Analysis of vitamin D status among children under 7 years of age in some regions of China / 中华儿科杂志

Objective: To explore current vitamin D status and influential factors of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China. Methods: According to the "province-city-hospital" sampling technical route, a total of 1 531 healthy children under 7 years of age were sampled from 11 provinces, autonomous regions or municipalities in China by the cluster random sampling method from November 2020 to November 2021. The demographic information, family conditions, behavior and living habits and feeding behaviors were collected using unified questionnaire. Serum 25-hydroxyvitamin D(25(OH)D) levels were measured by liquid chromatography-tandem mass spectrometry. Serum 25(OH)D<30 nmol/L was considered deficient and 30-50 nmol/L was considered insufficient. With 25(OH)D≤50 nmol/L as the dependent variable, multivariate Logistic regression was applied to analyze the association between vitamin D deficiency and insufficiency and potential influential factors. Results: The prevalence of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China was 14.0% (215/1 531), 3.8% (25/664) and 21.9% (190/867) in 0-<3 and 3-<7 of age years, respectively. Compared to children aged 0-<3 years, children aged 3-<7 years had a 2.6-fold increased risk of vitamin D deficiency and insufficiency (OR=3.60, 95%CI 1.93-6.72, P<0.001). Frequent sunlight exposure (OR=0.46, 95%CI 0.29-0.73, P=0.001), vitamin D supplementation (sometimes, OR=0.33, 95%CI 0.21-0.51, P<0.001; daily, OR=0.20, 95%CI 0.11-0.36, P<0.001) and infant formula intake(4-7 times per weeks, OR=0.43, 95%CI 0.28-0.68, P<0.001) were protective factors for vitamin D deficiency and insufficiency. Conclusion: Vitamin D deficiency and insufficiency are common among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China, which is affected by age, sunlight exposure, vitamin D supplementation and infant formula intake.

Association between serum trace elements and core symptoms in children with autism spectrum disorder: a national multicenter survey / 中国当代儿科杂志

OBJECTIVE@#To study the association of serum levels of trace elements with core symptoms in children with autism spectrum disorder (ASD).@*METHODS@#From September 2018 to September 2019, an investigation was performed for 1 020 children with ASD and 1 038 healthy children matched for age and sex in the outpatient service of grade A tertiary hospitals and special education institutions in 13 cities of China. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Childhood Autism Rating Scale (CARS) were used to assess the core symptoms of the children with ASD. The inductively coupled plasma mass spectrometry was used to measure serum levels of trace elements magnesium, iron, copper, and zinc.@*RESULTS@#The children with ASD had significantly lower serum levels of magnesium, copper, and zinc than the healthy children (@*CONCLUSIONS@#The serum levels of magnesium and zinc may be associated with core symptoms in children with ASD, which requires further studies. The nutritional status of trace elements should be monitored for children with ASD in clinical practice.

Intelligence structure and clinical features of school-age children with attention deficit hyperactivity disorder and specific learning disorder / 中国当代儿科杂志

OBJECTIVE@#To study the intelligence structure and clinical features of children with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD).@*METHODS@#A retrospective analysis was performed on 88 school-age children with ADHD. According to the presence or absence of SLD, they were divided into two groups: simple ADHD group with 45 children and ADHD+SLD group with 43 children. Intelligence structure and clinical features were compared between the two groups.@*RESULTS@#Compared with the simple ADHD group, the ADHD+SLD group had significantly lower verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full intelligence quotient (FIQ) (P<0.05), significantly lower scores of VIQ factors (including information, similarities, arithmetic, and recitation) (P<0.05), and significantly lower scores of PIQ factors (including picture completion, picture arrangement, block design, and object assembly) (P<0.05). The development of SLD was negatively correlated with FIQ, VIQ, and PIQ. It was also negatively correlated with the scores of intelligence structure factors (including information, similarities, arithmetic, recitation, picture completion, picture arrangement, block design, and object assembly) (P<0.05).@*CONCLUSIONS@#Children with ADHD and SLD have poorer FIQ, VIQ, and PIQ than those with ADHD alone, which mainly manifests as the weak abilities of most intelligence structure factors. It is necessary to pay attention to the management and intervention of SLD in school-age children with ADHD.

