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06 March 2009, Volume 24 Issue 03 Previous Issue    Next Issue
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Current situation investigation and analysis of SGA in China. WANG Qing-hong,YANG Yu-jia,WEI Ke-lun,DU Li-zhong. 2009, 24(03): 177-180 .  Abstract ( )   Objective　To investigate the current situation of small for gestational age infants （ SGA ） in China. Methods　The data were from the 86 hospitals in 22 provinces of China. A retrospective investigation was carried out in 45 014 cases from Obstetric Departments and 54 466 cases from newborn nursery between Jan. 1 and Dec. 31 of 2005. Results　（1） The incidence of SGA was 6.61% in 2005， in which the incidence of SGA in preterms （13.10 %） is higher than full terms （6.05 %）. （2） The number of SGA accounted for 9.19 % of hospitalized neonates in newborn nursery.（3） The ratio of asphyxia， RDS，pulmonary hemorrhage， apnea， HIE， gastric retention， alimentary tract hemorrhage， NEC， cold injury， and congenital malformation in SGA were higher than in appropriate for gestational age （AGA） and large for gestational age infants （LGA）. （4） About 57.47 % of hospitalized neonates were cured， 27.41 % were improved and 1.95 % died. The mortality of SGA was higher than AGA and LGA， and the rate of cure and improvement was lower than AGA and LGA. Conclusion 　The mobidity and mortality of SGA are still high in China. Perinatal monitoring and intervention should be enhanced in our country.

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Clinical analysis of neonatal methylmalonic academia in 20 cases. HE Jian-ping，ZHONG Yan，YANG Xue-fang，WANG Hui-xin，YANG Cai-yun，GU Song. 2009, 24(03): 181-183 .  Abstract ( )   Objective　This study aimed to explore the clinical characteristics and treatment of neonatal methylmalonic academia（MMA）. Methods　The clinical data of 20 patients with neonatal MMA were analyzed and the diagnoses were confirmed by gas chromatography-mass spectrometry（GC/MS）. Results　The patients consisted of 15 males and 5 females， whose age of onset ranged from 0 to 23 days with 15 cases （75%）early in the first week after birth.The main clinical manifestations were poor feeding（16 cases）， weak reaction（14 cases）， vomitting（6 cases）， hyperpnea（4 casas）， convulsion（3 cases）， hypotonia（13 cases）， etc. Ten cases presented with thrombocytopenia. The laboratory findings showed metabolic acidosis in 6 cases， hyperammonemia in 8 cases and remarkable elevation of urinary methylmalonic acid concentration in all cases. Some abnormalities were noted by the brain CT in 15 cases. Of the 10 cases without therapy ， one patient died before the diagnosis was made， 7 cases died at home after giving up therapy， 2 cases failed to have follow-up. Ten cases received therapy of vitamin B12 and supplementation of L-carnitine with restricted-protein diet. The follow-up for a period ranging from 2 months to 3 years and 5 months of the 8 survivals with medical therapy showed a favorable outcome,no symptoms in 4 cases and apparent improvement in 4 cases. Conclusion　The clinical manifestations of neonatal MMA are nonspecific. GC/MS can be used to confirm the diagnosis. Early diagnosis and early treatment is the key to improve the prognosis.

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The efficacy of different course of EEG biofeedback treatment on ADHD children. JIANG Rong-huan，SUN Li，WANG Yu-feng,GU Bo-mei. 2009, 24(03): 184-186 .  Abstract ( )   Objective　To explore the efficacy of different course of EEG biofeedback treatment on ADHD children. Methods　Twenty children according to DSM-IV Criteria of Attention Deficit Hyperactivity Disorder （ADHD）were included in EEG biofeedback treatment. Conners Rating Scale， Wechsler Memory Scale（WMS），Number Cancellation Test， Stroop Test were tested before treatment， after 20 sessions and after 40 sessions of EEG biofeedback treatment. The results of ADHD children were also compared with the normal children. Results　After 20 sessions’ treatment， ADHD children’s clinical symptoms had no improvement，but short - term memory in WMS， time of Stroop color test and Stroop color interference test，and the first and second part of Number Cancellation Test improved ，having no significant difference with normal controls （ P > 0.05）. After 40 sessions’ treatment, Conners’ somatic factor and anxiety factor， instant memory， Stroop word test and the third part of Number Cancellation Test treatment continued to improve, and had no significant difference with normal controls （ P > 0.05 ）.But the long-term memory， Stroop word-interference test， Conners’ behavior factor， learning factor， hyperactivity factor and hyperactivity index were worse than the normal controls（P < 0.05）. Conclusion　Forty session’ EEG feedback treatment is more effective than 20 sessions’ on ADHD children’s clinical symptoms and cognitive functions， some even as good as the normal children after 40 sessions treatment.

