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06 November 2017, Volume 32 Issue 11 Previous Issue    Next Issue

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Expert advice on the assessment methods for behavioral neurological assessment in NICU Rehabilitation Group of Pediatric Branch of Chinese Medical Association 2017, 32(11): 801-806.  DOI: 10.19538/j.ek2017110601 Abstract ( )

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Paying attention to developmental behavior and psychological evaluation of premature and critically ill newborns XIAO Nong*，CHEN Yan-ni 2017, 32(11): 807-812.  DOI: 10.19538/j.ek2017110602 Abstract ( )   With the development of medical technology，survival rates have greatly improved in recent years in premature and critically ill newborns. However，these infants are at risk of long-term adverse neurobehavioral outcomes，including cognitive，motor and psychological problems and behavioral impairments. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities，such as school difficulties and behavioural problems，become apparent and persist into adolescence. At present，the focus for early screening and interventions are to develop strategies to reduce long-term morbidity，especially to prevent brain injury and abnormal brain development. Due to the late start and weak foundation，the related researches in China is still in the early stages of development. To find abnormality is the first step to intervene，so it is particularly important to screen early. Thus，this review discusses key components of early evaluation，including commencing the evaluation as early as possible，preferably in the neonatal intensive care unit，and promoting developmental skills overtime in an appropriate enriched environment.

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Clinical application of the test of infant motor performance HE Li，CHEN Yan-ni 2017, 32(11): 813-816.  DOI: 10.19538/j.ek2017110603 Abstract ( )   As the number of premature infant is increasing，motor delay identification early is very important for prognosis，and the experts also pay attention to this. In this article，we introduce TIMP in detail. The greatest advantage of TIMP is that it’s suitable for the premature infants aged from gestational age 34 weeks to 4 months. We also compare the TIMP with other assessment methods，so as to provide more useful data to evaluate the premature infants.

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Application of general movements assessment for brain development in preterm and young infants YIN Huan-huan，YANG Hong 2017, 32(11): 816-820.  DOI: 10.19538/j.ek2017110604 Abstract ( )   Pediatric professionals are facing two challenges when following up the preterm and young infants. One of the challenges is to identify those infants at high risk of neurodevelopmental disorders as early as possible and provide intervention for them. Another one is to identify the infants with normal developmental outcomes to avoid excessive diagnosis and intervention. In resent years，the general movements assessment has been widely used at home and abroad to predict the developmental outcomes of  high risk infants with its high sensitivity and specificity，especially for cerebral palsy. It is suitable for application in the basic maternal and child health care institutions and the pediatric clinics at various levels in China. This paper describes the results of clinical studies of general movements assessment at home and abroad as well as its clinical experience in China.

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Application of neonatal behavioral neurological assessment and observation to the assessement of brain development and early intervention in preterm and young infants BAO Xiu-lan*，LIU Wei-min 2017, 32(11): 820-822.  DOI: 10.19538/j.ek2017110605 Abstract ( )   Neonatal behavioral neurological assessment（NBNA） can early predict the neurodevelopmental outcome of all high-risk infants（including preterm infants with corrected gestational age）. At the same time，in the process of evaluation，NBNA stresses that the medical staff should share observation and interpretation of these behaviors with parents and give the necessary guidance，so that parents can understand their infant behavior and unique personality，this process is called neonatal behavioral neurological observation（NBNO）. NBNO can be used of early intervention for preterm infants and high-risk children from birth to 3 months.

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Assessment of brain development in preterm and little infants by neonatal behavior observation LI Hui，ZHANG Hui-ping，ZHU Zhong-liang 2017, 32(11): 822-825.  DOI: 10.19538/j.ek2017110606 Abstract ( )   Brain development in preterm and little infants is immature. They are particularly vulnerable to various environmental stress factors，resulting in neurobehavioral abnormalities. However，due to the brain plasticity of preterm and little infants，early detection and intervention can reduce or eliminate neurobehavioral abnormalities. Neonatal behavior observation（NBO） is an observation - intervention tool，which has a unique advantage in the early assessment and intervention of neurobehavioral abnormalities in preterm and little infants. NBO is cost-effective，practical，efficient，easily implemented，flexible and satisfactory. NBO has been widely used in many affiliated hospitals and preventive care organizations，and has achieved satisfactory results in clinical work.

