five children aged <14 years who were diagnosed with ordinary COVID-19 from February to March 2020 served as the control group. The epidemiological data, clinical features, and laboratory examination results were compared between the two groups. Results There was no significant difference in the proportion of children with clinical symptoms between the two groups (P>0.05). There were no significant differences in white blood cell count, lymphocyte count, and platelet count between the two groups (P>0.05), while the variant group had a lower neutrophil count than the control group (P<0.05). Lymphocytopenia was not observed in either group. Compared with the control group, the variant group had a higher proportion of children with an increase in creatine kinase isoenzyme (P<0.05), while there were no significant differences in the proportion of children with an increase in lactate dehydrogenase, D-Dimer, C-reactive protein or interleukin-6 between the two groups (P>0.05). Among the 9 children in the variant group, 5 tested positive for IgM antibody at week 2 after admission, and all children tested positive for IgG antibody. At week 3 after admission, the level of IgM antibody tended to decrease in 9 children, and the level of IgG antibody tended to decrease in 8 children. Conclusions Delta variant is more infectious. COVID-19 caused by Delta variant infection may cause more serious myocardial damage than ordinary COVID-19 in children. In children infected with Delta variant, IgG antibody appears at almost the same time as IgM antibody.
		2021 Vol. 23 (12): 1267-1270 [Abstract] ( 1761 ) [HTML 1KB] [PDF 543KB] ( 644 )

	1271	Jiangsu Province Medical Quality Control Centre of Neonatal Department
		An investigation on the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit ^Hot!
		Objective To investigate the current status of the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit (NICU). Methods A self-made scale was developed according to "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)" and was used to distribute questionnaires to the medical staff in the NICU from the member units of Jiangsu Province Medical Quality Control Centre of Neonatal Department to evaluate their levels of understanding the basic knowledge, assessment, and management of neonatal pain. Results A total of 957 questionnaires (from 383 doctors and 574 nurses) were collected. Doctors and nurses had mean correct rates of 38% and 39% respectively in answering the questions on the basic knowledge of neonatal pain. They had median correct rates of 0% and 50% respectively in answering the questions on neonatal pain assessment, and mean correct rates of 73% and 68% respectively in answering on analgesia management. Compared with those who did not receive the training on neonatal pain, the medical staff who received such training had significantly higher correct rates in answering the questions on the basic knowledge of neonatal pain and neonatal pain assessment (P<0.05). The medical staff from tertiary hospitals had significantly higher correct rates in answering the questions on the basic knowledge of neonatal pain and neonatal pain assessment than those from secondary hospitals (P<0.05). Conclusions The medical staff in the NICU have insufficient cognition of neonatal pain, and thus it is necessary to carry out the special training on neonatal pain, focusing on the promotion and practical application of "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)", in order to improve the level of neonatal pain assessment and analgesia management among medical staff in the NICU.
		2021 Vol. 23 (12): 1271-1276 [Abstract] ( 1765 ) [HTML 1KB] [PDF 526KB] ( 638 )

RARE DISEASE RESEARCH

	1276	WANG Xin, ZHANG Bi-Li, CHEN Xiao-Ying, GUO Zhen
		Cystinosis induced by CTNS gene mutation: a rare disease study ^Hot!
		A boy, aged 1 year and 6 months, was found to have persistent positive urine glucose at the age of 4 months, with polydipsia, polyuria, and growth retardation. Laboratory examinations suggested that the boy had low specific weight urine, anemia, hypokalemia, hyponatremia, hypomagnesemia, metabolic acidosis, glycosuria, acidaminuria, increased fractional excretion of potassium, and decreased tubular reabsorption of phosphate. X-ray examinations of the head, thorax, and right hand showed changes of renal rickets. The slit-lamp examination showed a large number of cystine crystals in the cornea. The genetic testing showed a suspected pathogenic homozygous mutation of the CTNS gene, C.922g>A(p.Gly308Arg). The boy was finally diagnosed with cystinosis. At the beginning of treatment, symptomatic supportive treatment was given to maintain the stability of the internal environment, and cysteamine tartaric acid capsules were used after diagnosis to remove cysteine. This article reported a case of cystinosis caused by CTNS gene mutation and summarized the etiology, clinical features, diagnosis, and treatment of this disease, which can provide a reference for the early diagnosis, treatment, and subsequent study of the disease.
		2021 Vol. 23 (12): 1276-1281 [Abstract] ( 1928 ) [HTML 1KB] [PDF 919KB] ( 884 )

