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06 December 2015, Volume 30 Issue 12 Previous Issue    Next Issue

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Dual burden facing Chinese children: Malnutrition and overweight or obesity LI Ting-yu 2015, 30(12): 881.  DOI: 10.7504/ek2015120601 Abstract ( )   Children whose nutritional condition has been improved still face dual burden including malnutrition and overweight/ obesity in China. In early life，the nutritional status not only affects growth and development of children，but also has relation to disease and quality of life in adult period. Focusing on and investing in children nutrition，it is beneficial for not only individual development，but also public health and social improvement.

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Quality and quantity of proteins and the health of children DING Ye，WANG Zhi-xu 2015, 30(12): 884.  DOI: 10.7504/ek2015120602 Abstract ( )   The physiological characteristics of children determine their own particularity of their needs for the quality and quantity of proteins. Proteins not only play an important role in the development of children’s growth and development，cognitive function and immune function，but also have important effects on the long-term health of children.In this paper，the dietary protein reference intakes，amino acid patterns，dietary amino acid reference intakes，sources of high quality protein，and harm of deficiency and excess of protein in children were discussed in detail.

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Failure to thrive in children CHENG Qian 2015, 30(12): 889.  DOI: 10.7504/ek2015120603 Abstract ( )   Failure to thrive（FTT） is a condition commonly seen by primary care pediatrician. Many children with FTT are not identified unless careful attention is paid to plotting growth parameters at routine checkups. It is a signal of undernutrition.But the etiology of FTT is seldom the results of a single causative medical，genetic or socioeconomic factor. There is increasing recognition that in many children the cause is multifactorial and includes biologic，psychosocial，and environmental contributors. The prolonged malnutrition can negatively affect a child’s future growth and cognitive development and behavioral problem and learning difficulties are identified in a significant portion of FTT population. A thorough history and physical examination is the best guide to establishing the etiology of the FTT and directing further evaluation and management.The approach to nutritional rehabilitation in FTT requires individualization. Prompt multidisciplinary interventions are important for preventing malnutrition and developmental sequelae.

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Appropriate iron nutrition and the development of children’s brain and behavior in early life time SHAO Jie 2015, 30(12): 892.  DOI: 10.7504/ek2015120604 Abstract ( )   Iron is an essential mineral to human body. It is necessary for the synthesis of hemoglobin and myoglobin as well as for the function of many vital iron-dependent enzymes. Many studies have reported that the changes in brain structure，neurotransmitter，neurometabolism with altered gene and protein profiles related to early iron deficiency may result in changes in sensory/motor，cognitive/ language，and social-emotional development. Iron status in early life time should be determined by various factors during prenatal，perinatal and postnatal periods. The physiological needs for iron vary to meet the requirements for growth and development of fetus and infants. Updated research findings imply an iron-dependent time window existing for developing brain，emphasizing the importance of optimal supplementary of iron during different periods in early life time.

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Selection of specific functional formula for infants HU Yan 2015, 30(12): 897.  DOI: 10.7504/ek2015120605 Abstract ( )   Breast milk is the ideal food for infants，while for those who can not be breastfed，the commercial standard formula is the first choice. However，formula with special nutrients are necessary for infants with special needs，due to special physiology or diseases. It is helpful for pediatricans to know the characteristic of those specific functional formula in order to do clinical feeding and nutritional guidance.

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Effects of vitamin D on childhood extraskeletal systems YI Ming-ji 2015, 30(12): 900.  DOI: 10.7504/ek2015120606 Abstract ( )   Vitamin D may play an important role in extraskeletal system beyond its traditional effect on the skeleton. Emerging evidence supports an association between 25-hydroxyvitamin D3 （25［OH］D3） levels and brain development，immune function，obesity，metabolic syndrome，insulin resistance，infection，allergy，cancers，and cardiovascular diseases in pediatric and adolescent populations. Mary studies have influenced the definition of vitamin D deficiency and what level of vitamin D should be regarded as optimal. Given the important role of vitamin D in childhood health，more time spent in outdoor activity and vitamin D supplementation may be necessary for optimal health in infants，children，and adolescents.

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Interaction of drug therapy with nutrition HONG Li 2015, 30(12): 905.  DOI: 10.7504/ek2015120607 Abstract ( )   The nutritional status of patients and the constituents of their diet can significantly impact the pharmacokinetic and pharmacodynamic properties of drugs. The drugs can also interfere the digestion and absorption of various nutrients and nutrition status of patient’s through the drug’s metabolism and actions. When developing a therapeutic plan for the pediatric patient，it is important that practitioners consider the interactions that occur among nutritional status，age，disease state，and drug action.