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Imaging assessment of brain development of preterm and young infants YANG Jian，WANG Miao-miao，LIU Heng，et al 2017, 32(11): 825-830.  DOI: 10.19538/j.ek2017110607 Abstract ( )   Accurate evaluation of the brain development of neonates and infants is of great significance in clinical diagnosis and early intervention. This paper introduces the main progress of advanced MRI imaging in assessing brain development，and further discusses the MRI characteristics and existing misunderstandings of common injury diseases. Finally，some problems to be solved and challenges in this field are pointed out.

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Optimizing  early  development  by  targeted  activities HUANG Zhen，WANG Cui 2017, 32(11): 830-833.  DOI: 10.19538/j.ek2017110608 Abstract ( )   A large number of studies have demonstrated that the infants in development have great “use-dependent plasticity”. It is driven by targeted activities to develop the best control strategy accompanied with the adaptive changes from brain to muscle in the structure and function. Therefore，the design of targeted activities according to the individual situation is considered to be the most effective strategy to optimize early development in the high risk infants with brain damage.

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Evaluation of the brain injury and brain development in preterm infants LIU Li 2017, 32(11): 833-837.  DOI: 10.19538/j.ek2017110609 Abstract ( )   The brain structure and function of premature infant is underdevelopment, it is easy to be injured and develop abnormally. Correctly evaluating the state of brain in different stages can help early detection of brain injury, early intervention and reduction of disability rate. In this paper, the evaluation methods of brain development and brain injury of premature infants are summarized.

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Value of serum intestinal fatty acid binding protein and serum amyloid A in the diagnosis of severe necrotizing enterocolitis in the newborn WANG Jun-ping*，LIU Ying，YU Dong-ling，et al 2017, 32(11): 838-841.  DOI: 10.19538/j.ek2017110610 Abstract ( )   Objective　To investigate the value of serum intestinal fatty acid binding protein（I-FABP） and serum amyloid A（SAA） in the diagnosis of necrotizing enterocolitis（NEC）in the newborn. Methods　Fifty-six preterm infants with a confirmed diagnosis of NEC from October 2014 to October 2015 were recruited as case group（stageⅠ：26 cases；stageⅡ/Ⅲ：30 cases）. Thirty children diagnosed with non-digestive diseases in the same period were recruited as the control group. Serum levels of I-FABP and SAA were determined by enzyme-linked immunosorbent assay.The diagnostic value of I-FABP and SAA for severe NEC was assessed using the receiver operating characteristic（ROC）curve. Results　StageⅡ/Ⅲ cases in the case group had significantly higher serum I-FABP levels and SAA levels than the control group and StageⅠcases（P＜0.05）. The area under the ROC curve for serum I-FABP was 0.80（95%CI：0.69-0.92），with the optimal cut-off point of 21.8 μg/L. Under this cut-off point，the sensitivity and specificity were 70.0%and 81.0%，respectively. The area under the ROC curve for SAA was 0.76（95%CI：0.63-0.89），with the optimal cut-off point of 1657.8 μg/L. Under this cut-off point，the sensitivity and specificity were 67.0% and 80.0%，respectively. Conclusion　In newborn infants with NEC，serum I-FABP and SAA l can be used as biomarkers for the diagnosis of severe NEC.

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StageⅠpediatric testicular germ cell tumors：An analysis of 41 cases YAO Qiang-hua*，TANG Jing-yan，PAN Ci，et al 2017, 32(11): 842-845.  DOI: 10.19538/j.ek2017110611 Abstract ( )   Objective　To analyze the clinical characteristics and outcomes of children with stage I testicular germ cell tumors（TGCT），and to discuss the treatment strategy for this disease after radical inguinal orchiectomy. Methods　Clinical data of 41 patients with stage I TGCT at Shanghai Children’s Medical Center，Shanghai Jiaotong University School of Medicine between June 2003 to December 2013 were retrospectively analyzed. Their clinical characteristics，therapy and outcomes were analyzed. Results　（1）The median age at diagnosis was 18（3 to 43）months old. Among them，38 children（92.7%） were younger than 3 years old.The pathological subtype included 35 cases of yolk sac（85.4%），4 immature teratoma（9.7%） and 2 mixed germ cell tumors（4.9%）.（2）Serum AFP levels were elevated in 38 patients（92.7%）. AFP reduced to normal in 27 cases（71.1%）4 weeks after surgery and in 35 cases（92.1%） after 2 courses of chemotherapy respectively，but 2 cases of them relapsed with AFP increasing again.（3）Forty out of 41 patients underwent surgery and 3～4 courses of chemotherapy with cyclophosvnamide，vincristine and dactinomycin D（VAC）. One patient received surgery alone. The median follow-up period was 64 months. One of the 32 patients who received adjuvant chemotherapy relapsed and then lost follow-up without treatment. The recurrence rate was 3.1% and the 5-year overall survival was 100%. No complication related to chemotherapy occurred during the follow-up. The only one patient treated with surgery alone relapsed at 5 months and achieved complete response after salvage treatment. Conclusion　（1）The relationship between the decrease of serum AFP and the prognosis is uncertain and needs to be further studied.（2）Short course chemotherapy with mild toxic side effects can reduce the recurrence rate effectively， so it can be used as a necessary treatment for patients with high risk of relapse，and it can also be used as a selective treatment for patients with low risk of recurrence.