EXPERIMENTAL RESEARCH

	1282	ZHANG Min, CHENG Li-Hua, YIN Xiao-Tong, LUO Hao, CAI Cheng
		Protective effect of adrenomedullin on hyperoxia-induced lung injury ^Hot!
		Objective To study the role of adrenomedullin (ADM) in hyperoxia-induced lung injury by examining the effect of ADM on the expression of calcitonin receptor-like receptor (CRLR), receptor activity-modifying protein 2 (RAMP2), extracellular signal-regulated kinase (ERK), and protein kinase B (PKB) in human pulmonary microvascular endothelial cells (HPMECs) under different experimental conditions. Methods HPMECs were randomly divided into an air group and a hyperoxia group (n=3 each).The HPMECs in the hyperoxia group were cultured in an atmosphere of 92% O₂(3 L/minute) +5% CO₂. RT-qPCR and Western blot were used to measure the mRNA and protein expression levels of ADM, CRLR, RAMP2, ERK1/2, and PKB. Other HPMECs were divided into a non-interference group and an interference group (n=3 each), and the mRNA and protein expression levels of ADM, ERK1/2, and PKB were measured after the HPMECs in the interference group were transfected with ADM siRNA. Results Compared with the air group, the hyperoxia group had significant increases in the mRNA and protein expression levels of ADM, CRLR, RAMP2, ERK1/2, and PKB (P<0.05). Compared with the non-interference group, the interference group had significant reductions in the mRNA and protein expression levels of ADM, ERK1/2, and PKB (P<0.05). Conclusions ERK1/2 and PKB may be the downstream targets of the ADM signaling pathway. ADM mediates the ERK/PKB signaling pathway by regulating CRLR/RAMP2 and participates in the protection of hyperoxia-induced lung injury.
		2021 Vol. 23 (12): 1282-1288 [Abstract] ( 1693 ) [HTML 1KB] [PDF 665KB] ( 859 )

	1289	ZHENG Ya-Fei, ZHU Hai-Yan, WANG Wei, HU Jing-Jing, BAO Tian-Ping, TIAN Zhao-Fang
		Role of the LRP1-pPyk2-MMP9 pathway in hyperoxia-induced lung injury in neonatal rats ^Hot!
		Objective To study the role of the low-density lipoprotein receptor-related protein 1 (LRP1)-proline-rich tyrosine kinase 2 phosphorylation (pPyk2)-matrix metalloproteinases 9 (MMP9) pathway in hyperoxia-induced lung injury in neonatal rats. Methods A total of 16 neonatal rats were randomly placed in chambers containing room air (air group) or 95% medical oxygen (hyperoxia group) immediately after birth, with 8 rats in each group. All of the rats were sacrificed on day 8 of life. Hematoxylin and eosin staining was used to observe the pathological changes of lung tissue. ELISA was used to measure the levels of soluble LRP1 (sLRP1) and MMP9 in serum and bronchoalveolar lavage fluid (BALF). Western blot was used to measure the protein expression levels of LRP1, MMP9, Pyk2, and pPyk2 in lung tissue. RT-PCR was used to measure the mRNA expression levels of LRP1 and MMP9 in lung tissue. Results The hyperoxia group had significantly higher levels of sLRP1 and MMP9 in serum and BALF than the air group (P<0.05). Compared with the air group, the hyperoxia group had significant increases in the protein expression levels of LRP1, MMP9, and pPyk2 in lung tissue (P<0.05). The hyperoxia group had significantly higher relative mRNA expression levels of LRP1 and MMP9 in lung tissue than the air group (P<0.05). Conclusions The activation of the LRP1-pPyk2-MMP9 pathway is enhanced in hyperoxia-induced lung injury in neonatal rats, which may be involved in the pathogenesis of bronchopulmonary dysplasia.
		2021 Vol. 23 (12): 1289-1294 [Abstract] ( 2073 ) [HTML 1KB] [PDF 764KB] ( 865 )

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