Comparison of Electroacupuncture and Body Acupuncture on Gastrocnemius Muscle Tone in Children with Spastic Cerebral Palsy: A Single Blinded, Randomized Controlled Pilot Trial / 中国结合医学杂志

OBJECTIVE@#To compare the immediate effects of electroacupuncture (EA) and body acupuncture (BA) on gastrocnemius muscle tone in children with spastic cerebral palsy (CP).@*METHODS@#Children with spastic CP, age from 24 to 60 months, who all received rehabilitation treatment in the Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University from April 2016 to May 2017 were enrolled in this trial and assigned to EA group and BA group through a random number table. Both EA and BA therapies were performed on acupoints of Zusanli (ST 36), Shangjuxu (ST 37), Sanyinjiao (SP 6), and Xuanzhong (GB 39) for 30 min once. The root mean square (RMS), integrated electromyogram (iEMG) of the gastrocnemius of surface electromyography (sEMG), and Modified Tardieu Scale (MTS) of the two groups were evaluated before and after treatment. All adverse events were accurately recorded.@*RESULTS@#Thirty-six children with spastic CP completed the study (18 cases and 32 legs in the EA group; 18 cases and 31 legs in the BA group). There was no significant difference in RMS, iEMG and MTS between the two groups before treatment (P>0.05). After treatment, compared with before treatment, RMS and iEMG significantly reduced and MTS (R2-R1) significantly increased in both EA and BA groups (P0.05). There was no serious adverse event during this clinical trial.@*CONCLUSION@#Both EA and BA could significantly relieve the gastrocnemius muscle tone in spastic CP, and EA was more effective than BA. (Registration No. ChiCTRONC-15007633).

Effect of parental training based on Early Start Denver Model combined with intensive training on children with autism spectrum disorder and its impact on parenting stress / 中国当代儿科杂志

OBJECTIVE@#To explore the effect of parental training based on the Early Start Denver Model (ESDM) combined with intensive training on the treatment outcome of children with autism spectrum disorder (ASD) and its impact on parenting stress.@*METHODS@#Seventy children aged 2-5 years who were diagnosed with ASD were enrolled in the study. They were divided into an ESDM group and a parental training group by the random number table method (n=35 each). The ESDM group received intensive training based on ESDM. In addition to intensive ESDM-based training, parents of the children in the parental training group received ESDM skills training. Both groups were assessed by Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC) and Parenting Stress Index-Short Form (PSI-SF) before and after the intervention of 3 months.@*RESULTS@#After 3 months of intervention, the total scores of ABC, CARS and ATEC were both significantly decreased in the two groups (P0.05). The change between ABC, CARS and ATEC total scores in the two groups had no significant difference (P>0.05). After 3 months of intervention, the total scores of PSI-SF were both significantly decreased in the two groups (P<0.05). The difficult child sub-scale scores in PSI-SF were significantly decreased in the ESDM group (P<0.05). While three sub-scale scores of parent distress, parent-child dysfunctional interaction and difficult child in PSI-SF were significantly decreased in the parental training group (P<0.05). Before and after intervention of 3 months, no significant difference was found in PSI-SF total scores between the two groups. Compared with the ESDM group, the change between PSI-SF total scores and two sub-scales of PSI-SF (parent distress and difficult child) were significantly bigger in the parental training group (P<0.05).@*CONCLUSIONS@#Both the combination of intensive training and parent training based on ESDM and ESDM intensive training alone can improve the core symptoms of children with ASD aged 2-5 years and relieve the parenting stress, however, the former is more effective in relieving parenting stress.

Advances in respiratory assessment and treatment in children undergoing invasive mechanical ventilation / 中国当代儿科杂志

The widespread use of mechanical ventilation technology has contributed to the successful treatment of many children with respiratory failure. At the same time, forced ventilation and changes in normal respiratory physiology and mechanics may lead to respiratory dysfunction and decreased airway clearance ability. Therefore, how to perform a comprehensive and accurate respiratory function assessment, conduct appropriate respiratory function rehabilitation, perform extubation as soon as possible, and shorten the duration of mechanical ventilation based on the children's own physiological characteristics, is a focus of the research on effective weaning from mechanical ventilation in children with severe conditions. This article reviews the advances in the respiratory function assessment and treatment methods in children undergoing invasive mechanical ventilation.

