1601
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Abstract
The pulmonary circulation rapidly adapts at birth to establish lungs as the site of gas exchange. Abnormal transition at birth and/or parenchymal lung disease can result in neonatal hypoxemic respiratory failure. This article reviews the functional changes in pulmonary hemodynamics and structural changes in pulmonary vasculature secondary to (1) normal and abnormal transition at birth, and (2) diseases associated with neonatal hypoxemic respiratory failure. Various management strategies to correct respiratory failure are also discussed.
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Affiliation(s)
- Satyan Lakshminrusimha
- Division of Neonatology, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
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1602
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McAdams RM, Erdenebileg A, Batra M, Gerelmaa Z. Attitudes of healthcare providers towards non-initiation and withdrawal of neonatal resuscitation for preterm infants in Mongolia. J Health Popul Nutr 2012; 30:346-352. [PMID: 23082636 PMCID: PMC3489950 DOI: 10.3329/jhpn.v30i3.12298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Antenatal parental counselling by healthcare providers is recommended to inform parents and assist with decision-making before the birth of a child with anticipated poor prognosis. In the setting of a low-income country, like Mongolia, attitudes of healthcare providers towards resuscitation of high-risk newborns are unknown. The purpose of this study was to examine the attitudes of healthcare providers regarding ethical decisions pertaining to non-initiation and withdrawal of neonatal resuscitation in Mongolia. A questionnaire on attitudes towards decision-making for non-initiation and withdrawal of neonatal resuscitation was administered to 113 healthcare providers attending neonatal resuscitation training courses in 2009 in Ulaanbaatar, the capital and the largest city of Mongolia where -40% of deliveries in the country occur. The questionnaire was developed in English and translated into Mongolian and included multiple choices and free-text responses. Participation was voluntary, and anonymity of the participants was strictly maintained. In total, 113 sets of questionnaire were completed by Mongolian healthcare providers, including neonatologists, paediatricians, neonatal and obstetrical nurses, and midwives, with 100% response rate. Ninety-six percent of respondents were women, with 73% of participants from Ulaanbaatar and 27% (all midwives) from the countryside. The majority (96%) of healthcare providers stated they attempt pre-delivery counselling to discuss potential poor outcomes when mothers present with preterm labour. However, most (90%) healthcare providers stated they feel uncomfortable discussing not initiating or withdrawing neonatal resuscitation for a baby born alive with little chance of survival. Religious beliefs and concerns about long-term pain for the baby were the most common reasons for not initiating neonatal resuscitation or withdrawing care for a baby born too premature or with congenital birth-defects. Most Mongolian healthcare providers provide antenatal counselling to parents regarding neonatal resuscitation. Additional research is needed to determine if the above-said difficulty with counselling stems from deficiencies in communication training and whether these same counselling-related issues exist in other countries. Future educational efforts in teaching neonatal resuscitation in Mongolia should incorporate culturally-sensitive training on antenatal counselling.
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Affiliation(s)
- Ryan M McAdams
- Department of Pediatrics, Division of Neonatology, University of Washington, Box 356320, Seattle, WA 98195-6320, USA.
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1603
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Abstract
Background Low Birth Weight is a major public health problem in developing countries. The causes of LBW are multifactorial including complication during pregnancy, genetic, environmental, social-cultural, demographic and nutritional variables. Comparison of anthropometric risk factors for neonatal size of adolescent mothers are lacking from West Bengal. Therefore, this study was undertaken to identify maternal anthropometric characteristics, which most strongly influence neonate weight and length among Bengalee mothers. Methods A hospital based cross-sectional study was undertaken during 2004 in a Government general hospital in South Kolkata, India. A total of 76 adolescent (age<20years) pregnant women were enrolled from obstetric ward who were admitted for delivery. Due to 4 perinatal deaths; a total of 72 adolescent mother- baby pairs were included in this analysis. Anthropometric measurements were undertaken immediately after delivery following stabilization as well maternal body mass index (BMI) was calculated using standard formula. Results The prevalence of low birth weight (LBW) in the present study was 52.8%. The results revealed that 30.6% of mothers were undernourished (BMI<19.8 kg/m2). It was noted that about 64% of undernourished mothers delivered LBW baby. Linear regression analyses of neonatal weight and length as dependent variables revealed that in both cases, maternal height had the most significant impact. It showed 12.9% (birth weight) and 16.1% (birth length) of variation. Moreover, the proportion of LBW was 75%, 52.3% and 25% among short (height ≤145 cm), average (146–155cm) and tall (>155cm) mothers (x2=6.855, p<0.01), respectively. Short mothers had 2.74 and 9.0 fold greater risk of delivering LBW baby than average and tall mothers. In contrast, mean birth weight and length of baby was lower in short mother than their counterparts. Conclusion This study revealed that maternal height had the strongest significant impact on neonate size. This strong association could have serious health implications for Bengalee adolescent mothers. However, since this is a preliminary finding, it needs validation using a larger sample of adolescent mothers.
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Affiliation(s)
- Samiran Bisai
- Department of Anthropology, Vidyasagar University, Midnapore, West Bengal, India
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1604
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Wei KL, Yang YJ, Yao YJ, Du LZ, Wang QH, Wang RH, Wang L, Lin Y, Liu J, Wang H, Wang XL, Wu HM, Wu K, Chen Y, Zhong XY, Yu JL, Tan Q, Huang YC, Chen C, Wang JM, Yi B, Nong SH, Li B, Song X, Liu XZ, Lai JP, Zhang YX, Cui QL, Wang YD, Shi L, Guo XF, Guo SL, Yao L, Hong M, Xia SW, Gao XR, Cheng LX, Li Y, Wang HY, Liu DY, Meng QZ, Mu XR, Wang QX, Yan CY, Liu GS, Xie JY, Muheter D, Wu J, Lin LX, Xu JH, Zhao BL, Zhang JH, Wu Y, Chen X, Shan RB, Huang ZH, Hu X, Zhang SR, Ye ZZ, Wu BQ, Chen CH, Xiong Y, Liu YM, Yang ZY, Guo J, Chang LW, Wu GQ, Chen XJ, Liu HC, Wang D, Yu SQ, Liu L, Cai YH, Chen XH, Zeng JW, Li MX, Wu GQ, Li MZ, Li L, Fu ML, Li AY, Li L, Xiong H, Cheng XY, Cheng ZQ. Epidemiologic survey on hospitalized neonates in China. Transl Pediatr 2012; 1:15-22. [PMID: 26835259 PMCID: PMC4728849 DOI: 10.3978/j.issn.2224-4336.2011.10.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To carry out a nationwide epidemiologic survey on the neonates in urban hospitals with an attempt to understand the disease spectrum and treatment outcomes of hospitalized neonates in China. METHODS The clinical data of 43,289 hospitalized neonates from 86 hospitals in 47 Chinese cities (22 provinces) between January 1, 2005 and December 31, 2005 were retrospectively analyzed. RESULTS The male:female ratio was 1.73:1. Premature infants accounted for 26.2% of the hospitalized neonates, which was higher than that reported in 2002 (19.7%). The top three diseases during the neonatal period were jaundice, pneumonia, and hypoxic-ischemic encephalopathy. The incidences of pneumonia, meconium aspiration syndrome, and bilirubin encephalopathy in term infants were higher than those in premature infants, while the incidences of asphyxia, respiratory distress syndrome, and pulmonary hemorrhage in term infants were lower than those in premature infants. The incidences of asphyxia, small for gestational age infant, and wet lung were higher in neonates whose mother had pregnancy induced hypertension. The outcomes of these hospitalized neonates included: recovered, 63.9%; improved, 27.3%; discharged due to the family's own decisions, 7.6%, and died, 1.2%. Nearly half (46.4%) of the neonatal death occurred within 24 hrs after admission. CONCLUSION The incidence of premature birth shows an increasing trend among hospitalized neonates. Since the neonatal deaths mainly occur within 24 hrs after admission, monitoring during this period should be enhanced.