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The change of bone mineral density and its influencing factors among obese children. MO Juan,WU Jing,LEI Min-xiang，HUANG Chao-wen，PENG Lie-wu，XU Li，YANG Xiao-chun，YU Xian. 2009, 24(03): 187-190 .  Abstract ( )   To study the change of bone mineral density（BMD） and its influencing factors among obese children and to provide the scientific evidence for early osteoporosis prevention.Methods　Obesity was assessed by the method of body mass index（BMI） among children aged 7 to 12 years in five primary schools of Kaifu District in Changsha in 2007， and 119 obese subjects and 103 control subjects were randomly selected.Total-body dual-energy x-ray absorptiometry （DEXA） scans were performed to obtain BMD and body composition. Results　 Obesity group had higher height， weight， BMI， waist circumference and waist to hip ratio as compared with those of control group. Obesity group had greater values of lean mass（LM）， fat mass（FM）， percentage of body fat and truncal FM proportion， but lower values of extremity FM proportion in comparison to controls. Obesity group had higher BMD and bone mineral content（BMC） as compared with those of controls. When FM was controlled， there was positive correlation between BMD（or BMC） and LM. When LM was controlled， there was positive correlation between BMC and FM. Multiple stepwise regression models indicated that LM was the dominant influencing factor of BMD in children. Conclusion　The findings of this study suggest that obese children have higher BMD than controls and LM is the primary determinant of BMD in developmemt of children.

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The clinical and electroencephalographic features of childhood occipital epilepsy of Gastaut. SHU Xiao-mei,ZHANG Gui-ping,YANG Bing-zhu,LI Juan. 2009, 24(03): 191-193 .  Abstract ( )   Objective　To characterize the clinical features and electroencephalographic （EEG） features of childhood occipital epilepsy of Gastaut （COE-G）. Methods　The clinical and EEG characteristics of 7 children who were diagnosed as COE-G were identified and followed-up clinically， with sleep and awake EEGs. Results　COE-G had a peak age of onset at about 9 years. Visual manifestations were the most common ictal event. Ictal deviation of the eyes associated with ipsilateral turning of the head and migraine-like symptoms were frequent. Hemiconvulsions occurred in 3 children， and only one child had secondarily generalized tonic-clonic seizures （GTCS）. In all patients the seizures occurred while awake， and 2 also had seizures during sleep. EEG showed that the majority of the patients had occipital spike-wave discharges when the eyes were closed, which disappeared when the eyes were open. One child continued having frequent seizures despite antiepileptic drugs treatment and two cases had subtle cognitive deficits. Conclusion　COE-G， a late onset childhood occipital seizures， is a distinctive epilepsy syndrome， and sheds some doubts on the prognosis and longterm evolution.

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Study on the relationship between behavior problems and sleep disorder in children aged 6～12 years. LI Jie-min，YI Zhu-wen，LUO Xue-mei，CAI Yi-min，SU Lin-yan. 2009, 24(03): 194-196 .  Abstract ( )   Objective　To explore the relation of attention deficit and hyperactivity disorder with sleep disorder in children. Methods　 In Changsha 1736 children at the age of 6～12 years were randomly selected among the 5 districts.Their parents completed the questionnaires about children’s sleep condition and attention deficit and hyperactivity disorder. Results　In the 1736 children， the incidence rate of sleep disorder was 31.9%. The group of sleep disorder had attention deficit for 21.7%， hyperactivity disorder for 13.7%， day drowsiness for 35.9% ，and all the numbers were more than 13.0% ， 7.9%， 24.7% of non-sleep disorder group（P＜0.001）. Behavior problem was related to snore frequency； the attention deficit incidence rate for usual snoring group was 31.3%， more than 8.8% of non-snore group and 9.9% of occasional snore group（P＜0.05）. In the score for sleep disordered breathing， the attention deficit incidence rate of high score groups was 19.2%～26.2%， and the hyperactivity disorder rate of the highest group was 16.2%， obviously more than other low score groups ： 10.9%～ 12.3%， 5.7%～8.3%（P＜0.01）. Sex differences existed between the incidence rate of sleep disorder and attention deficit， and hyperactivity disorder， male being more than female（P＜0.01）. Conclusion　In children a series of behavior problems such as attention deficit and hyperactivity disorder are related to sleep disorders， so it’s essential to pay close attention to their sleep conditions in children with attention deficit and hyperactivity disorders.

