Reference values for inspiratory muscle related indexes of preschool children in Nanjing / 中国儿童保健杂志

【Objective】 To generate reference values for inspiratory muscle of preschool children in Nanjing, so as to provide a reference index for evaluating children′s lung function and exercise performance. 【Methods】 A total of 236 preschool children were selected from the main urban area of Nanjing by stratified cluster sampling.The inspiratory muscles were evaluated by breath link respiratory function evaluation system to obtain the maximum inspiratory pressure (MIP) and inspiratory peak flow rate.Pearson analysis was used to determine the correlation of MIP and inspiratory peak flow rate with gender, age, height and weight.Multiple linear stepwise regression analysis was used to obtain the formula of MIP and inspiratory peak flow rate. 【Results】 Differences in MIP and peak inspiratory flow rate were not significant between boys and girls (P>0.05), but were statistically significant among different age groups and showed an increasing trend with age (F=13.660, 33.581, P<0.001).MIP and peak inspiratory flow rate were positively correlated with children′s age, height and weight (P<0.001).The regression model, proved to be statistically significant(F=12.913、22.398, P<0.08), indicated that height was the best predictor of MIP and age was the best predictor of inspiratory peak flow rate. 【Conclusions】 This study is the first study on the predicted value of inspiratory muscle in preschool children in China.The predicted value formula can provide a reference for clinical inspiratory muscle evaluation.

Establishment of early learning opportunities in nurturing care / 中国儿童保健杂志

Both UNICEF and WHO mention that nurturing care is the most direct and effective approach to promoting early childhood development. Nurturing care emphasizes the importance of caregivers creating a suitable nurturing environment for the early development of children to promote their health and potential. The provision of early learning opportunities is an important aspect of creating a high-quality nurturing environment. This review focuses on the importance of establishing early learning opportunities, the methods of establishing early learning environments, implementing supportive strategies, and employing relevant evaluation methods, in order to provide reference and support for the establishment of early learning opportunities in nurturing care.

Relationship between responsive caregiving for infants and young children and parenting confidence among caregivers / 中国儿童保健杂志

【Objective】 To investigate the current state of infant responsive caregiving and to analyze its correlation with caregiver parenting confidence, in order to provide theoretical basis for improving the level of responsive care for infants and young children. 【Methods】 A cross-sectional survey was conducted from October 2022 to February 2023 to select 1 028 infants and young children under 3 years old who underwent health examinations in the Department of Child Healthcare. Participants completed a general data questionnaire, the Karitane Parenting Confidence Scale, and the Infant Responsive Caregiving Scale. Hierarchical multiple linear regression analysis was used to investigate the related influencing factors of infant responsive care and to analyze the relationship between caregiver parenting confidence and responsive caregiving. 【Results】 The level of responsive caregiving was found to be associated with various factors such as infant age(χ2=21.196), mode of pregnancy(Z=-2.072), history of pregnancy protection during pregnancy(Z=-4.713), history of pregnancy complications (Z=-4.504), gestational week at birth(χ2=41.358), small for term infants(Z=-3.497), neonatal intracranial hemorrhage(Z=-5.425), neonatal hyperbilirubinemia(Z=-2.184), maternal education level(χ2=9.419), family income(χ2=11.211) as well as type of family (χ2=15.360)(P < 0.05). Additionally, a significant correlation was observed between parenting confidence and responsive caregiving(r=0.421,P<0.001). Hierarchical multiple linear regression analysis revealed that caregiver parenting confidence had a significant positive effect on the level of responsive caregiving (B=0.623, P<0.05), even after controlling for the effect of demographic factors. 【Conclusion】 The level of infant responsive caregiving is influenced by caregiver parenting confidence, and increasing caregiver parenting confidence can effectively improve the quality of responsive caregiving for infants and young children.