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Treatment for recurrent/refractory neuroblastoma with venous arsenic trioxide combined with chemotherapy  in 7 cases QI Kai，LI Yang，GUO Hai-xia，et al 2017, 32(11): 846-850.  DOI: 10.19538/j.ek2017110612 Abstract ( )   Objective　To summarize the efficacy and safety of arsenic trioxide combined with chemotherapy for children with recurrent/refractory neuroblastoma. Methods　Retrospective analysis was made in seven cases of neuroblastoma treated with traditional chemotherapy combined with venous arsenic trioxide after diagnosis with poor prognosis or the condition deteriorated. Results　Among the seven patients treated with chemotherapy combined with venous arsenic trioxide for 3 to 7 courses，4 were effective and 3 were ineffective. Patient 3 was treated with arsenic trioxide combined with following regimen after tumor was not resected totally，and patient 5，6 and 7 were given arsenic trioxide combined with preoperative chemotherapy. Patient 3 and patient 5 achieved complete remission after combination chemotherapy，and patient 6 and patient 7 showed decreased tumor volume and tumor marker. Patient 1，2 and 4 were given arsenic trioxide after failure of conventional chemotherapy. Metastasis in patient 1 disappeared at first，but the disease relapsed after 11 months. The tumor responded poorly and increased in size and number in patient 2 and patient 4. Patient 1 the use of arsenic trioxide was stopped in patient 1 because of prolonged QT interval（0.51s），who returned normal after symptomatic treatment. Five patients are still alive and they have lived for 3.5 y，3.0 y，1.2 y，1.0 y and 0.7 y，respectively. Conclusion　Venous arsenic trioxide combined with chemotherapy can be a choice of treatment for recurrent/refractory neuroblastoma，whose effect and safety requires further investigation.

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Alendronate sodium phosphate for children with spontaneous fracture caused by glucocorticoid：A report of 3 cases and literature review FU Hui，YANG Yong-chang，WU Yu-bin 2017, 32(11): 851-855.  DOI: 10.19538/j.ek2017110613 Abstract ( )   Objective　To investigate the efficacy and safety of Alendronate for the treatment of glucocorticoid-induced spontaneous fractures in children. Methods　Make an analysis of 3 children with spontaneous fractures cured after treatment with Alendronate in the Pediatric Department of Renal Rheumatism and Immunology of Shengjing Hospital affiliated to China Medical University. All of them undertook a prospective，self-compared study lasting 1 year. The 3 children，including 1 male and 2 female，were diagnosed respectively as mixed connective tissue disease（MTCD），refractory nephrotic syndrome（NS） and systemic lupus erythematosus （SLE）. The onset of spontaneous fractures in these 3 children was at the 6th， 4th and 6th month after GC treatment，the mean being （5.33±1.15）months. The onset age was 13，12 and 10 years old，respectively，the mean being （11.66±1.52）years. After diagnosis of fracture，all the subjects were treated with GC reduction without affecting the primary disease and took Caltrate D600 2 pill qd，then Alendronate was given， 70mg or 46.6mg per week orally， and they were interviewed every 3 months. Measure the BMD（bone mineral density） of spine，β-Crosslaps， osteocalcin， and bone imaging examination before the treatment and after the treatment at 3m，6m，9m and 1 year. Also，observe that whether or not the subjects had adverse reactions，such as nausea， vomiting or stomachache during the treatment in order to evaluate the therapeutic effect， safety and tolerance of oral Alendronte. Results　The clinical symptoms of the 3 cases disappeared quickly， and no adverse reactions were found after taking Alendronate. The relevant laboratory indicators were gradually improved as administration time extended， and no fractures occurred a second time. Conclusion　Alendronate in the treatment of children with fracture induced by GC can significantly increase the BMD，degrade the bone  transformational index，and has few side effects. It has satisfactory efficacy，safety and tolerance.