Clinical effect of vitamin D combined with the Early Start Denver Model in the treatment of autism spectrum disorder in toddlers / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect of vitamin D (VitD) combined with the Early Start Denver Model (ESDM) in the treatment of autism spectrum disorder (ASD) in toddlers.@*METHODS@#A total of 102 toddlers with ASD, aged 1 to 3 years, were enrolled. According to the wishes of their parents, they were divided into conventional rehabilitation, ESDM and ESDM+VitD groups. Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS) were used evaluate behavior problems before treatment and after 3 months of treatment.@*RESULTS@#The conventional rehabilitation group had significant reductions in the total score and the scores on somatic movement and self-care subscales of the ABC scale after 3 months of treatment (P<0.05). After 3 months of treatment, the ESDM group had significant reductions in the total score and the scores on somatic movement, self-care, social interaction and language subscales of the ABC scale (P<0.05), as well as a significant reduction in the total score of the CARS (P<0.05). After 3 months of treatment, the ESDM+VitD group had a significant increase in the level of 25(OH)D and significant reductions in the total score and the scores on self-care, sensation, social interaction and language subscales of the ABC scale (P<0.05), as well as a significant reduction in the total score of the CARS (P<0.05). The ESDM group had a significantly greater reduction in the score on social interaction subscale than the conventional rehabilitation group (P<0.05). The ESDM+VitD group had a significantly greater reduction in the score on social interaction subscale than the other two groups (P<0.05).@*CONCLUSIONS@#ESDM can effectively improve the clinical symptoms of toddlers with ASD, with a significantly better clinical effect in improving social interaction and somatic movement than conventional rehabilitation. ESDM combined with VitD has a significantly better clinical effect in improving social communication skills and may be one of the best strategies for improving the clinical symptoms of toddlers with ASD.

Preliminary application of Early Start Denver Model in children with autism spectrum disorder / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of the Early Start Denver Model (ESDM) in children with autism spectrum disorder (ASD).</p><p><b>METHODS</b>Forty children aged 2-5 years who were diagnosed with ASD from September 2017 to January 2018 were enrolled in the study and were randomly divided into conventional intervention group and ESDM intervention group (n=20 each). Both groups were assessed by the Aberrant Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Clinical Global Impression-Severity (CGI-S) scale before intervention and by the ABC, CARS, CGI-S scale, and Clinical Global Impression-Improvement (CGI-I) scale after 3 months of intervention.</p><p><b>RESULTS</b>After 3 months of intervention, the total scores of ABC and CARS were both significantly decreased in the two groups (P<0.01); the scores on the social withdrawal and hyperactivity subscales of ABC were significantly decreased in the conventional intervention group (P<0.01), and the scores on the mood swings, social withdrawal, hyperactivity, and stereotyped behavior subscales of ABC were significantly decreased in the ESDM intervention group (P<0.01). Compared with the conventional intervention group, the ESDM intervention group had significantly greater changes in total score of ABC, scores on three subscales of ABC (mood swings, social withdrawal, and hyperactivity), and total score of CARS after intervention (P<0.05). After 3 months of intervention, the CGI-I scoring system showed that the disease improvement was significantly better in the ESDM intervention group than in the conventional intervention group (P<0.05).</p><p><b>CONCLUSIONS</b>Both conventional intervention and ESDM intervention can improve the social withdrawal and hyperactivity in children with ASD aged 2 to 5 years, but ESDM is more effective in improving the aberrant behavior of children with ASD.</p>

A review on the management of tic disorders in children: psychoeducation and behavioral intervention / 中国当代儿科杂志

Tic disorders (TD) are a group of neurodevelopmental disorders that are characterized by motor and/or vocal tics in children and adolescents. The etiology and pathogenesis of TD remain unclear, and it is believed to be caused by a combination of genetic, biological, psychological, and environmental factors. The major treatment for TD includes psychoeducation, behavioral intervention, and drug treatment. To further explore the management of TD, this article reviews the research advances in psychoeducation and behavioral intervention for patients with TD.

