New screening approach to detecting congenital syphilis in China: a retrospective cohort study.

BACKGROUND: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

[Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study].

OBJECTIVE: To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. METHODS: A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. RESULTS: There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P<0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P<0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P<0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P<0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P<0.05) and fine motor (OR=2.679, P<0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P<0.05), fine motor (OR=3.710, P<0.05), and social ability (OR=3.515, P<0.05). CONCLUSIONS: The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.

The Effect of Different Treatment Regimens and Multiple Risk Factors on Adverse Pregnancy Outcomes among Syphilis-Seropositive Women in Guangzhou: A Retrospective Cohort Study.

BACKGROUND: To eliminate mother-to-child transmission of syphilis, the Chinese government recommends a treatment regimen that slightly differs from the World Health Organization- (WHO-) recommended treatment. However, little is known about their difference in efficacy. This study is aimed at comparing the effect of China-recommended and WHO-recommend treatment regimens on adverse pregnancy outcomes (APOs) and at examining associated risk factors of APOs among syphilis-seropositive women. METHODS: Using the syphilis registry data, we retrospectively collected data from 4488 syphilis-infected pregnant women in Guangzhou during 2011-2018. Multivariate analyses were used to investigate the association between treatment regimens and APOs (ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth or low birth weight, newborn smaller than gestational age, congenital syphilis, and infant death) and the association between risk factors and APOs. RESULTS: Of 3474 participants, 27.3% had at least one APO. Compared to those receiving WHO-recommended treatment, women who received China-recommended treatment were less likely to have APOs (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.38-0.57), whereas those who received no treatment had 1.6 times higher odds of experiencing APOs. One common risk factor across different APOs was high levels of log2-transformed toluidine red unheated serum test (TRUST) titers before treatment (OR 1.14, 95% CI 1.10-1.19). China-recommended treatment was effective in reducing APOs for those with TRUST ≥ 1 : 8 (OR 0.21, 95% CI 0.14-0.29) and those with TRUST < 1 : 8 (OR 0.62, 95% CI 0.50-0.77). CONCLUSIONS: Syphilis-seropositive women receiving China-recommended treatment had lower odds of APOs, especially when TRUST titers before treatment were high. Findings can be used to guide health professionals to reduce APOs among syphilis-infected mothers and promote nationwide use of China-recommended treatment.

Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes: A Prospective Cohort Study in Guangzhou, China.

OBJECTIVE: This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children. METHODS: This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART (cART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age (SGA)] and adverse early growth outcome (including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age). RESULTS: Adverse pregnancy outcomes occurred in 202 (35.1%) of all enrolled HIV-infected women, and 121 (31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with cART or mono/dual ART (P < 0.05). However, women treated with cART had a higher rate of SGA, compared to untreated women (P < 0.05). No differences in early infant growth were observed among the different treatment regimens. CONCLUSION: Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival..

Effectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity.

BACKGROUND AND OBJECTIVES: Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness. METHODS: This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese. RESULTS: By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of -0.31 (95% CI -0.47 to -0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status. CONCLUSIONS: Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.

[Epidemiological study on the trend of accidental deaths among children under five in Guangzhou, 2001 - 2010].

OBJECTIVE: To study the trend of accidental death among children under 5 years of age. METHODS: A survey on accidental death among children was performed in Guangzhou to compare the data from the national monitoring program on the deaths under five in the same period during 2001 - 2010. Data on mortality and causes of injures were adjusted by missing reports. RESULTS: Mortality rates on injuries were decreasing annually from 2001 to 2010. Comparing with 2001, the magnitude of the drop in mortality among the 0, 1 - 4 and under 5 year groups were 72.02%, 77.17% and 74.66% respectively, with statistically significant differences (P = 0.000). During the 10 years of observation, data showed a dropping trend (P = 0.000) of the mortalities on drowning, traffic accident, suffocation and falling, especially on drowning and suffocation. The main causes of death were suffocation in the 0 year group, drowning in the 1-2-year group, traffic accident and poisoning in the 3-year group, traffic accident and falling in the 4-year group. The accidental deaths happened in 'C area' which including Huadu, Conghua, Zengcheng, Panyu and Nansha, with the total proportion of accidental death in Guangzhou as 75.69%. CONCLUSION: The mortality of accidental deaths among children under 5 years of age in Guangzhou had been decreasing during 2001 - 2010, mainly owing to the practice of intervention programs on drowning and suffocation, suggesting the necessity of integrating the health education programs on accidental injury with the healthcare management system in children in the country, focusing on the suburban and county levels where economy was relatively undeveloped or with more floating population.

[Study on the status of unintentional injuries in children under age 7 in Guangzhou].

OBJECTIVE: To understand the prevalence and distribution of unintentional injuries in children under age 7 in Guangzhou. METHODS: Data was descriptively analyzed from the Guangzhou Unintentional Injuries Surveillance System among 470 770 children under age 7 living scatter or collectively. RESULTS: The incidence rates of unintentional injuries among children in Guangzhou was 1.48%, among which the incidence rates were: living scatter as 1.11% living collectively as 1.66%, living in urban areas as 1.36% in rural as 2.52%. In order, the proportion of main causes of children's unintentional injuries were as follows: falls (70.54%), animal injuries (8.48%), burn and scald (5.75%), blunt force injuries (3.92%), and road traffic injuries (RTIs) (3.48%). The main body parts being injured were head and face (60.00%), wrist and hand (15.48%), knee and leg (11.70%), elbow and forearm (4.54%), shoulder and arm (2.99%). The degrees of children's unintentional injuries were as follows: mild impairment (85.35%), moderate impairment (9.12%), and severe impairment (0.57%). Places that the patients went were as follows: hospital outpatient department or emergency room (49.66%), inpatient department or ICU (2.06%), home and kindergarten (43.34%). CONCLUSION: The overall incidence rate of children's unintentional injuries under age 7 in Guangzhou was 1.48%, with main causes as fall, animal injuries, burn and scald, blunt force injuries, and RTIs. There were considerable differences of characteristics and distributions on age and areas among the patients.