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Rational nutrition for small-for-gestational-age infants WU Meng-meng，YANG Fan 2015, 30(12): 913.  DOI: 10.7504/ek2015120608 Abstract ( )   As a special group of neonates，small-for-gestational-age infants have a higher rate of morbidity and mortality during perinatal period. Even those who have survived also have increased risk of growth and developmental disorders in later life.Recent studies have showed a strong association between being born small for gestational age and increased risk of diabetes mellitus，metabolic syndrome and heart diseases in adulthood. Hence，rational nutritional support is needed for improving the survival rate，promoting growth and reducing the long-term risk of intellectual impairment and metabolic risks.

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Folic acid and children’s growth and development ZHANG Ting 2015, 30(12): 916.  DOI: 10.7504/ek2015120609 Abstract ( )   Folic acid is a kind of very important water-soluble B vitamins，catalyzed by dihydrofolate reductase to make the active tetrahydrofolate in vivo. The main role of the tetrahydrofolate is the coenzyme of one-carbon unit transferase，which mediates the transfer of one-carbon units in a number of important metabolic reactions，and is involved in the synthesis of purines and pyrimidine bases，the transformation of certain amino acids as well as in the methylation of many substances such as DNA，proteins，and so on. Folic acid plays an important role in cell division and tissue growth. In order to provide more based evidence for the prevention and treatment of children with developmental disorders，the effect and molecular mechanism of folic acid on children’s growth and development is discussed from the viewpoint of nutriology and epigenetics in the paper.

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Changes of blood pressure and soluble E-selectin in serum in children with coarctation of aorta and their clinical significances ZENG Jie-min，FENG Hao-ran，HUANG Ping，LU Gen，ZHANG Li，CHEN Xin-xin，CUI Hu-jun，YUAN Jia，GONG Fang，HUANG Xi-jing 2015, 30(12): 921.  DOI: 10.7504/ek2015120610 Abstract ( )   Objective    To monitor blood pressure and level of soluble E-selectin in serum in children before operation and in the short-and mid-term follow-up after operation，and to explore their clinical significances. Methods    Twenty-three children who underwent successful surgery for aortic coarctation between January 2010 and October 2010 in Guangzhou Women and Children’s Medical Center were enrolled in the study. There were 6 patients with isolated CoA，and 14 patients with CoA associated with other heart malformations （CoA group）. Meanwhile 20 patients with isolated ventricular septal defect （VSD） were selected as VSD group. Another 20 healthy children with normal echocardiographic findings was observed. Blood pressure and soluble E-selectin in serum were measured in all subjects at 1 day prior to operation （or blank treatment） and at 1 month，6 months and 1 year of follow-up， respectively. There was no statistical difference in age，gender，BMI or triglyceride in serum among three groups. Results     Hypertension at rest was not found in all children in different periods. Except that right lower limb blood pressure in CoA group before operation was lower than that in the healthy group，right upper limb blood pressure and right lower limb blood pressure in CoA group and VSD group were similar those of the healthy group in the same period. In the same period，soluble E-selectin in serum in CoA group was significantly elevated compared to healthy group（P＜0.01），but VSD group was similar to healthy group（P＞0.05）. There was no statistical change in soluble E-selectin in serum at 1 year of follow-up in CoA group compared to that before operation，and so it was similar with VSD group and healthy group （P＞0.05）. Soluble E-selectin level in serum in isolated CoA was similar to that in CoA associated with other heart malformation （P＞0.05）. Conclusion    Endothelial damage may be persistent， which is probably associated with the long-term cardiovascular complications after operation for CoA， but endothelial damage in CoA associated with other heart malformation is not worse than isolated CoA. A long period of follow-up is necessary.

