Zhengyan Zhao

Melamine-contaminated milk products induced urinary tract calculi in children

BackgroundMelamine is an industrial chemical used primarily as plastics stabilizer and fire retardant. On September 11, 2008, melamine-contaminated milk products were reported to be responsible for urinary tract calculi in infants and children in China. This study aimed to investigate the prevalence, lesions, risk factors, clinical features, and management of children fed with the melamine-contaminated milk products.MethodsA total of 15 577 infants and children fed with the milk products were screened at our hospital. Ultrasonography was performed in all the infants and children. For those found with urinary tract calculion ultrasonography, urnalysis was done. Among them, 846 with detailed data screened from September 17 to 25 were enrolled for further analysis in this study. They were divided into calculus group (326 children) and non-calculus group (520 children) according to the results of ultrasonography. They included 429 boys and 417 girls, aged from 1 month to 5 years (median, 18 months). Their clinical and laboratory data, ultrasonograms, and treatment results were analyzed.ResultsOf the 15 577 children screened, 562 (3.61%) had urinary tract calculi. The rate was closely related to the melamine concentration in patients fed with formula. In 846 children with detailed data enrolled in this analysis, weight and head circumference Z scores in the calculus group were lower than those in the non-calculus group (P=0.048, P=0.046). Long duration of formula feeding, high melamine contained formula, and minimal water intake were the risk factors for calculi (P<0.05, respectively). Of 326 children with calculi, 281 had small calculiless than 0.5 cm in diameter, 227 had multiple calculi, and 34 had urinary tract distention. Moreover, diffuse renal lesions, renal failure and ascites were noted in 4, 3 and 2 patients, respectively. After 1-month treatment with sodium bicarbonate and Chinese traditional medicine, calculi disappeared in 49 of 54 outpatients. In 41 inpatients, 5 had calculi removed operatively and 36 had calculi minimized.ConclusionsMelamine-contaminated milk products induced urinary tract calculi, which have a good response to conservative therapy. Long-term follow-up of infants and children fed with melamine-contaminated milk products is required, and food safety should be supervised increasingly for the health of children.

High prevalence of vitamin D deficiency among children aged 1 month to 16 years in Hangzhou, China

BackgroundRecent studies have suggested that vitamin D deficiency in children is widespread. But the vitamin D status of Chinese children is seldom investigated. The objective of the present study was to survey the serum levels of 25-hydroxyvitamin D [25(OH)D] in more than 6,000 children aged 1 month to 16 years in Hangzhou (latitude: 30°N), the capital of Zhejiang Province, southeast China.MethodsThe children aged 1 month to 16 years who came to the child health care department of our hospital, the childrens hospital affiliated to Zhejiang university school of medicine, for health examination were taken blood for 25(OH) D measurement. Serum 25(OH) D levels were determined by direct enzyme-linked immunosorbent assay and categorized as < 25, < 50, and < 75 nmol/L.ResultsA total of 6,008 children aged 1 month to 16 years participated in this cross-sectional study. All the subjects were divided into subgroups according to their age: 0-1y, 2-5y, 6-11y and 12-16y representing infancy, preschool, school age and adolescence stages respectively. The highest mean level of serum 25(OH)D was found in the 0-1y stage (99 nmol/L) and the lowest one was found in 12-16y stage (52 nmol/L). Accordingly, the prevalence of serum 25(OH)D levels of < 75 nmol/L and < 50 nmol/L were at the lowest among infants (33.6% and 5.4% respectively) and rose to the highest among adolescents (89.6% and 46.4% respectively). The mean levels of serum 25(OH)D and the prevalence of vitamin D deficiency changed according to seasons. In winter and spring, more than 50% of school age children and adolescents had a 25(OH)D level at < 50 nmol/L. If the threshold is changed to < 75 nmol/L, all of the adolescents (100%) had low 25(OH)D levels in winter and 93.7% school age children as well.ConclusionsThe prevalence of vitamin D deficiency and insufficiency among children in Hangzhou Zhejiang province is high, especially among children aged 6-16 years. We suggest that the recommendation for vitamin D supplementation in Chinese children should be extended to adolescence.

The association analysis of RELN and GRM8 genes with autistic spectrum disorder in Chinese Han population.