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Relative analysis of plasma monocyte/macrophage chemoattractant protein and related parameters of insulin resisitance in children with simple LIU Yan-ming，NONG Guang-min,WU Jiao-hua. 2009, 24(03): 197-199 .  Abstract ( )   Objective　To investigate the correlations between plasma monocyte /macrophage chemoattractant protein and related parameters of insulin resisitance in children with simple obesity. Methods　70 children with simple obesity were enrolled as study group，30 healthy children as control group. Body mass index（BMI ）and waist circumference （WC）were detected as indices of obesity .Plasma levels of macrophage inflammatory protein-1α（MIP-1α）、monocyte chemoattractant protein-1（MCP-1 ）were measured by ELISA.The rate of CD68 positive cells in blood were detected by flow cytometry（FCM）： Plasma levels of insulin 、adiponectin were measured by RIA， Insulin resisitance index （InRI） were caculated by homeostasis model assessment of insulin resistance （HOMA-IR）. The associations between MIP-1α、MCP-1 levels and adiponectin and related parameters were analyzed with Pearson correlation analysis or partial correlation analysis．Results　The concentration of MIP-1α and MCP-1 in plasma in children with simple obesity were higher than that in control group. There was a significant difference between the two groups （P < 0. 05）. The rate of CD68 positive cells in blood of simple obesity had no significant difference between that in control group （P > 0.05）.The concentration of MIP-1α and MCP-1 in plasma had positive correlations with BMI and WC and InRI（P < 0. 05）. The concentration of adiponectin in plasma had negetive correlations with BMI and WC and InRI （P < 0. 05）. The rate of CD68+ cell in blood had no correlation with BMI and WC and InRI（P < 0. 05）.Conclusion　We found that a differential low-grade inflammation is associated with obesity of children .The levels of MIP-1α、MCP-1 in blood of obesity were associated with insulin resistance and abdominal obesity. The levels of plasma MIP-1α、MCP-1、adiponectin may predict the onset of obesity related complications.

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Clinical analysis of autosomal dominant noctumal frontal lobe epilepsy. ZHAI Qiong-xiang,GUI Juan,ZHANG Yu-xin，CHEN Zhi-hong. 2009, 24(03): 200-202 .  Abstract ( )   Objective　To explore the clinical characteristics of 6 pedigrees of autosomal dominant noctumal frontal lobe epilepsy in China. Methods　The probands of 6 families in China from January,2001 to December, 2007, who were referred to our department for recurrent seizures and seizure history were investigated on affected individuals and unaffected， thus the comprehensive pedigrees were constructed and the clinical data were analyzed. Types and epilepsy syndromes were classified according to international classification. The results were analyzed with the software of SPSS 13. 0 and the incidence of recurred seizures was tested in males and females with χ2 test. Results　There were 59 people in 6 families， including 24 patients, but only 22 survived （9 male and 13 female）. The incidence of recurrent seizures in males and females had no significant difference（χ2=0. 413，P > 0. 05）. There were 20 patients who were characterized by clusters of brief seizures during night sleep and EEG showed spike-slow waves in frontal lobe. One patient’s symptom was tonic seizures, developing from simple partial seizures. His AEEG showed spike-slow waves and high amplitude θ waves in frontal section on both sides. And the other patient symptom was self-motion syndrome and seizures during night sleep. The EEG showed spike-slow waves in frontal and center sections on left side. The attacks were well controlled by antiepileptic drugs. All the patients ‘nerve system examination and MRI were normal. Conclusion　 ADNFLE is characterized by clusters of brief seizures during night sleep that are often misdiagnosed as nightmares.