A review on the role of γ-aminobutyric acid signaling pathway in autism spectrum disorder / 中国当代儿科杂志

The etiology and pathogenesis of autism spectrum disorder (ASD) are not yet clear. Studies have shown that there are many neurotransmitter abnormalities in children with ASD, mainly involving in glutamate, γ-aminobutyric acid (GABA), dopamine, 5-HT and oxytocin. The imbalance of excitatory glutamatergic neurotransmitters and inhibitory GABAergic neurotransmitters is closely related to the pathogenesis of ASD. Both animal model studies and clinical studies on ASD suggest that GABA signaling pathway may play an important role in the pathogenesis of ASD. This article reviews the research on the association between GABA signaling pathway and the pathogenesis of ASD to further explore the pathogenesis of ASD and provide theoretical basis for the treatment of ASD.

Serum levels of 25-hydroxyvitamin D in children with tic disorders / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine serum 25-hydroxyvitamin D levels in children with tic disorders (TD) and to explore the relationship between vitamin D level and TD.</p><p><b>METHODS</b>One hundred and thirty-two children who were diagnosed with TD between November 2016 and May 2017 were enrolled as the TD group, including 8 cases of Tourette syndrome, 32 cases of chronic TD, and 92 cases of transient TD. One hundred and forty-four healthy children served as the control group. Peripheral venous blood samples were collected from each child. Serum levels of 25-hydroxyvitamin D were measured using HPLC-MS/MS. The categories of vitamin D status based on serum 25-hydroxyvitamin D level included: normal (>30 ng/mL), insufficiency (10-30 ng/mL) and deficiency (<10 ng/mL).</p><p><b>RESULTS</b>Mean serum level of 25-hydroxyvitamin D in the TD group was significantly lower than that in the control group (P<0.01). The rate of vitamin D insufficiency or deficiency in the TD group was significantly higher than in the control group (P<0.01). Mean serum level of 25-hydroxyvitamin D in the transient tic group was higher than in the TS group (P<0.05).</p><p><b>CONCLUSIONS</b>Vitamin D insufficiency or deficiency might be associated with the development of TD, and the level of serum 25-hydroxyvitamin D might be related to the classification of TD.</p>

Application of movement recognition technology in assessing spontaneous general movements in preterm infants / 中国当代儿科杂志

Preterm birth is a major factor which induces neurological and motor impairments, particularly cerebral palsy, in high-risk infants. Early identification of potential neurodevelopmental impairments provides the opportunity to improve neurodevelopmental outcomes in preterm infants through early rehabilitation interventions. Clinically, the general movement assessment is a pivotal tool to predict neurodevelopmental outcomes, especially motor developmental outcomes, in high-risk infants. Movement recognition can continuously capture relevant limb movements and perform objective and quantitative assessment using computerized approaches. Various methods of recording and analyzing spontaneous general movements for infants at a risk of cerebral palsy have been extensively explored. This article summarizes the general movement assessment method and reviews the translational research on using movement recognition technology for the assessment of spontaneous general movements of preterm infants.

Research advances in the role of vitamin D in autism spectrum disorders / 中国当代儿科杂志

The etiology and pathogenic mechanism of autism spectrum disorders (ASD) are still unclear. The relationship between vitamin D and ASD has drawn attention in recent years due to common vitamin D deficiency in children with ASD. This article reviews the peripheral blood levels of vitamin D in children with ASD, the possible reasons for hypovitamin D and its possible roles in the etiology of ASD and the efficacy of vitamin D supplementation in ASD.

Research advances in the management of autism spectrum disorders in children / 中国当代儿科杂志

Autism spectrum disorders (ASD) are a group of developmental dysfuntion of nervous system characterized by social interaction and communication disorders, restricted interests and repetitive stereotyped behaviors. The incidence of ASD has been increasing through the world. Some studies have shown that early reasonable individualized comprehensive intervention can obviously improve the prognosis of children with ASD. The etiology of ASD is unclear now, and behavioral and developmental intervention is the main therapy for ASD. The reasonable application of some drugs can improve the efficacy of the behavioral intervention for concomitant symptoms in ASD. With the in-depth study of the pathogenesis of ASD, bumetanide, oxytocin, vitamin D and hyperbaric oxygen therapy have been found to be promising for the improvement of core symptoms of ASD. This article reviews the research advances in the behavioral and developmental intervention and drug therapy for ASD.