The region on chromosome 7q stands out as the region of suggestive linkage to aetiology of autism with the greatest concordance in many independent genome‐wide scans. RELN and GRM8, the two genes selected in this study, are located within this region. The protein products of both genes are considered to play a pivotal role in the development of the central nervous system. In addition, biochemical and neuroanatomical data indicated that RELN and GRM8 genes are likely involved in the pathogenesis of autistic disorder. Therefore, both RELN and GRM8 genes are considered to be not only the positional but also the functional candidate genes to autism for association research. In this study, we genotyped 12 single nucleotide polymorphisms (SNPs) located within the RELN and GRM8 genes in 213 children with autistic spectrum disorder (ASD) and 160 controls. A significant genetic association between SNP2 (located in intron 59 of RELN) and ASD was observed, and the log‐additive model was accepted as the best inheritance model fitting this data (OR: 0.72, 95% CI: 0.54–0.97, P = 0.03). Haplotype‐specific association analysis revealed that the result was consistent with the individual SNP study; the combination of SNP1/SNP2/SNP3/SNP4 which are in strong linkage disequilibrium (LD) (D′ > 0.75) showed significant association with ASD (P = 0.027). Neither the single SNP nor the haplotype analysis showed significant association between ASD and the markers of GRM8 gene. Hence, our study suggested the possible involvement of RELN gene in the susceptibility to ASD. Future replications are warranted before definitive conclusion can be drawn.

Neonatal screening for congenital hypothyroidism and phenylketonuria in China

BackgroundNeonatal screening is helpful to prevent serious disabitily and sufferings caused by congenital or inherited disease. This study was to review the status of neonatal screening for congenital hypothyroidism (CH) and phenylketonuria (PKU) in China.MethodsWe analyzed data of neonatal screening for CH and PKU in the past two decades which were obtained from the national network of neonatal screening centers collected by the National Center for Clinical Laboratory.ResultsOf 18.8 million newborns screened from 1985 to 2007, 9198 were identified with CH, giving a prevalence of 1/2047. In 19.0 million newborns screened in the same period, 1638 had PKU, with a prevalence of 1/11 572. An increasing number of neonates have been subjected to neonatal screening in China annually during this period. Data from Zhejiang Neonatal Screening Center showed that the recall rate of neonates suspected with CH and PKU was 95.52% in 2007. Confirmatory tests were performed and treatments were initiated in most of the neonates with CH and PKU within a month after birth.ConclusionsMore governmental support at different levels is needed to make neonatal screening more efficient. The screening should be improved with a satisfactory control system including shorter time of report and a higher recall rate.

Prevalence of obesity and overweight among Chinese children with attention deficit hyperactivity disorder: a survey in Zhejiang Province, China.

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is often comorbid with psychiatric and developmental disorders. This study aimed to investigate the prevalence of obesity and overweight among Chinese children with ADHD, and to explore which subtypes of the disorder may specifically be associated with obesity/overweight.MethodsChildren meeting the DSM-IV criteria for ADHD were enrolled in the study. Weight, weight z-score, height, height z-score, BMI, and BMI z-score were used to evaluate growth status. Obesity and overweight were determined using the National Growth Reference for Chinese Children and Adolescents. Relations between the prevalence of obesity/overweight and different ADHD subtypes and pubertal development were analyzed.ResultsA total of 158 children with ADHD (mean age: 9.2 years) were recruited for the study. The prevalences of obesity, overweight, and combined obesity/overweight were 12.0%, 17.1%, and 29.1%, respectively, which were significantly higher than in the general Chinese population (2.1%, 4.5%, and 6.6%, respectively). Multivariable analysis showed that the children with the combined subtype of ADHD and the onset of puberty were at a higher risk of becoming obese or overweight.ConclusionsThe prevalence of obesity in Chinese children with ADHD is higher than that of the general population. Children with the ADHD combined subtype who were at the onset of puberty were more likely to be overweight or obese.

No Relationship between Maternal Iron Status and Postpartum Depression in Two Samples in China

Maternal iron status is thought to be related to postpartum depressive symptoms. The purpose of the present study was to evaluate the relationship between pre- and postnatal maternal iron status and depressive symptoms in pilot (n = 137) and confirmatory (n = 567) samples of Chinese women. Iron status was evaluated at mid- and late pregnancy and 3 days postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depression 24–48 hours after delivery and 6 weeks later. In the pilot sample, correlations between early- and late-pregnancy maternal Hb and EPDS scores at 6 weeks were r = 0.07 and −0.01, respectively (nonsignificant). In the confirmatory sample, the correlations between maternal iron measures (Hb, MCV, ZPP, ferritin, sTfR, and sTfR Index) in mid- or late pregnancy or 3 days postpartum and EPDS scores shortly after delivery or at 6 weeks were also low (r values < 0.10). EPDS scores in anemic and nonanemic mothers did not differ, regardless of sample or timing of maternal iron status assessment. In addition, women with or without possible PPD were similar in iron status in both samples. Thus, there was no relationship between maternal iron status and postpartum depression in these samples.