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Affiliation(s)
- Ke-Lun Wei
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yu-Jia Yang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yu-Jia Yao
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li-Zhong Du
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Qing-Hong Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Rui-Hua Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ling Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ying Lin
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jing Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Hua Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiao-Lei Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Hong-Min Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Kai Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yin Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiao-Yun Zhong
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jia-Lin Yu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Qiu Tan
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yu-Chun Huang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Chao Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ji-Mei Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Bin Yi
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Shao-Han Nong
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Bo Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiong Song
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xian-Zhi Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jian-Pu Lai
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - You-Xiang Zhang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Qi-Liang Cui
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - You-De Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Lin Shi
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiu-Feng Guo
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Shao-Li Guo
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li Yao
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Mei Hong
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Shi-Wen Xia
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xi-Rong Gao
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Lin-Xia Cheng
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yun Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Hong-Yun Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Dong-Yan Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Qing-Zhi Meng
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiu-Rong Mu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Qi-Xin Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Chao-Ying Yan
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Guo-Sheng Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jun-Ying Xie
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Dawuti Muheter
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jing Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li-Xing Lin
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jia-Hui Xu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Bai-Li Zhao
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jing-Hua Zhang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ying Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiao Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ruo-Bing Shan
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Zu-Hui Huang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xia Hu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Shu-Rong Zhang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Zhen-Zhi Ye
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ben-Qing Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Chang-Hui Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ying Xiong
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yu-Min Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Zhen-Ying Yang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jing Guo
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li-Wen Chang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Gao-Qiang Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xu-Jie Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Han-Chu Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Dong Wang
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Shu-Qun Yu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li Liu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Yu-Hong Cai
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiao-Hua Chen
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Jian-Wu Zeng
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ming-Xia Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Gao-Qiang Wu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ming-Zhu Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Long Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Ming-Liang Fu
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - An-Ying Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Li Li
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Hong Xiong
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Xiu-Yong Cheng
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
| | - Zhi-Qiong Cheng
- 1 Department of Pediatrics, China Medical University Affiliated Shengjing Hospital; 2 Department of Pediatrics, Central South University Affiliated Xiangya Hospital; 3 Department of Pediatrics, Sichuan University Affiliated West China Second Hospital; 4 Zhejiang University School of Medicine Affiliated Children's Hospital; 5 Beihai Maternal and Child Health Care Hospital; 6 Beihai People's Hospital; 7 Beijing Children's Hospital Emergency Center; 8 Capital University of Medical Sciences Affiliated Beijing Obstetrics&Gynecology Hospital; 9 Chengdu Children's Hospital/Chengdu Children's Emergency Center; 10 Chongqing Fifth People's Hospital; 11 Chongqing Fulin District Maternal and Child Health Care Hospital; 12 Chongqing Maternal and Child Health Care Hospital; 13 Chongqing Medical University Affiliated Children's Hospital; 14 Chongqing Three Gorge Central Hospital Children Health Care Center; 15 Dalian Children's Hospital; 16 Fudan University Affiliated Children's Hospital; 17 Fudan University Affiliated Obstetrics & Gynecology Hospital; 18 Gansu Maternal and Child Health Care Hospital; 19 Guangdong People's Hospital; 20 Guangi Minzu Hospital; 21 Guangxi Children's Hospital; 22 Guangxi Maternal and Child Health Care Hospital; 23 Guangzhou Children's Hospital; 24 Guangzhou NO.1 People's Hospital; 25 Guangzhou NO.2 People's Hospital; 26 Guiyang Maternal and Child Health Care Hospital; 27 Haikou Maternal and Child Health Care Hospital; 28 Hainan Maternal and Child Health Care Hospital; 29 Hainan Medical College Affiliated Hospital; 30 Harbin Medical University Affiliated Second Hospital; 31 Hölün Buyer Maternal and Child Health Care Hospital; 32 Hubei Maternal and Child Health Care Hospital; 33 Hunan Children's Hospital; 34 Hunan Maternal and Child Health Care Hospital; 35 Hunan People's Hospital; 36 Inner Mongolia Maternal and Child Health Care Hospital; 37 Jiamusi University Affiliated First Hospital; 38 Jiaozuo Maternal and Child Health Care Hospital; 39 Jiaxi Chi
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1605
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Uzodimma CC, Okoromah CAN, Ekure E, Ezeaka CV, Njokanma FO. Serum cardiac troponin T in asphyxiated term neonates delivered at two teaching hospitals in lagos, Nigeria. World J Pediatr Congenit Heart Surg 2012; 3:330-6. [PMID: 23804866 DOI: 10.1177/2150135112442693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Asphyxia is a leading cause of perinatal morbidity and mortality in the developing countries. All organs including the myocardium are vulnerable to ischemic injury in asphyxia. The aim of the current study was to assess myocardial injury in asphyxiated full-term neonates using their serum cardiac troponin T levels. METHODS In all, 30 term asphyxiated neonates and 30 gestational age-, birth weight-, and sex-matched controls were studied. Asphyxia was defined by double criteria of low umbilical arterial blood pH <7.20 and low five-minutes Apgar score ≤6, while the controls were term nonasphyxiated neonates with umbilical arterial blood pH ≥7.20 and five minutes Apgar score >6. The umbilical arterial pH was done soon after delivery, while the serum cardiac troponin T was done within the first 4 to 24 hours of life. RESULTS Participants and controls were similar in terms of mean gestational age, mode of delivery, gender, and birth weight (P = 1.0, .07, 1.0, and 1.0, respectively). Two thirds of the asphyxiated babies had elevated serum cardiac troponin T in the high risk range (> 0.1 ng/mL). On the contrary, none of the controls had serum cardiac troponin T in that range. Serum cardiac troponin T showed negative correlation with pH (r = -.75), five-minute Apgar score (r = -.74), and one-minute Apgar score (r = -0.70). CONCLUSION The study identified perinatal asphyxia as a high-risk factor for elevated serum cardiac troponin T and hence for myocardial cellular injury.
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Affiliation(s)
- Chinyere C Uzodimma
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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1606
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Wiederhold NP, Herrera LA. Caspofungin for the treatment of immunocompromised and severely ill children and neonates with invasive fungal infections. Clin Med Insights Pediatr 2012; 6:19-31. [PMID: 23641163 PMCID: PMC3620773 DOI: 10.4137/cmped.s8016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Caspofungin is the first member of the echinocandin class of antifungals to receive an indication for the use in infants, children, and adolescents from the United States Food and Drug Administration. Daily doses of 50 mg/m(2) result in pharmacokinetic parameters that are similar to those observed in adults. Although fewer data are available, the response rates in pediatric patients who received caspofungin either as treatment or empiric therapy in clinical trials are similar to those reported in adults. In addition, caspofungin appears to be generally safe and well tolerated in this population. This represents a significant step forward in the treatment of invasive fungal infections within this population, as caspofungin is associated with few clinically significant drug-interactions and toxicities compared to other antifungals, such as the azoles and amphotericin B.
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Affiliation(s)
- Nathan P. Wiederhold
- University of Texas at Austin College of Pharmacy, Austin, TX
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Lydia A. Herrera
- Methodist Hospital System, Department of Pharmacy, San Antonio, TX
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1607
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Choi JS, Kim RY, Rho S, Ewann F, Mielcarek N, Song MK, Czerkinsky C, Kim JO. Effect of maternal immune status on responsiveness of bacillus calmette-gurin vaccination in mouse neonates. Osong Public Health Res Perspect 2012; 3:68-73. [PMID: 24159493 PMCID: PMC3747646 DOI: 10.1016/j.phrp.2012.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 01/17/2012] [Accepted: 01/20/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Bacillus Calmette-Guérin (BCG) vaccination has proven to be efficient in immunologically naïve infants; however, it has not been investigated that maternal natural exposure to Mycobacterium and/or BCG vaccine could influence the characteristics of immune responses to BCG in newborns. In this study, we analyzed whether the maternal immune status to M tuberculosis (M tb) can affect neonatal immunity to BCG using a mouse model. METHODS Neonates were obtained from mice that were previously exposed to live BCG, to live M avium, or to heat-killed M tb H37Rv, and from naïve control mothers. One week after birth, the neonates were divided into two subgroups: one group immunized with live BCG via the subcutaneous route and the other group of neonates sham-treated. Interferon-gamma (IFNγ) secretion in response to in vitro stimulation with heat-killed BCG or purified protein derivative (PPD) was examined. Protection against M tb infection was evaluated by challenging mice nasally with live M tb H37Rv followed by counting colonies from spleen and lung homogenates. RESULTS BCG-immunized neonates showed increased IFNγ secretion in response to heat-killed BCG or PPD. All mice in BCG-immunized neonates subgroups showed reduced bacterial burden (colony forming unit) in the lungs when compared with control naive neonate mice. However, no statistically significant difference was observed when comparing BCG-immunized mice born from mothers previously exposed to M avium or immunized with either heat-killed H37Rv or live BCG and mice born from naïve mothers. CONCLUSION The maternal immune status to M tb does not appear to impact on the immunogenicity of BCG vaccine in their progeny in our experimental conditions.
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Affiliation(s)
- Jong Su Choi
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | - Ryang Yeo Kim
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
- Institut Pasteur Korea, Soengnam, Korea
| | - Semi Rho
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | | | - Nathalie Mielcarek
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
- Inserm, Lille, France
| | - Man Ki Song
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | - Cecil Czerkinsky
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | - Jae-Ouk Kim
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
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1608
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Diao M, Li L, Cheng W. Single-incision laparoscopic hepaticojejunostomy using conventional instruments for neonates with extrahepatic biliary cystic lesions. Surg Innov 2012; 20:214-8. [PMID: 22589020 DOI: 10.1177/1553350612446355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery has been increasingly adopted in pediatric surgery. Nevertheless, its feasibility and safety in neonates with congenital biliary malformations is unclear. This study reports successful single-incision laparoscopic hepaticojejunostomy (SILH) for neonates with extrahepatic biliary cystic lesions. METHODS Ten neonates with extrahepatic biliary cystic lesions (choledochal cyst/correctable biliary atresia: 6/4) who underwent SILH between May 2011 and September 2011 were reviewed. Ultrasonography, upper gastrointestinal contrast studies, and laboratory tests were performed during the follow-up period. RESULTS Mean operative time, postoperative hospital stay, time to full feeding, and duration of drainage were comparable to our historic open-control groups of 15 neonates with choledochal cysts and 7 patients with correctable biliary atresia. Median follow-up duration was 6.0 months. They regularly took medical treatments during the follow-up periods. The jaundice subsided or liver function was normalized within 3 months postoperatively. So far, no mortality or morbidity of cholangitis, bile leak, anastomotic stenosis, and intrahepatic reflux were encountered. CONCLUSIONS In experienced hands, SILH for neonates with extrahepatic biliary cystic lesions is feasible and safe. It provides a new alternative for neonatal hepatobiliary surgery.
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Affiliation(s)
- Mei Diao
- Capital Institute of Pediatrics, Beijing, People's Republic of China
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1609
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Abstract
The neonatal period of life is described as particularly susceptible to develop tolerance. This status of neonatal tolerance has been studied for decades since the discovery that semiallogeneic spleen cells inoculated at birth can induce donor-type graft acceptance. The host neonatal T‑cell compartment that may account for this propensity to develop tolerance is mostly characterized by a Th2-type polarized response and a default in the cytotoxic T lymphocyte (CTL) functions that allow the establishment of lymphoid chimerism and promote donor-type graft survival. We highlighted a new role of alloreactive Th17 cells as a critical barrier to neonatal tolerance that prevents this lymphoid chimerism and further demonstrated that the Th2 immune deviation is essential to control this Th17-type response. We discuss here the potential impact of breaking the tolerizing effects of exposure of the developing offspring to alloantigens in the induction of Th17-type immunity.