Serum levels of 25-hydroxyvitamin D in children with autism spectrum disorders / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine serum 25-hydroxyvitamin D levels in children with autism spectrum disorders (ASD) and to explore the relationship between vitamin D level and ASD.</p><p><b>METHODS</b>Serum levels of 25-hydroxyvitamin D levels were determined by the HPLC-MS/MS method in 117 children with newly diagnosed ASD and 109 healthy controls. Vitamin D status were classified into normal (>30 ng/mL), insufficiency (10-30ng/mL) and deficiency (<10 ng/mL) according to 25-hydroxyvitamin D levels.</p><p><b>RESULTS</b>Serum level of 25-hydroxyvitamin D (19±9 ng/mL)in children with ASD was significantly lower than that in healthy controls (36±13 ng/mL; P<0.01). The rate of vitamin D insufficiency plus deficiency in the ASD group was significantly higher than in the control group (89.7% vs 52.3%; P<0.01).</p><p><b>CONCLUSIONS</b>Vitamin D insufficiency or deficiency is common in children with ASD and might be as one of the environmental or genetic factors for ASD.</p>

Research advances in immunological dysfunction in children with autism spectrum disorders / 中国当代儿科杂志

Autism spectrum disorders (ASD) are a group of neuro-developmental disorders in early childhood which are defined by social difficulties, communication deficits and repetitive or restrictive interests and behaviours. The etiology of ASD remains poorly understood. Much research has shown that children with ASD suffer from immunological dysfunction. This article reviews the current research progress on immunological dysfunction in children with ASD, including abnormalities in immune cells, antibodies, complements, cytokines, major histocompatibility complex and their potential association with ASD, and explores the impacts of maternal immunological activation on the immune dysfunction of children with ASD.

Relationship between vitamin D and autism spectrum disorder / 中国当代儿科杂志

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder, with multiple genetic and environmental risk factors. The interplay between genetic and environmental factors has become the subject of intensified research in the last several years. Vitamin D deficiency has recently been proposed as a possible environmental risk factor for ASD. Vitamin D has a unique role in brain homeostasis, embryogenesis and neurodevelopment, immunological modulation (including the brain's immune system), antioxidation, antiapoptosis, neural differentiation and gene regulation. Children with ASD had significantly lower serum levels of 25-hydroxy vitamin D than healthy children.Therefore vitamin D deficiency during pregnancy and early childhood may be an environmental trigger for ASD.

Effect of infra-low-frequency transcranial magnetic stimulation on motor function in children with spastic cerebral palsy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the therapeutic effects of infra-low-frequency transcranial magnetic stimulation in children with spastic cerebral palsy.</p><p><b>METHODS</b>Seventy-five children with spastic cerebral palsy were randomly divided into two groups: control (n=33) and treatment groups (n=42). The treatment group accepted infra-low-frequency transcranial magnetic stimulation besides conventional comprehensive rehabilitation therapy. The control group only accepted conventional comprehensive rehabilitation therapy. Motor functions were assessed by gross motor function measure (GMFM) and fine motor function measure (FMFM) at one and three months after treatment.</p><p><b>RESULTS</b>Improvement in the ability to sit in the treatment was better than in the control group at one month after treatment (P<0.05). Improvement in the ability to sit, crawl and kneel, total score of GMFM, and improvement of joint active ability of limbs, grasping ability and operating ability in the treatment group were better than the control group at three months after treatment (P<0.05).</p><p><b>CONCLUSIONS</b>Infra-low-frequency transcranial magnetic stimulation can effectively improve motor function in children with spastic cerebral palsy.</p>

The assessment of general movements: a reliable tool for predicting the neurodevelopment of preterm infants in an very early phase / 中国当代儿科杂志

Cerebral palsy (CP) is a permanent disorder in the development of movement and posture in the developing infant brain and is one of the major disabilities that result from extremely preterm birth. Early identification of possible neurodevelopmental injury offers the opportunity to deliver intervention at a very early age and thus prevent severe disability. The assessment of general movements (GMs), has emerged as a reliable and valid predictor of severe neurologic deficits in infants. This method is based on a visual Gestalt perception of the quality of GMs in the preterm and term periods, and postterm up to 5 months. The quality of "fidgety movements" is the most valuable marker for predicting neurologic outcomes.