Charting the Developmental Trajectories of Attention and Executive Function in Chinese School-Aged Children

Attention is a complex domain that has reawakened research interest in recent years. There are relatively few studies that have examined age-related changes across different attention subcomponents, such as selection, maintenance, and control, using large samples covering a wide age range. The present study assessed performance in 466 participants in order to identify the ages at which mature performance was reached across differing attention subcomponents. Furthermore, we investigated whether the nature of the attentional demands or task difficulty predicted the age at which stable levels of performance were reached. The results supported the former rather than the latter alternative.

Impact of Fetal-Neonatal Iron Deficiency on Recognition Memory at 2 Months of Age

OBJECTIVE To assess the effects of fetal-neonatal iron deficiency on recognition memory in early infancy. Perinatal iron deficiency delays or disrupts hippocampal development in animal models and thus may impair related neural functions in human infants, such as recognition memory. STUDY DESIGN Event-related potentials were used in an auditory recognition memory task to compare 2-month-old Chinese infants with iron sufficiency or deficiency at birth. Fetal-neonatal iron deficiency was defined 2 ways: high zinc protoporphyrin/heme ratio (ZPP/H > 118 μmol/mol) or low serum ferritin (<75 μg/L) in cord blood. Late slow wave was used to measure infant recognition of mothers voice. RESULTS Event related potentials patterns differed significantly for fetal-neonatal iron deficiency as defined by high cord ZPP/H but not low ferritin. Comparing 35 infants with iron deficiency (ZPP/H > 118 μmol/mol) to 92 with lower ZPP/H (iron-sufficient), only infants with iron sufficiency showed larger late slow wave amplitude for strangers voice than mothers voice in frontal-central and parietal-occipital locations, indicating the recognition of mothers voice. CONCLUSIONS Infants with iron sufficiency showed electrophysiological evidence of recognizing their mothers voice, whereas infants with fetal-neonatal iron deficiency did not. Their poorer auditory recognition memory at 2 months of age is consistent with effects of fetal-neonatal iron deficiency on the developing hippocampus.

Screening for inborn errors of metabolism in high-risk children: a 3-year pilot study in Zhejiang Province, China

BackgroundTandem mass spectrometry (MS/MS) has been available in China for 8 years. This technique makes it possible to screen for a wide range of previously unscreened inborn errors of metabolism (IEM) using a single test. This 3-year pilot study investigated the screening, diagnosis, treatment and outcomes of IEM in symptomatic infants and children.MethodsAll children encountered in the Newborn Screening Center of Zhejiang Province during a 3-year period with symptoms suspicious for IEM were screened for metabolic diseases. Dried blood spots were collected and analyzed by tandem mass spectrometry. The diagnoses were further confirmed by clinical symptoms and biochemical analysis. Neonatal intrahepatic cholestasis caused by citrin deficiency, ornithine transcarbamylase deficiency and primary carnitine deficiency were confirmed by DNA analysis.ResultsA total of 11,060 symptomatic patients (6,720 boys, 4,340 girls) with a median age of 28.8 months (range: 0.04-168.2 months) were screened. Among these, 62 were diagnosed with IEM, with a detection rate of 0.56%. Thirty-five were males and 27 females and the median age was 3.55 months (range 0.07-143.9 months). Of the 62 patients, 27 (43.5%) had aminoacidemias, 26 (41.9%) had organic acidemias and nine (14.5%) had fatty acid oxidation disorders.ConclusionsBecause most symptomatic patients are diagnosed at an older age, mental retardation and motor delay are difficult to reverse. Additionally, poor medication compliance reduces the efficacy of treatment. More extensive newborn screening is thus imperative for ensuring early diagnosis and enhancing the treatment efficacy of IEM.

Sex and gestational age effects on auditory brainstem responses in preterm and term infants

BACKGROUND Some studies find delayed development of the auditory brainstem in preterm infants, but others do not. AIM To compare auditory brainstem responses (ABRs) in healthy preterm and term infants depending on sex and gestational age (GA). METHODS Participants were 111 preterm (27-36weeks GA) and 92 term (37-41weeks GA) infants. ABR tests were conducted at 6weeks (corrected age if preterm). RESULTS There were no overall differences between term and preterm groups in ABRs. However, males showed longer latencies for waves III, V, and I-III, III-V, and I-V intervals and smaller amplitudes for wave III and V than females in both preterm and term groups (all p values≤.01). A 3-way interaction between group, sex, and GA (p<.05) showed that preterm males with later GA had longer wave I-V interval, whereas term females with later GA showed shorter wave I-V interval. Growth velocity predicted wave I-V interval in preterm infants, controlling for other factors (male: p=.07, female: p<.05). CONCLUSION ABRs in preterm and term infants were similar at 6weeks (corrected age if preterm), but males had less advanced ABRs than females. More rapid growth predicted less mature ABR in later GA preterm infants in this setting where they were unlikely to receive extra iron. The roles of GA, growth, and iron balance in ABR development warrant further study.