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Affiliation(s)
- Isabelle Debock
- Institut d'Immunologie Médicale, Université Libre de Bruxelles, Gosselies, Belgium
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1610
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Butts RJ, Scheurer MA, Atz AM, Zyblewski SC, Hulsey TC, Bradley SM, Graham EM. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol 2012; 33:633-8. [PMID: 22349666 DOI: 10.1007/s00246-012-0193-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
Low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score (VIS) have been used as surrogate markers for early postoperative outcomes in pediatric cardiac surgery. The objective of this study was to determine the associations between LCOS and maximum VIS with clinical outcomes in neonatal cardiac surgery. This was a secondary retrospective analysis of a prospective randomized trial, and the setting was a pediatric cardiac intensive care unit in a tertiary care children's hospital. Neonates (n = 76) undergoing corrective or palliative cardiac operations requiring cardiopulmonary bypass were prospectively enrolled. LCOS was defined by a standardized clinical criteria. VIS values were calculated by a standard formula during the first 36 postoperative hours, and the maximum score was recorded. Postoperative outcomes included hospital mortality, duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay (LOS), as well as total hospital charges. At surgery, the median age was 7 days and weight was 3.2 kg. LCOS occurred in 32 of 76 (42%) subjects. Median maximum VIS was 15 (range 5-33). LCOS was not associated with duration of mechanical ventilation, ICU LOS, hospital LOS, and hospital charges. Greater VIS was moderately associated with a longer duration of mechanical ventilation (p = 0.001, r = 0.36), longer ICU LOS (p = 0.02, r = 0.27), and greater total hospital costs (p = 0.05, r = 0.22) but not hospital LOS (p = 0.52). LCOS was not associated with early postoperative outcomes. Maximum VIS has only modest correlation with duration of mechanical ventilation, ICU LOS, and total hospital charges.
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1611
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Shankaran S, Laptook AR, Tyson JE, Ehrenkranz RA, Bann CM, Das A, Higgins RD, Bara R, Pappas A, McDonald SA, Goldberg RN, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Evolution of encephalopathy during whole body hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr 2012; 160:567-572.e3. [PMID: 22050871 DOI: 10.1016/j.jpeds.2011.09.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/29/2011] [Accepted: 09/08/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the predictive ability of stage of hypoxic-ischemic encephalopathy (HIE) for death or moderate/severe disability at 18 months among neonates undergoing hypothermia. STUDY DESIGN Stage of encephalopathy was evaluated at <6 hours of age, during study intervention, and at discharge among 204 participants in the National Institute of Child Health and Human Development Neonatal Research Network Trial of whole body hypothermia for HIE. HIE was examined as a predictor of outcome by regression models. RESULTS Moderate and severe HIE occurred at <6 hours of age among 68% and 32% of 101 hypothermia group infants and 60% and 40% of 103 control group infants, respectively. At 24 and 48 hours of study intervention, infants in the hypothermia group had less severe HIE than infants in the control group. Persistence of severe HIE at 72 hours increased the risk of death or disability after controlling for treatment group. The discharge exam improved the predictive value of stage of HIE at <6 hours for death/disability. CONCLUSIONS On serial neurologic examinations, improvement in stage of HIE was associated with cooling. Persistence of severe HIE at 72 hours and an abnormal neurologic exam at discharge were associated with a greater risk of death or disability.
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1612
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Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in critically ill children and adults. Neonates remain an understudied group, although previous evidence suggests that this association holds true for them as well. RECENT FINDINGS Attention to the issue of neonatal AKI is increasing. New studies in very low-birthweight infants, infants with congenital heart disease who undergo cardiopulmonary bypass, those who receive extracorporeal membrane oxygenation and infants with perinatal depression continue to demonstrate that AKI is common in neonates and associated with increased risk of morbidity and mortality. Additional advances in the field of neonatal AKI include adaptation of modern, categorical AKI definitions, as well as further evaluation of novel urinary biomarkers (e.g., neutrophil gelatinase-associated lipocalin) in this patient group. SUMMARY AKI is an independent risk factor for poor outcomes in critically ill neonates. Our ability to improve outcomes for these patients depends on heightened awareness of this issue both at the bedside as well as in research, commitment to using standardized AKI definitions in order to pool and compare data more effectively and improvement in our diagnostic methods with better AKI biomarkers so that we can identify AKI and intervene much earlier in the disease course.
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1613
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Lund IO, Fitzsimons H, Tuten M, Chisolm MS, O'Grady KE, Jones HE. Comparing methadone and buprenorphine maintenance with methadone-assisted withdrawal for the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Subst Abuse Rehabil 2012; 3:17-25. [PMID: 24474873 PMCID: PMC3889178 DOI: 10.2147/sar.s26288] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pregnancy can motivate opioid-dependent women to seek substance abuse treatment. Research has demonstrated that although prenatal exposure to buprenorphine results in less severe neonatal abstinence syndrome (NAS) relative to prenatal methadone exposure, the maternal and other neonatal outcomes are similar for the two medications. Maternal and neonatal outcomes for opioid-dependent pregnant women receiving these medications have not been systematically ompared with methadone-assisted withdrawal. The present study provides an initial assessment of the relative efficacy of both methadone and buprenorphine maintenance versus methadone-assisted withdrawal in terms of neonatal and maternal delivery outcomes. Data were derived from (1) the MOTHER (Maternal Opioid Treatment: Human Experimental Research) study at the Johns Hopkins University Bayview Medical Center (JHBMC), or (2) retrospective records review of women who underwent methadone-assisted withdrawal at the JHBMC during the time period in which participants were enrolled in the MOTHER study. Compared with the methadone maintenance group, the methadone-assisted withdrawal group had a significantly lower mean NAS peak score (Means = 13.7 vs 7.0; P = 0.002), required a significantly lower mean amount of morphine to treat NAS (Means = 82.8 vs 0.2; P < 0.001), had significantly fewer days medicated for NAS (Means = 31.5 vs 3.9; P < 0.001), and remained in the hospital for a significantly fewer number of days, on average (Means = 24.2 vs 7.0; P < 0.019). Compared with the buprenorphine maintenance group, the methadone-assisted withdrawal group required a significantly lower mean amount of morphine to treat NAS (Means = 8.2 vs 0.2; P < 0.001) and significantly fewer days medicated for NAS (Means = 12.0 vs 3.9; P = 0.008). Findings suggest that it is possible for some opioid-dependent pregnant women to succeed with methadone-assisted withdrawal. Future research needs to more fully evaluate the potential benefits and risks of methadone-assisted withdrawal for the maternal-fetal dyad.
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Affiliation(s)
- Ingunn O Lund
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Heather Fitzsimons
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michelle Tuten
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, MD
| | - Hendrée E Jones
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD ; Substance Abuse Treatment evaluations and interventions Research Program, RTI International, Research Triangle Park, NC, USA
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1614
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Holditch SJ, Eriksson EM, Tarosso LF, Kuebler PJ, Kallas EG, Nielsen EK, Wiznia AA, Rosenberg MG, Nixon DF. Decay kinetics of HIV-1 specific T cell responses in vertically HIV-1 exposed seronegative infants. Front Immunol 2012; 2:94. [PMID: 22566883 PMCID: PMC3341962 DOI: 10.3389/fimmu.2011.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 12/21/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The majority of infants born, in developed countries, to HIV-1 positive women are exposed to the HIV-1 virus in utero or peri/post-partum, but are born uninfected. We, and others, have previously shown HIV-1 specific T cell responses in HIV-1 exposed seronegative (HESN) neonates/infants. Our objective in this study was to examine the rate of decay in their HIV-1 specific T cell response over time from birth. DESIGN Cross-sectional and longitudinal studies of HIV-1 specific T cell responses in HESN infants were performed. METHODS Peripheral blood mononuclear cells (PBMC) were isolated from 18 HIV-1 DNA PCR negative infants born to HIV-1 infected mothers receiving care at the Jacobi Medical Center, Bronx, NY, USA. PBMC were examined for T cell responses to HIV-1 antigens by interferon-gamma (IFN-γ) ELISPOT. RESULTS PBMC from 15 HESN neonates/infants were analyzed. We observed a decay of HIV-1 specific T cell responses from birth at a rate of -0.599 spot forming unit/10⁶ cells per day, with a median half-life decay rate of 21.38 weeks (13.39-115.8). CONCLUSION Our results support the dynamic nature of T cell immunity in the context of a developing immune system. The disparate rate of decay with studies of adults placed on antiretroviral drugs suggests that antigen specific T cell responses are driven by the natural rate of decay of the T cell sub-populations themselves.
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Affiliation(s)
- Sara J Holditch
- Division of Experimental Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco San Francisco, CA, USA
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1615
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Tannuri ACA, Silva LM, Leal AJG, Moraes ACFD, Tannuri U. Does administering albumin to postoperative gastroschisis patients improve outcome? Clinics (Sao Paulo) 2012; 67:107-11. [PMID: 22358234 PMCID: PMC3275118 DOI: 10.6061/clinics/2012(02)04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/21/2011] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4% and 92.0%, respectively), were similar for both phases. CONCLUSIONS The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge.
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Affiliation(s)
- Ana Cristina A Tannuri
- Faculdade de Medicina, Universidade de São Paulo, Pediatric Surgery Division, Pediatric Liver Transplantation Unit, Brazil
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1616
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Abstract
Cerebral venous sinus thrombosis in children is increasingly recognized as diagnostic tools and clinical awareness has improved. It is a multifactorial disease where prothrombotic risk factors and predisposing clinical conditions usually in combination constitute the underlying etiology. Clinical features range from headache, seizures to comatose state. Although symptomatic treatment involving control of infections, seizures and intracranial hypertension is uniform, use of anticoagulation and local thrombolytic therapy is still controversial. Morbidity and mortality can be significant and long-term neurological sequelae include developmental delay, sensorimotor and visual deficits and epilepsy.