Development and test of reliability and validity of the Visual Cognitive Ability Assessment Scale for Preschool Children / 中国儿童保健杂志

【Objective】 To develop the Visual Cognitive Ability Assessment Scale for Preschool Children and to evaluate its reliability and validity, in order to provide reference for clinical evaluation of visual cognitive ability of preschool children. 【Methods】 1) From November 2021 to February 2022, construct the dimension framework was constructed and the pool of scale items was compiled according to the theory. 2) In March to June 2022, items were screened preliminarily through group discussion and Delphi method. In August 2022, the entries was revised by a pre-survey in a small sample (n=50). 3) Parents of children aged 4 - 7 from 8 kindergartens in 4 main urban areas of Nanjing were investigated by stratified cluster random sampling method in September to December 2022. The valid sample of the first survey (n=344) was analyzed to conduct item analysis and re-test reliability analysis, the valid sample of the second survey (n=695) was tested for reliability and confirmatory factor analysis, then the scale was finally compiled and evaluated. 【Results】 1) The scale contained 19 items in 4 dimensions:visual memory, discerning vision, spatial vision and visual integration. All items passed the project analysis test. 2) The Cronbach′s α coefficient of each dimension ranged from 0.604 to 0.886, and the Cronbach′s α coefficient of the whole scale was 0.917. During the two surveys, the scores of each item were correlated, and the average retest reliability coefficient was 0.601 (P< 0.05). 3) Content validity index (S-CVI) at scale level was 0.91, and item level content validity index (I-CVI) ranged from 0.8 to 1.0. After several rounds of model modification, the confirmatory factor model fit well. 【Conclusion】 The reliability and validity of the Visual Cognitive Ability Assessment Scale for Preschool Children are acceptable and meet the requirements of the scale, which provides a practical tool for clinical screening of visual and cognitive disorders.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Survey on the stunting of children under seven years of age in nine cities of China / 中华儿科杂志

Objective@#To survey the children under 7 years of age in nine cities of China for a better understanding of the current situation of childhood stunting.@*Methods@#According to a stratified cluster sampling design, a cross-sectional survey on children under 7 years of age was carried out in 9 cities (Beijing, Harbin and Xi′an in northern China; Shanghai, Nanjing and Wuhan in central China; and Guangzhou, Fuzhou and Kunming in southern China) from June to November in 2016. A total of 110 499 children were recruited. Height of children was evaluated using the growth standards for Chinese children (2009 edition) .Children with height less than the 3rd percentile of the growth standards were considered as stunting, and children with height between the 3rd and 10th percentiles of the growth standards were considered as relatively short stature. Chi-square test was used for comparison between data of boys and girls, urban and suburban, as well as among different ages and regions.@*Results@#Totally 113 084 children under 7 years of age should be investigated and actually 110 499 children were investigated, with a rate of 97.7%. The prevalence of stunting was 1.9% (2 141/110 499) among all the children. The prevalence of stunting in urban children (1.6%, 904/55 524) was lower than that in suburban children (2.3%, 1 237/54 975, χ2=56.246, P<0.01). The gender difference in stunting prevalence was not statistically significant (1.9% (1 121/57 921) in boys and 1.9% (1 020/52 578) in girls, χ2=0.003, P=0.965). The prevalence of stunting decreased with age for children younger than 3 years, from 1.8% (312/17 080) in 0-<1 year of age group to 1.2% (168/13 740) in 2-<3 years of age group, but increased to 2.2% (240/11 073) at 6-<7 years group. Comparison among different regions showed that the stunting prevalence in southern region was higher than those in the central and northern regions (0.9% (193/20 374) in northern urban, 0.8% (154/18 486) in central urban, and 3.3% (557/16 664) in southern urban children), showing a statistical significance (χ2=437.736, P<0.01); 1.1% (241/21 924) in northern suburban, 1.4% (227/16 775) in central suburban and 4.7% (769/16 276) in southern suburban children, showing a statistical significance (χ2=646.533, P<0.01). In urban areas, the difference between the central and northern regions showed no statistical significance (χ2=1.429, P=0.232) and the stunting prevalence of central Chinese children was slightly higher than that of northern Chinese children in suburban areas (χ2=5.130, P=0.024). Among the nine cities, the stunting prevalence of Guangzhou (6.1%, 613/10 019) was higher than those of other cities (χ2=1 559.64, P<0.01). Among the stunting children, 78.4% (1 679/2 141) were classified as borderline or mild and only 7.2% (154/2 141) were classified as severe. The prevalence of relatively short stature was 5.2% (5 721/110 499).@*Conclusions@#The prevalence of stunting among children under 7 years of age in nine cities of China is low and most of the stunting children were classified as mild; the prevalence of stunting in suburban children is higher than that in urban children; the gender difference show no statistical significance; and the prevalence of stunting in southern Chinese children is higher than those in central and northern Chinese children.