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Clinical outcome of seventy-three cases of pediatric acute T lymphoblastic leukemia and analysis of prognosis factors ZUO Ying-xi，WAN Yuan-yuan，JIA Yue-ping，et al 2017, 32(11): 856-860.  DOI: 10.19538/j.ek2017110614 Abstract ( )   Objective　To analyze the clinical characteristics and prognosis of pediatric acute T lymphoblastic leukemia. Methods　Clinical characteristics of 73 children with acute T lymphoblastic leukemia and T-cell lymphoblastic lymphoma involving the bone marrow treated in Peking University People’s Hospital from March 2003 to March 2014 were retrospectively analysed， and the prognosis factors were analyzed. Results　Of the 73 patients， 25 children relapsed and 3 died from complications during chemotherapy or transplantation. Their 5-year CRF was （37.89±6.02）% and 5-year EFS was （58.74±6.01）%. The 5-year EFS decreased significantly when the initial onset age was more than 13. The 5-year CRF increased significantly when the initial onset size of spleen was bigger than 9 cm under the costal margin or the IgH rearrangement was positive. The 5-year CRF decreased significantly and 5-year EFS increased significantly when average peak methotrexate （MTX） blood concentration was more than 40 μmol/L during high-dose MTX chemotherapy. Conclusion　The treatment result of children with T-ALL is unsatisfactory. Initial onset age ≥13 and huge spleen indicate poor prognosis. Positive IgH rearrangement may be associated with high risk of recurrence. T-ALL patients can benefit from high-dose MTX therapy.

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Clinical study of intermediate-long term therapy with desmopressin acetate for primary monosymptomatic nocturnal enuresis in children CHU Mei，CAO Li，CHEN Chao-ying，et al 2017, 32(11): 861-865.  DOI: 10.19538/j.ek2017110615 Abstract ( )   Objective　To explore the effect of intermediate-long term therapy with desmopressin acetate（DA）in treating children with enuresis. Methods　Totally 320 PMNE children treated with DA aged 5-15 years from November 2013 to March 2016 were included. The cases who stopped wetting bed for 2 months within 3-6 months of treatment were observed.According to convenience sampling method，the observed patients were divided into gradually withdraw（GW） group and immediate withdraw（DW） group. GW group use taper therapy and DA was gradually withdrawn within 9 months. In DW group DA was withdrawn immediately. The relapse cases were recorded 1 month after discontinuation of DA in the two groups. Compare the relapse and severity of enuresis. Results　Response of DA：full response（FR） in 224 cases（70.1%），partial response（PR） in 73 cases（23.0%） and no response（NR） in 23 cases（6.9%）. Totally 133 cases（continuously 2 months of dry bed） were up to withdrawal criteria in 3-6 months. Totally 26 cases were lost follow-up and 107 cases were observed，63 cases were included in GW group and 36 cases had DA withdrawal within 9 months；44 cases were included  in DW group. The relapse cases were 37 cases（84.1%） in DW group，and GW group，8 cases （22.2%）. The relapse rate was significantly different between the two groups. No obvious adverse events were observed in 27 cases with DA treatment for 1 year. Moderate- severe enuresis cases of the recurrence ones and the cases treated for 1 year were significantly higher than those of the non-recurrent cases. Conclusion　DA is a safe and effective way to treat PMNE. Gradually withdrawing the DA in intermediate-long term treatment can obviously decrease the recurrence of PMNE. The recurrence rate is higher in moderate- severe enuresis than that of mild cases.

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Research progress in clinical problems related to necrotizing enterocolitis in the newborn CAO Fang-fang，XUE Xin-dong 2017, 32(11): 866-870.  DOI: 10.19538/j.ek2017110616 Abstract ( )

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Epidemiological features of congenital heart disease in Chinese children LI Shuo-lin，GU Ruo-yi，HUANG Guo-ying 2017, 32(11): 871-875.  DOI: 10.19538/j.ek2017110617 Abstract ( )

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Kawasaki disease shock syndrome misdiagnosed as septic shock：A report of 1 case CHEN Li-qiong 2017, 32(11): 876-877.  DOI: 10.19538/j.ek2017110618 Abstract ( )

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Shwachman-Diamond syndrome：A report of 1 case LIU Jun-li，SHI Bao-hai，YAO Guo，et al 2017, 32(11): 878-880.  DOI: 10.19538/j.ek2017110619 Abstract ( )