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Affiliation(s)
- Mubashira Hashmi
- Department of Medicine, Section of Neurology, Aga Khan University and Hospital, Stadium Road, Karachi, Pakistan
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1617
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Zhang Y, Xue C, Zhu T, Du X, Su N, Qi H, Yang J, Shi Y, Chen L. Serum bone alkaline phosphatase in assessing illness severity of infected neonates in the neonatal intensive care unit. Int J Biol Sci 2011; 8:30-8. [PMID: 22211102 PMCID: PMC3226030 DOI: 10.7150/ijbs.8.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/23/2011] [Indexed: 12/18/2022] Open
Abstract
Background: Infections can influence bone metabolism of neonates, which may lead to changes in some bone metabolism biomarkers. The purpose of this study was to determine whether serum bone alkaline phosphatase (BALP), osteocalcin (OC) and beta carboxy-terminal peptide of type I collagen (CTX), as specific biomarkers of bone metabolism, can be used to assess the severity of neonatal infections. Methods: Sixty-three neonates in the NICU were enrolled in this study. The neonates were divided into infected group (n=33) and non-infected group (n=30). The scores for neonatal acute physiology-perinatal extension II (SNAPPE-II) were calculated and interleukin-6 (IL-6), procalcitonin (PCT), BALP, OC and CTX were measured among the neonates with or without infections, and among the infected neonates before and after treatment. Results: The serum BALP levels were lower in the infected group than that in the non-infected group (p<0.01). The serum BALP levels increased markedly in the infected neonates after treatment (p<0.01). The serum BALP levels were also inversely correlated with SNAPPE-II of infected neonates before and after treatment (r=-0.56, p<0.05; r=-0.37, p<0.05, respectively). In infected neonates, the differences between serum BALP levels before and after treatment were inversely correlated with those of IL-6 levels (p<0.05). There were no significant changes in the OC, CTX and PCT levels in the infected or non-infected group before and after treatment. Conclusion: Our data suggest that serum BALP level might be used as a marker for assessing the severity of illness in infected neonates.
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Affiliation(s)
- Yaozong Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Center of Bone Metabolism and Repair, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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1618
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May L, Byers-Heinlein K, Gervain J, Werker JF. Language and the newborn brain: does prenatal language experience shape the neonate neural response to speech? Front Psychol 2011; 2:222. [PMID: 21960980 PMCID: PMC3177294 DOI: 10.3389/fpsyg.2011.00222] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 08/22/2011] [Indexed: 11/29/2022] Open
Abstract
Previous research has shown that by the time of birth, the neonate brain responds specially to the native language when compared to acoustically similar non-language stimuli. In the current study, we use near-infrared spectroscopy to ask how prenatal language experience might shape the brain response to language in newborn infants. To do so, we examine the neural response of neonates when listening to familiar versus unfamiliar language, as well as to non language stimuli. Twenty monolingual English-exposed neonates aged 0–3 days were tested. Each infant heard low-pass filtered sentences of forward English (familiar language), forward Tagalog (unfamiliar language), and backward English and Tagalog (non-language). During exposure, neural activation was measured across 12 channels on each hemisphere. Our results indicate a bilateral effect of language familiarity on neonates’ brain response to language. Differential brain activation was seen when neonates listened to forward Tagalog (unfamiliar language) as compared to other types of language stimuli. We interpret these results as evidence that the prenatal experience with the native language gained in utero influences how the newborn brain responds to language across brain regions sensitive to speech processing.
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Affiliation(s)
- Lillian May
- Department of Psychology, University of British Columbia Vancouver, BC, Canada
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1619
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Arimitsu T, Uchida-Ota M, Yagihashi T, Kojima S, Watanabe S, Hokuto I, Ikeda K, Takahashi T, Minagawa-Kawai Y. Functional hemispheric specialization in processing phonemic and prosodic auditory changes in neonates. Front Psychol 2011; 2:202. [PMID: 21954386 PMCID: PMC3173826 DOI: 10.3389/fpsyg.2011.00202] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 08/09/2011] [Indexed: 11/15/2022] Open
Abstract
This study focuses on the early cerebral base of speech perception by examining functional lateralization in neonates for processing segmental and suprasegmental features of speech. For this purpose, auditory evoked responses of full-term neonates to phonemic and prosodic contrasts were measured in their temporal area and part of the frontal and parietal areas using near-infrared spectroscopy (NIRS). Stimuli used here were phonemic contrast /itta/ and /itte/ and prosodic contrast of declarative and interrogative forms /itta/ and /itta?/. The results showed clear hemodynamic responses to both phonemic and prosodic changes in the temporal areas and part of the parietal and frontal regions. In particular, significantly higher hemoglobin (Hb) changes were observed for the prosodic change in the right temporal area than for that in the left one, whereas Hb responses to the vowel change were similarly elicited in bilateral temporal areas. However, Hb responses to the vowel contrast were asymmetrical in the parietal area (around supra marginal gyrus), with stronger activation in the left. These results suggest a specialized function of the right hemisphere in prosody processing, which is already present in neonates. The parietal activities during phonemic processing were discussed in relation to verbal-auditory short-term memory. On the basis of this study and previous studies on older infants, the developmental process of functional lateralization from birth to 2 years of age for vowel and prosody was summarized.
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Affiliation(s)
- Takeshi Arimitsu
- Department of Pediatrics, School of Medicine, Keio University Tokyo, Japan
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1620
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Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 2011; 159:392-7. [PMID: 21489560 PMCID: PMC3137655 DOI: 10.1016/j.jpeds.2011.02.035] [Citation(s) in RCA: 264] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/07/2011] [Accepted: 02/24/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether duration of antibiotic exposure is an independent risk factor for necrotizing enterocolitis (NEC). STUDY DESIGN A retrospective, 2:1 control-case analysis was conducted comparing neonates with NEC to those without from 2000 through 2008. Control subjects were matched on gestational age, birth weight, and birth year. In each matched triad, demographic and risk factor data were collected from birth until the diagnosis of NEC in the case subject. Bivariate and multivariate analyses were used to assess associations between risk factors and NEC. RESULTS One hundred twenty-four cases of NEC were matched with 248 control subjects. Cases were less likely to have respiratory distress syndrome (P = .018) and more likely to reach full enteral feeding (P = .028) than control subjects. Cases were more likely to have culture-proven sepsis (P < .0001). Given the association between sepsis and antibiotic use, we tested for and found a significant interaction between the two variables (P = .001). When neonates with sepsis were removed from the cohort, the risk of NEC increased significantly with duration of antibiotic exposure. Exposure for >10 days resulted in a nearly threefold increase in the risk of developing NEC. CONCLUSIONS Duration of antibiotic exposure is associated with an increased risk of NEC among neonates without prior sepsis.
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1621
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Bhat Y R, Lewis LES, KE V. Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a center in India. Ital J Pediatr 2011; 37:32. [PMID: 21745376 PMCID: PMC3444145 DOI: 10.1186/1824-7288-37-32] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 07/11/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Epidemiology and surveillance of neonatal sepsis helps in implementation of rational empirical antibiotic strategy. OBJECTIVE To study the frequency of bacterial isolates of early onset neonatal sepsis (EONS) and their sensitivity pattern. METHODS In this retrospective study, a case of EONS was defined as an infant who had clinical signs or born to mothers with potential risk factors for infection, in whom blood culture obtained within 72 hours of life, grew a bacterial pathogen. Blood culture sample included a single sample from peripheral vein or artery. Relevant data was obtained from the unit register or neonatal case records. RESULTS Of 2182 neonates screened, there were 389 (17.8%) positive blood cultures. After excluding coagulase-negative Staphylococci (160), we identified 229 EONS cases. Preterm neonates were 40.6% and small for gestational age, 18.3%. Mean birth weight and male to female ratio were 2344.5 (696.9) g and 1.16:1 respectively. Gram negative species represented 90.8% of culture isolates. Pseudomonas (33.2%) and Klebsiella (31.4%) were common among them. Other pathogens included Acinetobacter (14.4%), Staphylococcus aureus (9.2%), E.coli (4.4%), Enterobacter (2.2%), Citrobacter (3.1%) and Enterococci (2.2%). In Gram negative group, best susceptibility was to Amikacin (74.5%), followed by other aminoglycosides, ciprofloxacin and cefotaxime. The susceptibility was remarkably low to ampicillin (8.4%). Gram positive group had susceptibility of 42.9% to erythromycin, 47.6% to ciprofloxacin and above 50% to aminoglycosides. Of all isolates, 83.8% were susceptible to either cefotaxime or amikacin CONCLUSION Gram-negative species especially Pseudomonas and Klebsiella were the predominant causative organisms. Initial empirical choice of cefotaxime in combination with amikacin appeared to be rational choice for a given cohort.
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Affiliation(s)
- Ramesh Bhat Y
- Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104. Udupi District, Karnataka, India
| | - Leslie Edward S Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104. Udupi District, Karnataka, India
| | - Vandana KE
- Department of Microbiology, Kasturba Medical College, Manipal University, Manipal-576104. Udupi District, Karnataka, India
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1622
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Chatziioannidis I, Samaras T, Nikolaidis N. Electrical Impedance Tomography: a new study method for neonatal Respiratory Distress Syndrome? Hippokratia 2011; 15:211-215. [PMID: 22435017 PMCID: PMC3306026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Treatment of cardiorespiratory system diseases is a procedure that usually demands data collection on terms of the anatomy and the operation of the organs that are under study. Electrical Impedance Tomography (EIT) is an alternative approach, in comparison to existing techniques. With EIT electrodes are placed in the perimeter of the human body and images of the estimated organ are reconstructed, using the measurement of its impendence (or resistance) distribution and determining its alteration through time, while at the same time the patient is not exposed to ionizing radiation. Its clinical use presupposes the correct placement of the electrodes over the perimeter of the human body, the rapid data collection and electrical safety. It is a low cost technique and it is implemented near the patient. It is able to determine the distribution of ventilation, blood supply, diffused or localized lung defects, but it can also estimate therapeutic interventions or alteration to assisted ventilation of the neonate. EIT was developed at the beginning of the 1980s, but it has only recently begun to be implemented on neonates, and especially in the study of their respiratory system function. The low rate of image analysis is considered to be a drawback, but it is offset by the potential offered for the estimation of lungs' function (both under normal and pathological conditions), since ventilation and resistance are two quite similar concepts. In this review the most important studies about EIT are mentioned as a method of estimating respiratory distress syndrome in neonates. In terms of the above mentioned development, it is supposed that this technique will offer a great amount of help to the doctor in his / her estimations of the cardiorespiratory system and to his / her selection of the best intervening strategies.