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Association between red cell distribution width and heart failure in children with dilated cardiomyopathy complicated with heart failure SUN Dong-ming，XIA Kun，LIU Ling，WANG Rui-geng，YIN Wei 2015, 30(12): 925.  DOI: 10.7504/ek2015120611 Abstract ( )   Objective    To observe the changes of red cell distribution width （RDW） in children with heart failure secondary to dilated cardiomyopathy（DCM），and to explore the correlations between RDW and the common parameters of cardiac function. Methods    Totally 68 children with heart failure secondary to DCM were enrolled. According to the modified Ross scoring system，the children were divided into 3 subgroups： mild，moderate and severe heart failure subgroups. Fifty healthy children were selected as control group. RDW levels were compared among the groups. The correlation analysis was performed between RDW and plasma N-terminal brain natriuretic peptide （NT-proBNP）as well as left ventricular ejection fraction（LVEF）. Results    RDW levels in children with heart failure secondary to DCM were significantly higher than the control group （P＜0.01）.With increasing heart failure grade，NT-proBNP levels were elevated gradually and LVEF were decreased gradually （both P＜0.01）；RDW levels had no significant difference among the heart failure groups（P＞0.05）. RDM was not correlated with NT-proBNP or LVEF（r＝0.144，r＝-0.158，P＞0.05）. Conclusion    In children with DCM，RDW can be used as a new diagnostic marker of heart failure，but it can not reflect the severity of heart failure.

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Comparison of dezocine and ketamine for anesthesia in children with cyanotic complex congenital heart disease on cardiac catheterization ZHANG Yan-li，ZHANG Dong-ya 2015, 30(12): 928.  DOI: 10.7504/ek2015120612 Abstract ( )   Objective    To investigate the effect and safety of single dose of dezocine for anesthesia in children with cyanotic complex congenital heart disease on cardiac catheterization，and compare it with ketamine. Methods    Sixty-four children with cyanotic complex congenital heart disease undergoing cardiac catheterization（under 6 years old） between January 2014 and April 2015 in the First Hospital of Tsinghua University were randomly divided into intravenous dezocine（0.2 mg/kg） group （group D，n = 32） and intravenous ketamine（2.0 mg/kg） group （group L，n = 32） as soon as arriving at OR. All patients were inserted the laryngeal mask（LMA）after the same intravenous induction and the initial end-tidal concentration of sevoflurane was 2.0% to 2.5%. The time to lose consciousness（T1），mask assisted ventilation time（T2），anesthesia recovery time（T3），and such adverse reactions as airway spasm，respiratory depression，dysphoria，pain，nausea and vomiting were recorded. Results    T1 of group D was significantly longer than that of group L（P＜0.05）. T3 of group D was significantly shorter than that of group L（P＜0.05）. The cases whose drop of SPO2 during induction and after extubation was greater than 20% and who needed suction more than twice in group D were fewer than in group L（P＜0.05）. Conclusion    Single dose dezocine of 0.2 mg/kg can be safely used in children with cyanotic complex congenital heart disease on cardiac catheterization，providing satisfactory sedation and analgesia，and the incidence of airway adverse reaction  is lower than that of ketamine.

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Long-term follow-up of permanent transvenous pacemaker for atrioventricular block in children WU Qiang，AN Ya-ping，WANG Yong-mei，ZHOU Song，BU Jie，YU Shan 2015, 30(12): 931.  DOI: 10.7504/ek2015120613 Abstract ( )   Objective    To retrospectively analyze the implantation and follow-up of permanent transvenous pacemaker and treatment for complications in children. Methods    Eleven children［aged 5～14 years old，mean age（12.0±2.8） years old］ underwent implantation of permanent transvenous pacemaker for atrioventricular block between May 1992 and December 2013 in Department of Cardiology，Guizhou provincial People’s Hospital and were followed up for 1～22 years （mean 6.1 years）.Results    VVI/VVIR were implanted in 7 cases，DDD/DDDR in 4 cases；the endocardial leads were implanted via cephalic vein in only one case and via subclavian vein in other cases.The atrial leads were placed in the right auricle or interatrial septum；the right ventricular leads were positioned in the right ventricular apex in 4 cases and the right ventricular septum in 7 cases.There were no significant differences in pacing thresholds，impedance or R/P-wave amplitude（P＞0.05）.The ventricular lead fracture was found at the 5th year after implantation of VVI in one case，and then a new lead and pacemaker was reimplanted.Left ventricular dysfunction associated with ventricular pacing was found in one case at the 3rd year after implantation of DDDR，and upgrading to the cardiac resynchronization therapy elevated his ejection fraction. Conclusion    Permanent transvenous pacemaker implantation and the follow-up must be in accordance with the physiological and pathological characteristics of children.Implantation of permanent transvenous pacemaker in children is easy，safe and efficient.