Investigation on rapid automatic naming and rapid alternating stimulus tests on 1 048 school－aged children in Nanjing / 中华实用儿科临床杂志

Objective To develop norms for the rapid automatic naming and rapid alternating stimulus tests (RAN/RAS tests)on school children.Methods A multi－stage sampling procedure was used to select primary school students randomly from 8 schools in Nanjing,aged from 7 to 12 years old.The RAN/RAS tests included 6 classes of stimuli:objects,colors,numbers,simplified Chinese characters,numbers and simplified Chinese characters mixture,numbers and simplified Chinese characters and colors mixture. Results (1)A total of 1 048 students were randomly selected to participate in the study in 6 groups,with sex ratio of 1.001.04.(2)The scores of the boys and girls did not differ sig-nificantly by any of the methods(objects,colors,numbers,simplified Chinese characters,numbers and simplified Chinese characters mixture,numbers and simplified Chinese characters and colors mixture)(all P＞0.05).(3)On any of the measures in all groups,the scores decreased as the age increasing(P＜0.001).(4)Compared with the three－item scores (objects,colors,numbers)between Chinese and English,there were significant statistical differences among all age groups (all P＜0.001).(5)Time reliability correlation coefficient ranged from 0.84 to 0.92,and retest reliability correlation coefficient ranged from 0.98 to 0.99.The validity test showed that the correlation coefficient was statistically significant (P＜0.05).Conclusions The scores of RAN/RAS tests norms have nice reliability and validity and are in line with the law of development.The norms derived in this study are recommended as the norm RAN/RAS scores for Chinese children.

Responsive feeding in preterm infants and toddlers / 中华实用儿科临床杂志

The formation of dietary behavior in infants and toddlers depends on healthy foods and the society -dietary behavior factors during the feeding process. Among them,one important society - dietary behavior factor is " reci-procity between child and caregiver(mainly,the parents)",which is the responsive feeding principle. In recent years, the research has found that in the early life,responsive feeding has positive effects on children′s nutrition,growth,cogni-tion,and social development. Responsive feeding should be accepted by more families,child care experts and nutrition experts. Now,the strategy that how to promote and practice responsive feeding in preterm infants and toddlers is re-viewed.

Prevalence of children's eating problems among 1 to 7 years old and its correlation with their physical development / 中华实用儿科临床杂志

Objective To investigate the eating problems of outpatient infants,preschool age children(1 to 7 years old) enrolled in the Department of Child Health Care,Nanjing Maternal and Child Health Hospital Affiliated to Nanjing Medical University,and to analyze its correlation with children's physical development,so as to establish strategies for preventing abnormal eating habit in children.Methods A toll of 2458 children met the criteria,and caregivers (mothers) completed the Children's Eating Behavior Questionnaires (CEBQ) in Department of Child Health Care,Nanjing Maternal and Child Health Hospital Affiliated to Nanjing Medical University were selected and the children's sociodemographic data and the morbidity of children eating problems were investigated.The correlation between children's body mass index(BMI) with children's eating problems was determined by using Chi-square test and multiple regression analysis.Results About 66.2％ (1627/2458 cases) had normal weight,and 10.8％ (257/2458 cases) and 8.5 ％ (210/2458 cases) were overweight (BMI ＞ P85-P95) or obese (BMI ≥ P95),respectively.The prevalence of eating behavior problems was detected during 25-36 months.For 1-to-7-year-old children,the highest detection rate of eating problems was inattention and eating at non-permanent locations,occupying 64.7％ (1590/2458 cases)and 50.5％ (1241/2458 cases),respectively;the prevalence rate of preferring to junk food was the lowest,accounting for 19.3％ (474/2458 cases).The children's eating problems had a high association with the children's BMI.Among them,children with eating problems,such as difficultly in accepting the varying food stuff[at the age of 12 month,odds ratio(OR)=11.50,95％ confidence interval(CI):1.84-72.16] and eating at non-permanent locations(at 25-36month,OR=1.77,95 ％ CI:1.11-2.83),were prone to be wasting away;children with eating problems,such as preferring to junk food (at 12 month,OR=5.08,95 ％ CI:1.43-18.00;13-18 month,OR=2.17,95 ％ CI:1.06-4.44),rarely eating vegetables or fruit (19-24 month,OR=4.06,95％CI:1.46-11.31) and inattention (12 month,OR=3.85,95 ％ CI:1.52-9.79),were associated with overweight or obesity (all P＜0.01).Conclusions There was a high prevalence of eating problems in children between 12-84 month(1-7 years old) in Nanjing.Improper children's eating behaviors can increase the risks of wasting away or children's overweight/obesity.