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1623
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Minagawa-Kawai Y, Cristià A, Vendelin I, Cabrol D, Dupoux E. Assessing signal-driven mechanisms in neonates: brain responses to temporally and spectrally different sounds. Front Psychol 2011; 2:135. [PMID: 21720538 PMCID: PMC3118480 DOI: 10.3389/fpsyg.2011.00135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/07/2011] [Indexed: 01/28/2023] Open
Abstract
Past studies have found that, in adults, the acoustic properties of sound signals (such as fast versus slow temporal features) differentially activate the left and right hemispheres, and some have hypothesized that left-lateralization for speech processing may follow from left-lateralization to rapidly changing signals. Here, we tested whether newborns’ brains show some evidence of signal-specific lateralization responses using near-infrared spectroscopy (NIRS) and auditory stimuli that elicits lateralized responses in adults, composed of segments that vary in duration and spectral diversity. We found significantly greater bilateral responses of oxygenated hemoglobin (oxy-Hb) in the temporal areas for stimuli with a minimum segment duration of 21 ms, than stimuli with a minimum segment duration of 667 ms. However, we found no evidence for hemispheric asymmetries dependent on the stimulus characteristics. We hypothesize that acoustic-based functional brain asymmetries may develop throughout early infancy, and discuss their possible relationship with brain asymmetries for language.
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1624
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Wusthoff CJ, Kessler SK, Vossough A, Ichord R, Zelonis S, Halperin A, Gordon D, Vargas G, Licht DJ, Smith SE. Risk of later seizure after perinatal arterial ischemic stroke: a prospective cohort study. Pediatrics 2011; 127:e1550-7. [PMID: 21576305 PMCID: PMC3103276 DOI: 10.1542/peds.2010-1577] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although acute seizures are common among neonates with arterial ischemic stroke (AIS), the incidence of subsequent seizures is unknown. The goals of this study were to determine the incidence of seizures following hospital discharge after perinatal acute AIS, and to assess lesion characteristics associated with later seizure occurrence. METHODS Neonates with confirmed acute AIS on MRI were identified through a prospective stroke registry. Clinic visits and telephone follow-up identified occurrence of seizures after hospital discharge. MRI scans were graded for size and characteristics of infarct, and associations with seizures after stroke were analyzed. RESULTS At a mean (SD) follow-up of 31.3 (16.1) months, 11 of 46 (23.9%) patients with perinatal AIS had at least 1 seizure. Five patients had a single episode of seizure, and 6 developed epilepsy. The Kaplan-Meier probability of remaining seizure-free at 3 years was 73%. Stroke size on MRI was significantly associated with development of later seizures, with an incidence rate of later seizures 6.2 times higher among those with larger stroke size. CONCLUSIONS Seizures occurred in <25% of patients during initial follow-up after perinatal AIS. Of those with seizures, nearly half had a single episode of seizure and not early epilepsy. Larger stroke size was associated with higher risk of seizure. These data suggest that prolonged treatment with anticonvulsant agents may not be indicated for seizure prophylaxis after perinatal AIS. These findings may help guide clinicians in counseling families and could form the basis for much-needed future research in this area.
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Affiliation(s)
| | - Sudha Kilaru Kessler
- Division of Neurology, Department of Pediatrics, and ,Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Rebecca Ichord
- Division of Neurology, Department of Pediatrics, and ,Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Sarah Zelonis
- Division of Neurology, Department of Pediatrics, and
| | | | | | - Gray Vargas
- Division of Neurology, Department of Pediatrics, and
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, and ,Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Sabrina E. Smith
- Division of Neurology, Department of Pediatrics, and ,Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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1625
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Manortey S, Carey A, Ansong D, Harvey R, Good B, Boaheng J, Crookston B, Dickerson T. Verbal autopsy: an analysis of the common causes of childhood death in the Barekese sub-district of Ghana. J Public Health Afr 2011; 2:e18. [PMID: 28299059 PMCID: PMC5345491 DOI: 10.4081/jphia.2011.e18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/24/2011] [Indexed: 12/30/2022] Open
Abstract
The availability of mortality data for any society plays an essential role in health monitoring and evaluation, as well as in the design of health interventions. However, most resource-poor countries such as Ghana have no reliable vital registration system. In these instances, verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana, the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third, blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians, this was assigned as the cause of death for the individual child. During the study period, we recorded 118 deaths from 92 households. Twenty-nine (24.6%) were neonatal deaths with the leading causes of death being neonatal sepsis, birth asphyxia and pneumonia. The remaining 89 (75.4%) were post-neonatal deaths with the most common causes of death being pneumonia, malaria and malnutrition. While 63/118 (53.4%) deaths occurred in the home, there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home.
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Affiliation(s)
- Stephen Manortey
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City
| | | | - Daniel Ansong
- Department of Child Health, Kwame Nkrumah University of Science & Technology, Kumasi
| | - Ryan Harvey
- College of Nursing, University of Utah, Salt Lake City
| | - Brian Good
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Joseph Boaheng
- Research and Development Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Benjamin Crookston
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City
| | - Ty Dickerson
- Department of Pediatrics, University of Utah, Salt Lake City
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1626
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Abstract
Although newborns have surprised scientists with their learning skills, proficiency on concurrent schedules of reinforcement requires (in effect) the ability to integrate and compare behavior-consequence relations over time. Can very young animals obey the quantitative relation that applies to such repeated choices, the generalized matching law? The provenance of the skill is not well understood, and this study provides the first investigation of matching in neonates. Northern bobwhite (Colinus virginianus) hatchlings pecked left and right targets on a touchscreen for heat delivery on a concurrent variable-interval reinforcement schedule. Within 5 days after hatching, the chicks showed sensitivity levels significantly greater than zero, but short of typical adult levels. However, stable sequential patterns emerged almost immediately, including a consistent choose-rich tendency after unreinforced responses, one that entails some degree of temporal integration. These exploratory data suggest that the basic ability to match develops quickly in this precocial species, but that more extensive experience may be required to achieve the higher sensitivities typically seen in adults.
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Affiliation(s)
- Susan M Schneider
- Department of Psychology, University of the Pacific, Stockton, CA 95211, USA.
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1627
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Singh D, Rana KS, Mathai S. Role of prophylactic surfactant in preterm infants. Med J Armed Forces India 2011; 67:138-41. [PMID: 27365784 DOI: 10.1016/s0377-1237(11)60012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 02/12/2011] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Respiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. The physiological function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread. A wide variety of surfactant products have been formulated and studied in clinical trials. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity. METHODS This was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. One hundred preterm newborns (controls) less than 34 weeks gestation were managed in the conventional manner as per the existing protocols in the neonatal intensive care unit. Twenty-five consecutively delivered preterm newborns less than 34 weeks gestation were administered surfactant. Data regarding clinical outcomes including mortality and morbidity profile was collected and analysed. RESULTS The mean duration of ventilation in the ventilated babies in the control group and the surfactant group was 129.8 ± 43 hours and 85.7 ± 46 hours, respectively; the difference being statistically significant. In the surfactant group, four babies (16%) died and in the control group, 27 babies (27%) died. The difference was not statistically significant. The number of babies developing retinopathy of prematurity and needing laser treatment for retinopathy of prematurity was greater in the surfactant group. CONCLUSION Prophylactic administration of surfactant in preterm newborns of gestational age < 34 weeks is associated with a significant decrease in mean duration of ventilation and an increase in the incidence of retinopathy of prematurity.
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Affiliation(s)
| | - K S Rana
- Consultant (Paediatrics), CH (SC) Pune - 40
| | - Sheila Mathai
- Senior Advisor (Paediatrics), INHS Asvini Mumbai - 05
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1628
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Abstract
Invasive fungal infections in immunocompromised children are common and often fatal. The first antifungal agents such as amphotericin B and fluconazole offered effective treatment, but their use was often limited by toxicity and resistance. Numerous new antifungal agents have since been developed and appear to be as effective. Most dosing and safety trials have been done in adults, and extrapolation of this data to children has proven inadequate. We reviewed the literature regarding the pharmacokinetics/pharmacodynamics (PK/PD) and safety of antifungal agents with an emphasis on the newer azoles and echinocandins. From a small but growing number of PK/PD trials, better dosing guidelines have been developed.
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Affiliation(s)
- Kevin Watt
- Department of Pediatrics, Duke University, Durham, NC, USA
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1629
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Fernandez E, Perez R, Hernandez A, Tejada P, Arteta M, Ramos JT. Factors and Mechanisms for Pharmacokinetic Differences between Pediatric Population and Adults. Pharmaceutics 2011; 3:53-72. [PMID: 24310425 PMCID: PMC3857037 DOI: 10.3390/pharmaceutics3010053] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/28/2011] [Indexed: 12/14/2022] Open
Abstract
Many physiologic differences between children and adults may result in age-related changes in pharmacokinetics and pharmacodynamics. Factors such as gastric pH and emptying time, intestinal transit time, immaturity of secretion and activity of bile and pancreatic fluid among other factors determine the oral bioavailability of pediatric and adult populations. Anatomical, physiological and biochemical characteristics in children also affect the bioavailability of other routes of administration. Key factors explaining differences in drug distribution between the pediatric population and adults are membrane permeability, plasma protein binding and total body water. As far as drug metabolism is concerned, important differences have been found in the pediatric population compared with adults both for phase I and phase II metabolic enzymes. Immaturity of glomerular filtration, renal tubular secretion and tubular reabsorption at birth and their maturation determine the different excretion of drugs in the pediatric population compared to adults.