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Changes of the left ventricle voltage，QT interval and the QT interval dispersion after transcatheter closure for simple ventricular septal defect WEI Li，LU Yong-yi，QIAO Li-na，HUA Yi-min，WANG Yi-bin，WANG Xiao，YAN Song，WANG Feng-yang，LIU Ju-fang 2015, 30(12): 934.  DOI: 10.7504/ek2015120614 Abstract ( )   Objective    To observe the changes of left ventricular voltage，QT interval and QT interval dispersion before and after transcatheter closure for simple ventricular septal defect. Methods     The ECG RV5 （V5 lead r waves），SV1 （V1-lead s-wave），（RV5+SV1） voltage，QT interval and corrected QT interval，QT dispersion （QTd） and heart rate corrected QT dispersion （QTcd） were analyzed in 90 VSD children without arhythmia before transcatheter closure or 1，3，5 days and 1 month after it. All the patients were admitted between January 2014 and January 2015 in Department of Pediatrics West China Second University Hospital of Sichuan University. Results    Left ventricular voltage after transcatheter closure for ventricular septal defect （RV5+SV1） decreased，being with statistical significance on the third day after operation when compared with the preoperative one （P＜0.05）；there were significant differences in QTc before and on the fifth day after operation （P＜0.05）. QTd and QTcd one month after surgery，compared with preoperative and postoperative day，had statistically significant  difference （P ＜ 0.05）. Precordial leads RV5，SV1 voltage and QT interval in the preoperative，postoperative 1，3，5 days，1 month，had no statistically significant difference（P＞0.05）. Conclusion    Cardiac arrhythmia doesn’t occur in simple ventricular septal defect in children after transcatheter closure，and left ventricular voltage will be gradually reduced；corrected QT interval，QTd and QTcd will be shortened.

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Clinical characteristics of neonatal respiratory distress syndrome in term and nearly full-term infants and premature infants LI Xin，JIANG Chun-ming 2015, 30(12): 937.  DOI: 10.7504/ek2015120615 Abstract ( )   Objective    To investigate the different clinical characteristics of neonatal respiratory distress syndrome（NRDS） in infants of various gestational ages and to provide a new basis for clinical treatment. Methods    A total of 80 cases of NRDS infants in the First Affiliated Hospital of Harbin Medical University from March 2012 to March 2014 were divided into two groups according to gestational age: early preterm infants group（< 34 weeks，42 cases, M group），and nearly full-term group（≥ 34 weeks，38 cases, N group）.Lung surface active substances (PS) replacement and auxiliary ventilation were used, and the general situation，risk factors，treatment condition，prognosis and complications in each group were analyzed. Results    The morbidity of NRDS in the male was higher than in the female.  The onset time of M group was earlier than N group. In M group it was due to the fact that glucocorticoid was not used and premature birth . In N group it was due to caesarean section. The higher incidence of NRDS in M group was due to premature rupture of membranes and placental abnormality. The lower incidence of NRDS in M group was due to pregnancy hypertension, diabetes, intrauterine distress and abnormal umbilical cord . The PS use time in M group was less than N group. The secondary utilization rate in M group was higher than the N group. The distress degree of M group was higher, and assisted ventilation time and complications were more, compared to N group. Conclusion     There are different clinical characteristics of NRDS in infants of various gestational ages. Correct guidance should be given during pregnancy and childbirth and appropriate treatment should be chosen.

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One case of Langerhans cell histiocytosis in neonates and literature review XU Jia-ju，DING Yan-jie，ZHANG Xiao-hui 2015, 30(12): 941.  DOI: 10.7504/ek2015120616 Abstract ( )

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Research progress in the role of epigenetics in the pathogenesis of allergic diseases XING Meng-juan，HU Yan 2015, 30(12): 944.  DOI: 10.7504/ek2015120617 Abstract ( )

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Progress in the treatment for primary nocturnal enuresis in children ZHOU Wei-ran，SHEN Ying，LIU Xiao-mei 2015, 30(12): 948.  DOI: 10.7504/ek2015120618 Abstract ( )

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One case of eosinophilic cystitis and the literature review ZHANG Xin，ZHAO Kai-shu，ZHAO Bing-gang，et al 2015, 30(12): 952.  DOI: 10.7504/ek2015120619 Abstract ( )

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One case of Kawasaki disease complicated by leukemoid reaction DU Yan-qiang，JIANG Hong 2015, 30(12): 955.  DOI: 10.7504/ek2015120620 Abstract ( )

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One case of Blau syndrome in children LIU Li，ZHAO Qian-qian，LI Chong-wei，et al 2015, 30(12): 957.  DOI: 10.7504/ek2015120621 Abstract ( )

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One case of  neuroblastoma complicated by acute myeloid leukemia in children LIU Ying，HE Jia，CHENG Shi-kai，et al 2015, 30(12): 959.  DOI: 10.7504/ek2015120622 Abstract ( )