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Research on immune state of children with Henoch-Schonleinin acute in phase. QIAN Yi，FENG Qi-hua. 2009, 24(03): 203-205 .  Abstract ( )   Objective　To observe the changes of the functional states of lymphocyte subgroup and immunoglobulin level of children with Henoch -Schonlein（HSP）in acute phase， and to evaluate its mechanisms in the pathogenesis of HSP and their clinical significance. Methods　Forty HSP patients were divided into the group of Henoch-Schonlein purpura nephritis（HSPN）and the group of non-HSPN. The control group consisted of 20 healthy children. The plasma immunoglobulin IgA、 IgG and IgM were detected with nephelometer and lymphocyte subgroup CD3+、CD4+、CD8+ 、CD4+/CD8+、CD19+、CD19+23+、CD16+CD56+、CD4+/CD8+ and CD4+CD25+cell were detected with flow cytometry. Results　The contents of CD3+、CD4+ 、CD4+CD25+、CD16+CD56+ cell and the ratio of group CD4+/CD8+ cell in HSP group were significantly lower than that in control group （P < 0.01）.The contents of CD8+、CD19+、CD19+23+ cell in HSP group were significantly higher than that in control group（P < 0.01）. There was also no significant difference in the levels of lymphocyte subgroup between HSPN group and control group（P > 0.05）. However， the levels of IgA in HSPN group was significantly higher than that in control group（P < 0.01）. There was no significant difference in the levels of IgG and IgM between non-HSP group and control group （P > 0.05）.There was significant difference in the levels of IgG （P <0.05），and no significant difference between HSPN and non-HSPN（P > 0.05）. Conclusion　The results show that there is a polyclonal B cell activation characterized by significantly increased IgA in HSPN and NHSPN， which provides objective index and theoretical evidences for dignosis and treatment of HSP.

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The clinical characteristics and pathogens of purulent meningitis in children of different age. LI Hong,ZHANG Yu-qin,ZHU Jin,LI Dong,ZHANG Pei-yuan,LIU Xiao-jun,YE Lu-mei. 2009, 24(03): 206-208 .  Abstract ( )   Objective　To investigate the clinical characteristics and etiologic agents of pediatric purulent meningitis in different age groups， and to offer theoretical basis for the diagnosis and therapy. Methods　A retrospective study of 173 children with the clinical diagnosis of purulent meningitis in the past 5 years was conducted. All patients were divided into four groups according to the age： group1 （newborns，n =48），group2（infants，n =73），group3（1～5 years，n =22），group4（>5 years，n =30）.Results　Low-moderate grade fever was present in 66.7% of newborns in group1. Seizure was a common symptom of bacterial meningitis； the proportions of seizure attack（47/73 64.4% ） and bulging fontanel（43/73 58.9%） in group2 were the highest among all groups（P <0.01）. In group2 42/73（57.5%） and 15/73（20.6%） of the cases survived with complications and neurologic sequelae， and the incidence of empirical therapy modification was 33/73（45.2%）， which were higher than those in other groups（P <0.01）； 28/30（93.3%） cases had headache and signs of meningeal irritation in group4， the rates of them being significantly higher than other groups（P <0.01）; 8/30（27.3%） cases were associated with cerebrospinal fluid leaks and neurosurgical procedures in group 4；63 strains of pathogenic bacteria from 173 CSF specimens were identified， the positive culture rate being 36.4%. The most predominant pathogens in each group were Escherichia Coli， coagulase-negative staphylococcus， Neisseria meningitides and streptococcus pneumoniae， respectively. Conclusion　Etiology of purulent meningitis is affected most by the age of the children， and manifestations depend on the age too. Age of patient with purulent meningitis should be considered in the diagnosis and therapy.

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A clinical observation for the efficacy and safety of levetiracetam in treatment of children with epilepsy. LIU Zhi-sheng,WANG Fang-lin,HU Jia-sheng. 2009, 24(03): 209-211 .  Abstract ( )   Objective　To evaluate the therapeutic effect and safety of levetiracetam （Keppra）. Methods　A total of 56 children with epilepsy between the ages of 5 months and 14 years were treated with levetiracetam. There were 32 cases by monotherapy and 24 cases by add-on therapy. The starting dosage of levetiracetam was [5.2～20.8 mg/kg] of tablet per day twice daily， and its objective dosage was [14.4～41.6 mg/kg] per day twice daily in children with epilepsy. The follow-up period ranged from 3 to 12 months. Results 　The effective rate （> or = 50% reduction in seizures） was found in 68.8%， with 40.6% achieving seizure freedom in monotherapy of levetiracetam. The effective rate was found in 41.7%， with 8.3% achieving seizure freedom in add-on therapy of levetiracetam. The effective rate of monotherapy of levetiracetam showed significant difference as compared with add-on therapy （P＜0.05）. There were mild adverse reactions in levetiracetam treatment of children with epilepsy， including gastrointestinal dysfunction， dizziness， somnolence and irritability， etc. Conclusion　The levetiracetam is effective as monotherapy and as add-on therapy， and well tolerated for epilepsy in children. The efficacy of monotherapy is higher than that of add-on therapy in levetiracetam treatment of children with epilepsy.