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Affiliation(s)
- Eva Fernandez
- Department of Pharmacy, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
| | - Raul Perez
- Department of Pharmacy, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
| | - Alfredo Hernandez
- Department of Pharmacy, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
| | - Pilar Tejada
- Department of Pharmacy, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
| | - Marta Arteta
- Department of Pharmacy, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
| | - Jose T. Ramos
- Department of Paediatrics, Getafe University Hospital, Carretera Toledo Km 12,5 Getafe, Madrid, Spain
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1630
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van Imhoff DE, Dijk PH, Weykamp CW, Cobbaert CM, Hulzebos CV. Measurements of neonatal bilirubin and albumin concentrations: a need for improvement and quality control. Eur J Pediatr 2011; 170:977-82. [PMID: 21213112 PMCID: PMC3139054 DOI: 10.1007/s00431-010-1383-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Accurate and precise bilirubin and albumin measurements are essential for proper management of jaundiced neonates. Data hereon are lacking for Dutch laboratories. We aimed to determine variability of measurements of bilirubin and albumin concentrations typical for (preterm) neonates. Aqueous, human serum albumin-based samples with different concentrations of bilirubin (100, 200, 300, 400, and 500 μmol/L) and albumin (0, 10, 15, 20, 25, and 30 g/L) were sent to laboratories of all Dutch neonatal intensive care units (n = 10). Bilirubin and albumin recoveries of the specimens were measured using locally available routine analytical methods. The mean, standard deviation, and coefficients of variations (CV) were calculated per sample. Bilirubin concentrations were underestimated in the absence of albumin (maximal CV 26.0%). When the albumin concentration was 10 or 20 g/L, the bilirubin concentrations of the samples were overestimated (maximal CV 14.1% and 9.2%, respectively). Variability increased with higher weighed-in bilirubin concentrations. Measured albumin levels were ~10% lower than albumin levels of manufactured samples. Bilirubin concentration did not influence albumin measurements. The maximal CV was 6.8%. In conclusion, interlaboratory variability of bilirubin and albumin measurements is high. Recalibration and introduction of a specific quality assessment scheme for neonatal samples is recommended to ensure exchangeability of bilirubin and albumin measurements among laboratories and to control the observed large variability.
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Affiliation(s)
- Deirdre E. van Imhoff
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Peter H. Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Cas W. Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry, University Medical Center Leiden, Leiden, The Netherlands
| | - Christian V. Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - On behalf of the BARTrial Study Group
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
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1631
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Tannuri ACA, Sbragia L, Tannuri U, Silva LM, Leal AJG, Schmidt AFS, Oliveira-Filho AG, Bustorff-Silva JM, Vicente YAMVA, Tazima MDFGS, Pileggi FO, Camperoni AL. Evolution of critically ill patients with gastroschisis from three tertiary centers. Clinics (Sao Paulo) 2011; 66:17-20. [PMID: 21437430 PMCID: PMC3045707 DOI: 10.1590/s1807-59322011000100004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 10/01/2010] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers. METHODS From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables. RESULTS 163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1%). The mean serum sodium level was 127.4 ± 6.7 mEq/L, and the mean serum albumin level was 2.35 ± 0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9%. CONCLUSION In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome.
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Affiliation(s)
- Ana Cristina A Tannuri
- Pediatric Surgery Division Pediatric Liver Transplantation Unit Laboratory of Research in Pediatric Surgery, Medical School, University of Sao Paulo, Sao Paulo, Brazil.
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1632
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White M. The end at the beginning. Ochsner J 2011; 11:309-16. [PMID: 22190880 PMCID: PMC3241062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The clinical management of infants born with disabilities and at the cusp of viability has been a focus of attention in recent years because of medical advances as well as legislative activity. This article looks at the history, in terms of law and medical tradition, of this issue as well as how healthcare providers have been and could be affected.
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Affiliation(s)
- Michael White
- Department of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans, LA
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1633
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Balamurugan R, Magne F, Balakrishnan D, Suau A, Ramani S, Kang G, Ramakrishna BS. Faecal bifidobacteria in Indian neonates & the effect of asymptomatic rotavirus infection during the first month of life. Indian J Med Res 2010; 132:721-7. [PMID: 21245621 PMCID: PMC3102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Bifidobacteria colonize the gut after the first week of life and remain an important component of the gut microbiota in infancy. This study was carried out to characterize the diversity and number of bifidobacteria colonizing the gut in Indian neonates and to investigate whether asymptomatic infection with rotavirus in the first month of life affected gut colonization by bifidobacteria. METHODS DNA was isolated from faeces of 14 term-born neonates who were under surveillance for rotavirus infection. Bacterial and bifidobacterial diversity was evaluated by temporal temperature gradient electrophoresis (TTGE) of 16S rDNA amplified using total bacteria and bifidobacteria-specific primers. Real time PCR, targeting 16S rDNA, was used to quantitate faecal bifidobacteria and enterobacteria. RESULTS TTGE of conserved bacterial 16S rDNA showed 3 dominant bands of which Escherichia coli (family Enterobacteriaceae) and Bifidobacterium (family Bifidobacteriaceae) were constant. TTGE of Bifidobacterium genus-specific DNA showed a single band in all neonates identified by sequencing as Bifidobacterium longum subsp. infantis. Faecal bifidobacterial counts (log 10 cfu/g faeces) ranged from 6.1 to 9.3 and enterobacterial counts from 6.3 to 9.5. Neonates without and with rotavirus infection in the first week of life did not show significant differences in the median count of bifidobacteria (log 10 count 7.48 vs. 7.41) or enterobacteria (log 10 count 8.79 vs. 7.92). INTERPRETATION AND CONCLUSIONS B. longum subsp. infantis was the sole bifidobacterial species colonizing the gut of Indian neonates. Asymptomatic rotavirus infection in the first month of life was not associated with alteration in faecal bifidobacteria or enterobacteria.
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Affiliation(s)
- Ramadass Balamurugan
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Divya Balakrishnan
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Sasirekha Ramani
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Balakrishnan S. Ramakrishna
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India,Reprint requests: Dr B.S. Ramakrishna, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India e-mail:
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1634
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Abstract
OBJECTIVES To investigate outcomes among neonates with herpes virus infection reported to the Extracorporeal Life Support Organization (ELSO) Registry and analyze factors associated with death before hospital discharge with this virus. Currently, scant data exist regarding extracorporeal membrane oxygenation support in neonates with herpes virus infection. DESIGN Retrospective analysis of ELSO Registry data set from 1985 to 2005. SETTING A total of 114 extracorporeal membrane oxygenation centers contributing data to the ELSO Registry. PATIENTS Patients, 0 to 31 days of age, with herpes simplex virus infection supported with extracorporeal membrane oxygenation and reported to the ELSO Registry. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical characteristics, outcomes, and factors associated with death before hospital discharge were investigated for patients in the virus group. Kaplan-Meier estimates of survival to hospital discharge according to virus type were investigated. Newborns with herpes simplex virus infection requiring extracorporeal membrane oxygenation support demonstrated much lower hospital survival rates (25%). Clinical presentation with septicemia/shock was significantly associated with mortality for the herpes simplex virus group on multivariate analysis. There was no difference in herpes simplex virus mortality when comparing two eras (> or =2000 vs. <2000). CONCLUSIONS In this cohort of neonatal patients with overwhelming infections due to herpes simplex virus who were supported with extracorporeal membrane oxygenation, survival was dismal. Patients with disseminated herpes simplex virus infection presenting with septicemia/shock are unlikely to survive, even with aggressive extracorporeal support.
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1635
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Abstract
We compared the rates of medical closure of patent ductus arteriosus (PDA) and complications (renal dysfunction, necrotizing enterocolitis, spontaneous intestinal perforation, and intraventricular hemorrhage) between infants treated with indomethacin and infants treated with ibuprofen. We performed a retrospective comparative cohort study of infants treated with indomethacin or ibuprofen for symptomatic PDA at Duke University Medical Center between November 2005 and November 2007. We identified 65 infants who received indomethacin and 57 who received ibuprofen. The rate of survival without surgical ductal ligation was 62% (40/65) in the indomethacin group and 58% (33/57) in the ibuprofen group (p = 0.71). The rate of the composite of complications (death, necrotizing enterocolitis, or intestinal perforation) was 40% (26/65) in the indomethacin group and 32% (18/57) in the ibuprofen group (p = 0.35). There was no significant difference between groups in elevation of serum creatinine during treatment. In clinical practice, ibuprofen appears to be as effective as indomethacin for closure of patent ductus arteriosus with similar complication rates. The decision to use one agent over the other should be based on dose schedule preference and the currently published clinical trials until more safety and effectiveness data are available.
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Affiliation(s)
- Lakshmi I Katakam
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - Ronald N Goldberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - Chi N Dang
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
| | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States, Duke Clinical Research Institute, Durham, North Carolina, United States
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1636
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Perani D, Saccuman MC, Scifo P, Spada D, Andreolli G, Rovelli R, Baldoli C, Koelsch S. Functional specializations for music processing in the human newborn brain. Proc Natl Acad Sci U S A 2010; 107:4758-63. [PMID: 20176953 PMCID: PMC2842045 DOI: 10.1073/pnas.0909074107] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In adults, specific neural systems with right-hemispheric weighting are necessary to process pitch, melody, and harmony as well as structure and meaning emerging from musical sequences. It is not known to what extent the specialization of these systems results from long-term exposure to music or from neurobiological constraints. One way to address this question is to examine how these systems function at birth, when auditory experience is minimal. We used functional MRI to measure brain activity in 1- to 3-day-old newborns while they heard excerpts of Western tonal music and altered versions of the same excerpts. Altered versions either included changes of the tonal key or were permanently dissonant. Music evoked predominantly right-hemispheric activations in primary and higher order auditory cortex. During presentation of the altered excerpts, hemodynamic responses were significantly reduced in the right auditory cortex, and activations emerged in the left inferior frontal cortex and limbic structures. These results demonstrate that the infant brain shows a hemispheric specialization in processing music as early as the first postnatal hours. Results also indicate that the neural architecture underlying music processing in newborns is sensitive to changes in tonal key as well as to differences in consonance and dissonance.
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Affiliation(s)
- Daniela Perani
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy.
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1637
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Rogers SP, Hicks PD, Hamzo M, Veit LE, Abrams SA. Continuous feedings of fortified human milk lead to nutrient losses of fat, calcium and phosphorous. Nutrients 2010; 2:230-40. [PMID: 22254018 DOI: 10.3390/nu2030240] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 02/25/2010] [Indexed: 11/17/2022] Open
Abstract
Substantial losses of nutrients may occur during tube (gavage) feeding of fortified human milk. Our objective was to compare the losses of key macronutrients and minerals based on method of fortification and gavage feeding method. We used clinically available gavage feeding systems and measured pre- and post-feeding (end-point) nutrient content of calcium (Ca), phosphorus (Phos), protein, and fat. Comparisons were made between continuous, gravity bolus, and 30-minute infusion pump feeding systems, as well as human milk fortified with donor human milk-based and bovine milk-based human milk fortifier using an in vitro model. Feeding method was significantly associated with fat and Ca losses, with increased losses in continuous feeds. Fat losses in continuous feeds were substantial, with 40 ± 3 % of initial fat lost during the feeding process. After correction for feeding method, human milk fortified with donor milk-based fortifier was associated with significantly less loss of Ca (8 ± 4% vs. 28 ± 4%, p< 0.001), Phos (3 ± 4% vs. 24 ± 4%, p < 0.001), and fat (17 ± 2% vs. 25 ± 2%, p = 0.001) than human milk fortified with a bovine milk-based fortifier (Mean ± SEM).
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1638
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Patel SJ, Oshodi A, Prasad P, Delamora P, Larson E, Zaoutis T, Paul DA, Saiman L. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. Pediatr Infect Dis J 2009; 28:1047-51. [PMID: 19858773 DOI: 10.1097/INF.0b013e3181b12484] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) 12-Step Campaign to Prevent Antimicrobial Resistance was launched to educate clinicians about antimicrobial resistance and provide strategies to improve clinical practice, including antimicrobial utilization. METHODS A multicenter retrospective observational study of antibiotic use was performed in 4 tertiary care NICUs to assess adherence to the guidelines defined by the CDC 12-Step Campaign using predetermined criteria. Fifty infants per NICU were identified who received intravenous antibiotics at greater than 72 hours of age. Antibiotic regimens, clinical and microbiologic data, and indications for initiation and continuation of antibiotics (after 72 hours of use) were recorded. Inappropriate utilization was characterized at initiation, continuation, by agent, and by CDC 12-Step. RESULTS Two hundred neonates received 323 antibiotic courses totaling 3344 antibiotic-days. Ninety (28%) courses and 806 (24%) days were judged to be nonadherent to a CDC 12-Step. Inappropriate use was more common with continuation of antibiotics (39%) than with initiation (4%) of therapy. Vancomycin was the most commonly used drug (n = 895 antibiotic-days) of which 284 (32%) days were considered inappropriate. Carbapenems were used less frequently (n = 310 antibiotic-days), and 132 (43%) of these days were inappropriate. Common reasons for nonadherence at the time of continuation included failure to narrow antibiotic coverage after microbiologic results were known and prolonged antibiotic prophylaxis after surgery with chest tube placement. CONCLUSIONS The CDC 12-Step Campaign can be modified for neonatal populations. Inappropriate antibiotic prescribing was common in the study NICUs. Improvement efforts should target antibiotic use 72 hours after initiation, particularly focusing on narrowing therapy and instituting protocols to limit prophylaxis.
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1639
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Abstract
OBJECTIVE Currently, there is no standardized approach to the calculation of growth velocity (GV; g kg (-1) day(-1)) in hospitalized very low birth weight (VLBW) infants. Thus, differing methods are used to estimate GV, resulting in different medical centers and studies reporting growth results that are difficult to compare. The objective of this study was to compare actual GV calculated from infant daily weights during hospitalization in a Neonatal Intensive Care Unit (NICU) with estimated GV using two mathematical models that have been shown earlier to provide good estimated GVs in extremely low birth weight (ELBW) infants: an exponential model (EM) and a 2-Point model (2-PM). STUDY DESIGN Daily weights from 81 infants with birth weights (BWs) of 1000 to 1499 g were used to calculate actual GV in daily increments from two starting points: (1) birth and (2) day of life (DOL) of regaining BW. These daily GV values were then averaged over the NICU stay to yield overall NICU GV from the two starting points. We compared these actual GV with estimated GV calculated using the EM and 2-PM methods. RESULTS The mean absolute difference between actual and EM estimates of GV showed <1% error for 100% of infants from both starting points. The mean absolute difference between actual and 2-PM estimates showed <1% error for only 38 and 44% of infants from birth and regaining BW, respectively. The EM was unaffected by decreasing BW and increasing length of NICU stay, whereas the accuracy of the 2-PM was diminished significantly (P<0.001) by both factors. CONCLUSION In contrast to the 2-PM, the EM provides an extremely accurate estimate of GV in larger VLBW infants, and its accuracy is unaffected by common infant factors. The EM has now been validated for use in all VLBW infants to assess growth and provides a simple-to-use and consistent approach.
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Affiliation(s)
- Aloka L Patel
- Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Janet L Engstrom
- College of Nursing, Rush University Medical Center, Chicago, IL, United States
| | - Paula P Meier
- College of Nursing, Rush University Medical Center, Chicago, IL, United States
| | - Briana J Jegier
- College of Nursing, Rush University Medical Center, Chicago, IL, United States
| | - Robert E Kimura
- Pediatrics, Rush University Medical Center, Chicago, IL, United States
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1640
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Abstract
SQUID Array for Reproductive Assessment is a unique magnetoencephalography device designed for the noninvasive recording of fetal brain activity. In this article, we provide a general overview of the technology and its potential application to fetal medicine. A large number of studies that have been conducted and published describing this device since it was brought into operation are referenced throughout the article.
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Affiliation(s)
- Curtis L Lowery
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, AR 72205, USA.
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1641
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Armstead WM, Ganguly K, Kiessling JW, Chen XH, Smith DH, Higazi AAR, Cines DB, Bdeir K, Zaitsev S, Muzykantov VR. Red blood cells-coupled tPA prevents impairment of cerebral vasodilatory responses and tissue injury in pediatric cerebral hypoxia/ischemia through inhibition of ERK MAPK activation. J Cereb Blood Flow Metab 2009; 29:1463-74. [PMID: 19436314 PMCID: PMC2719676 DOI: 10.1038/jcbfm.2009.61] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Babies experience hypoxia (H) and ischemia (I) from stroke. The only approved treatment for stroke is fibrinolytic therapy with tissue-type plasminogen activator (tPA). However, tPA potentiates H/I-induced impairment of responses to cerebrovasodilators such as hypercapnia and hypotension, and blockade of tPA-mediated vasoactivity prevents this deleterious effect. Coupling of tPA to red blood cells (RBCs) reduces its central nervous system (CNS) toxicity through spatially confining the drug to the vasculature. Mitogen-activated protein kinase (MAPK), a family of at least three kinases, is upregulated after H/I. In this study we determined whether RBC-tPA given before or after cerebral H/I would preserve responses to cerebrovasodilators and prevent neuronal injury mediated through the extracellular signal-related kinase (ERK) MAPK pathway. Animals given RBC-tPA maintained responses to cerebrovasodilators at levels equivalent to pre-H/I values. cerebrospinal fluid and brain parenchymal ERK MAPK was elevated by H/I and this upregulation was potentiated by tPA, but blunted by RBC-tPA. U0126, an ERK MAPK antagonist, also maintained cerebrovasodilation post H/I. Neuronal degeneration in CA1 hippocampus after H/I was not improved by tPA, but was ameliorated by RBC-tPA and U0126. These data suggest that coupling of tPA to RBCs offers a novel approach toward increasing the benefit/risk ratio of thrombolytic therapy for CNS disorders associated with H/I.
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Affiliation(s)
- William M Armstead
- Department of Anesthesiology and Critical Care, 3620 Hamilton Walk, JM3, University of Pennsylvania, Philadelphia, PA l9l04, USA.
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1642
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Ramani S, Iturriza-Gomara M, Jana AK, Kuruvilla KA, Gray JJ, Brown DW, Kang G. Whole genome characterization of reassortant G10P[11] strain (N155) from a neonate with symptomatic rotavirus infection: identification of genes of human and animal rotavirus origin. J Clin Virol 2009; 45:237-44. [PMID: 19505846 PMCID: PMC2913240 DOI: 10.1016/j.jcv.2009.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 04/28/2009] [Accepted: 05/03/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Rotavirus G10P[11] strains have long been associated with asymptomatic neonatal infections in some parts of India. We have previously reported G10P[11] strains associated with both asymptomatic infections and severe gastrointestinal disease in neonates from Vellore in southern India, with >90% partial nucleotide and amino acid identity to the VP4, VP6, VP7 and NSP4 genes of the exclusively asymptomatic G10P[11] strain I321. OBJECTIVES In this study, the whole genome of a G10P[11] isolate (N155) from a neonate with severe gastrointestinal disease was characterized to determine whether there were significant differences in its genetic makeup in comparison to G10P[11] strain I321 and to establish the origin of the G10P[11] strains in Vellore. STUDY DESIGN PCR amplification and complete genome sequencing was carried out for all 11 gene segments of symptomatic G10P[11] rotavirus isolate N155. Nucleotide and amino acid sequence similarity with I321, other human and bovine strains for each gene segment were determined. The origin of each gene was determined based on the degree of identity to bovine or human rotavirus strains. RESULTS N155 was found to be a reassortant between human and bovine rotaviruses. With the exception of NSP2, gene sequences of strain N155 showed >90% identity to published sequences of I321. Gene segments encoding NSP1, 2 and 3 were of human rotavirus origin for both strains; however, phylogenetic analysis of NSP2 sequences indicated that the human parental strain that led to the origin of these bovine-human reassortant strains was different. There were no significant differences between NSP2 sequences of strains from symptomatic and asymptomatic neonates in the same setting. CONCLUSIONS The study shows that the difference in clinical presentations in neonates may not be due to the limited variability in the genome sequence of G10P[11] strains and that G10P[11] strains in different parts of India could have evolved through reassortment of different parental strains.