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Study on the association between vitamin D receptor gene polymorphisms and rickets. XU Feng-lan，XING Yu-feng，SUN Guang-feng，YU Xiao-bo，ZHU Jin-ling. 2009, 24(03): 212-213 .  Abstract ( )   Objective　To study the relationship between vitamin D receptor gene polymorphisms and the hereditary susceptibility of vitamin D deficiency rickets. Methods　PCR-RFLP analyzes the technology using the polymerase chain reaction-restrictive fragment length multi-state properties to examine 159 examples vitamins D deficiency rickets child and 78 examples normal children （comparison group ） the vitamin D accept or （VDR） the gene Bsm I spot multi-state properties ， compared with two group of between， VDR gene and gene frequency. Results　 Vitamin D deficiency rickets sickness and comparison group child’s VDR the gene Bsm I spot gene distribution frequency respectively is： BB （0%）， Bb（15.7%）， bb（84.3%） and BB（0%）， Bb（11.5%）， bb（88.5%）， two group of between difference not remarkable statistics significance （P > 0.05）； vitamin D deficiency rickets sickness and comparison group child’s VDR the gene Bsm I spot allele distribution frequency respectively is： B（7.9%）， b（92.1%）， with B（5.8%），b（94.2%） two group of between difference not remarkable statistics significance （P > 0.05） Conclusion　VDR the gene Bsm I enzyme cuts the position spot the multi-state properties possibly to have nothing to do with the vitamin D deficiency rickets heredity easy perception .

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Epidemiologic investigation of sleep disorders in the children of 2～12 years. QU Xiang,CAI Yan-hua,HONG Yu,WANG Hua. 2009, 24(03): 214-216 .  Abstract ( )   Objective　To study the sleep conditions and the prevalence of sleep disorders， and analyze the related factors in 2～12 years old children who received medical treatment in the Department of Pediatrics of Shengjing Hospital of China Medical University. Methods　From November of 2007 to March of 2008，300 children aged 2～12 who received medical treatment in the Department of Pediatrics of Shengjing Hospital of China Medical University were investigated， whose parents were also investigated with questionnaires, which contained the family and social environment and the sleep conditions of the children.Results　The total prevalence rate of parasomnias was 65.72%（186/283）， the total prevalence rate of difficulty in falling asleep was 19.43%（55/283） and the total prevalence rate of drowsiness was 7.42%（21/283） among the children who were investigated. The average time of daily sleep of each group among 2～12 was from （11.75±1.19） hours to （9.00 ±0.84） h hours respectively. The main possible risk factors that affected the sleep conditions were gender， age， history of respiratory system diseases， smoking history of parents， educational background of parents and snoring history of parents.Conclusion　There is a higher prevalence rate of sleep disorders in 2～12-year old children receiving medical treatment in the Department of Pediatrics in the city of Shenyang . The main risk factors that affect the sleep disorders are family and social environments as well as body diseases.

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Influence of cardiac function on the cerebral blood flow in preterm infants. LIU Zhen，WU Ben-qing，LI Jianming，YAN Yu-qin，DING Lu. 2009, 24(03): 217-219 .  Abstract ( )   Objective　To investigate the influence of cardiac function on the cerebral blood flow in preterm infants. Methods　From January 2007 to July 2007 in our hospital Neonatal Department，261 preterm infants aged from 29 w to 36+6 w were divided into 3 groups according to left ventricular ejection fraction（EF）. The index of blood flow rate and blood vessel elasticity of arteria cerebri media were monitored by transcranial Doppler on the first day，the third day and the seventh day；cardiac pumping function and peak flow rate of aorta valve orifice were monitored by the color Doppler echocardiography in the preterm infants；meanwhile，the temperature，blood gas，blood glucose，blood pressure and hematocrit were monitored on the first day in the preterm infants，their gestational age and birth weight being recorded. Results　The cerebral blood flow gradually increased with left ventricular EF. There were positive correlation between EF and systolic peak velocity，diastolic velocity and mean velocity of arteria cerebri media（r was 0.70、0.41、0.61 respectively，P <0.01），while there was no significant correlation between EF and resistent index or elasticity index. Conclusion　The velocity of cerebral blood flow is influenced by left ventricular function in the preterm infants；gestational age and birth weight are important factors influencing left ventricular function.