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Affiliation(s)
- Sasirekha Ramani
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, India
| | - Miren Iturriza-Gomara
- Virus Reference Department, Centre for Infection, Health Protection Agency, London, United Kingdom
| | - Atanu Kumar Jana
- Department of Neonatology, Christian Medical College, Vellore, India
| | | | - James J. Gray
- Virus Reference Department, Centre for Infection, Health Protection Agency, London, United Kingdom
| | - David W. Brown
- Virus Reference Department, Centre for Infection, Health Protection Agency, London, United Kingdom
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, India
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1643
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Abstract
PURPOSE OF REVIEW Antenatally detected renal abnormalities are frequently encountered. Recommended postnatal evaluation of these infants has evolved to minimize invasive testing while maximizing detection of significant abnormalities. RECENT FINDINGS There is a low rate of detectable renal abnormalities in infants with a normal postnatal sonogram at 4-6 weeks of age. Routine prophylactic antibiotics are not indicated in infants with isolated antenatal hydronephrosis. Infants with a multicystic dysplastic kidney and a normal contralateral kidney on renal ultrasound do not require further evaluation. Parents of these children should be counseled on symptoms of urinary tract infections to allow prompt diagnosis. SUMMARY All infants with abnormalities on antenatal sonogram should undergo postnatal evaluation with a sonogram after birth and at 4-6 weeks of age. Further evaluation can be safely limited when the postnatal sonogram is normal at 6 weeks of age.
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1644
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Abstract
OBJECTIVE This study examined parental beliefs about participating in clinical trials involving greater than minimal risk to their neonate, and explored their views of their experiences. STUDY DESIGN In this qualitative descriptive study, parents in the neonatal intensive care unit (NICU) who had been approached for permission for their neonates to be enrolled in research were asked to describe their decisions about their consent for or disagreement to their neonate's research participation. A total of 27 parents from three different hospital NICUs in the Mid-Atlantic region of the United States participated. Transcribed interviews were analyzed using qualitative content analysis. RESULTS Participant decisions developed through a dynamic process of meaning-making based on their beliefs about themselves and their neonates. The processes involved making sense of the chaos that they perceived in the environment and their own vulnerability, through taking control of their situation.
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1645
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Jadcherla SR, Stoner E, Gupta A, Bates DG, Fernandez S, Di Lorenzo C, Linscheid T. Evaluation and management of neonatal dysphagia: impact of pharyngoesophageal motility studies and multidisciplinary feeding strategy. J Pediatr Gastroenterol Nutr 2009; 48:186-92. [PMID: 19179881 DOI: 10.1097/MPG.0b013e3181752ce7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy. METHODS Twenty dysphagic neonates (mean gestation +/- standard deviation [SD] = 30.9 +/- 4.9 weeks; median 31.1 weeks; range = 23.7-38.6 weeks) with abnormal VSS results were evaluated at 49.9 +/- 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding. RESULTS At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P < 0.05) between the primary oral feeders versus the chronic tube feeders for swallow frequency, swallow propagation, presence of adaptive peristaltic reflexes, oral feeding challenge test results, and upper esophageal sphincter tone. VSS results or disease characteristics had little effect on the feeding outcomes (P = NS). CONCLUSIONS Swallow-integrated esophageal motility studies permit prolonged evaluation of swallowing reflexes and responses to stimuli under controlled conditions at cribside. The dysfunctional neuromotor mechanisms may be responsible for neonatal dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs.
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1646
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Beneri CA, Nicolau DP, Seiden HS, Rubin LG. Successful treatment of a neonate with persistent vancomycin-resistant enterococcal bacteremia with a daptomycin-containing regimen. Infect Drug Resist 2008; 1:9-11. [PMID: 21694874 PMCID: PMC3108720 DOI: 10.2147/idr.s3649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Infections caused by vancomycin-resistant enterococci (VRE) may be difficult to treat because of the limited armamentarium of antimicrobial agents. The difficulty is compounded in pediatric patients in general and neonates in particular because many of the newer antimicrobials have not been studied or approved for children. We report a 3-week-old infant who developed enterococcal bacteremia on post-operative day 10 after a surgical palliation for complex congenital heart disease that was complicated by acute renal failure. Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted. It was not cleared until daptomycin (in combination with doxycycline) was started. This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.
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Affiliation(s)
- Christy A Beneri
- Pediatric Infectious Diseases, Schneider Children's Hospital - North Shore-LIJ Health System, New Hyde Park, New York, USA
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1647
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Abstract
The use of drugs for indications unapproved by the Food and Drug Administration (FDA), often called "off label use, "is widespread in children, including neonates. The widespread off-label use of drugs in neonates presents ethical and safety challenges. Since the passage of the Best Pharmaceuticals for Children Act (BPCA) in 2002, both the FDA and National Institutes of Health (NIH) have taken initiatives to facilitate and encourage research to achieve the necessary labeling for drugs routinely used in infants and children. Federal regulations provide broad rules and guidance for the protection of human subjects in research. However, there are ethical issues that a physician may face when designing clinical trials of drugs in neonates that are routinely used off-label and widely believed to be beneficial. We attempt to describe these ethical challenges and provide recommendations, including alternative study designs, to resolve them in an ethical framework that takes into account the Belmont Report, the statement of the World Medical Association (WMA), and federal regulations.
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Affiliation(s)
- Sanjiv B Amin
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA.
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1648
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Abstract
Viral infection of the central nervous system (CNS) can result in a multitude of responses including pathology, persistence or immune clearance. Lymphocytic choriomeningitis virus (LCMV) is a powerful model system to explore these potential outcomes of CNS infection due to the diversity of responses that can be achieved after viral inoculation. Several factors including tropism, timing, dose and variant of LCMV in combination with the development or suppression of the corresponding immune response dictates whether lethal meningitis, chronic infection or clearance of LCMV in the CNS will occur. Importantly, the functionality and positioning of the LCMV-specific CD8+ T cell response are critical in directing the subsequent outcome of CNS LCMV infection. Although a basic understanding of LCMV and immune interactions in the brain exists, the molecular machinery that shapes the balance between pathogenesis and clearance in the LCMV-infected CNS remains to be elucidated. This review covers the various outcomes of LCMV infection in the CNS and what is currently known about the impact of the virus itself versus the immune response in the development of disease or clearance.
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Affiliation(s)
- Silvia S. Kang
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037
| | - Dorian B. McGavern
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037
- Harold L. Dorris Neurological Research Institute, The Scripps Research Institute, La Jolla, CA 92037
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1649
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Cohen-Wolkowiez M, Smith PB, Benjamin DK Jr, Fowler VG Jr, Wade KC. Daptomycin use in infants: report of two cases with peak and trough drug concentrations. J Perinatol 2008; 28:233-4. [PMID: 18309318 DOI: 10.1038/sj.jp.7211898] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report two infants treated with daptomycin for methicillin-resistant Staphylococcus aureus infection and describe peak and trough blood concentrations measured during therapy. The peak concentrations were 41.7 and 36.7 mcg ml(-1), and the 12-hour trough concentrations were 12.7 and 16.3 mcg ml(-1), respectively. Even though the infants received higher doses than adults, their drug concentrations were comparable to those observed in adults treated with regular dosing of daptomycin.
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1650
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Chanbang Y, Arthur FH, Wilde GE, Throne JE, Subramanyam B. Susceptibility of eggs and adult fecundity of the lesser grain borer, Rhyzopertha dominca, exposed to methoprene. J Insect Sci 2008; 8:1-5. [PMID: 20233095 PMCID: PMC3127415 DOI: 10.1673/031.008.4801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/26/2007] [Indexed: 05/28/2023]
Abstract
A series of tests were conducted to determine the susceptibility of eggs and neonates of the lesser grain borer Rhyzopertha dominica (F.) (Coleoptera: Bostrichidae = Bostrychidae), exposed to the insect growth regulator, methoprene, on filter paper and on rough rice. In the first test, the hatch rate of eggs exposed on filter paper treated with methoprene at the label rate of 0.003 mg [AI]/cm(2) when used as a surface treatment in structures was 52.0 +/- 7.3% compared to 93.0 +/- 3.3% on untreated controls. In the second test, eggs were exposed to a dose-response series of 0.00003 to 0.03 mg[AI]/cm(2). Egg hatch was directly proportional to concentration and ranged from 85.0 +/- 2.0% on untreated controls to 26.7 +/- 8.3% at the highest concentration tested. In the third test, 1 ppm of methoprene was sprayed on long grain rough rice (paddy) (Cocodrie variety), and then individual kernels were cracked and an egg of R. dominica was placed directly on the kernel. On untreated rice kernels, 67.5 +/- 11.6% of the eggs hatched and were able to bore inside, and all of these larvae emerged as adults. In contrast, 40.0 +/- 5.3% of the eggs placed on treated cracked kernels were able to develop to where the larvae were visible through X-ray detection, but none emerged as adults. In the final test, newly-emerged adults were exposed on rough rice treated with 1 ppm methoprene. The number of eggs from adults on untreated rice was 52.1 +/- 4.3 eggs per female, and on treated rice the average egg production was 12.5 +/- 1.1 eggs per female. Methoprene applied on a surface or on rough rice affected development of egg hatch also reduced fecundity of parent adults exposed on the treated rough rice.
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Affiliation(s)
| | - F. H. Arthur
- USDA-ARS Grain Marketing and Production Research Center, 1515 College Avenue Manhattan, KS, 66502
| | - G. E. Wilde
- Department of Entomology, Kansas State University, 123 W. Waters Hall, Manhattan, KS, 66506-4404
| | - J. E. Throne
- Department of Grain Science and Industry, Kansas State University, 210 Shellenberger Hall, Manhattan, KS, 66506-4404
| | - Bh. Subramanyam
- Department of Grain Science and Industry, Kansas State University, 210 Shellenberger Hall, Manhattan, KS, 66506-4404
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