BACKGROUND:The long-term association between exposure to air pollution-particularly during early life-and hand, foot, and mouth disease (HFMD) remains unclear. Moreover, evidence is lacking regarding the potentially differential effects of PM2.5 constituents on HFMD. METHODS:We included 41,256 children aged 0-6 years from a nationwide survey covering 15 Chinese provinces in 2013. Using satellite-based exposure models, we estimated the levels of air pollutants at each child's residence. Logistic regression models were used to assess the long-term associations between exposure to criteria air pollutants and PM2.5 constituents during different time windows and HFMD. RESULTS:Early-life exposure to fine particulate matter (PM2.5), coarse particulate matter (PM2.5-10), nitrogen dioxide (NO2), and ozone (O3) was linked to increased odds of HFMD. During pregnancy as well as the first two years are critical exposure windows. PM2.5-10 presented the largest effects on HFMD, followed by O3. Odds ratios with 95 % confidence intervals of HFMD per interquartile range increase during the entire pregnancy were 1.19 (1.09-1.29), 1.44 (1.32-1.57), and 1.26 (1.14-1.39) for PM2.5, PM2.5-10, and O3, respectively. During the first year after birth, odds ratios were 1.16 (1.07-1.26), 1.37 (1.26-1.49), 1.12 (1.03-1.22), and 1.31 (1.20-1.43) for PM2.5, PM2.5-10, NO2, and O3, respectively. Among constituents, nitrate presented the strongest association with HFMD, followed by ammonium, and sulfate. Children 3 years and under, those who spend more time outdoors and those in rural settings were more susceptible. The exposure response curves demonstrated an approximately linear relationship between air pollutants and HFMD. CONCLUSIONS:Our findings provided first-hand evidence linking early-life air pollution exposure with heightened HFMD risk in children, highlighting the need for air quality interventions to mitigate pediatric health impacts, particularly during pregnancy and the first two years of life.

Background Mothers’ perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explor e the relationship between maternal perceptions of infant hunger cues and different feeding methods. Methods A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers’ perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators. Results We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant’s “hand sucking” (67.6% vs. 53.6%) and “moving head frantically from side to side” (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01–2.85), “hand sucking” (OR = 1.72, 95% CI: 1.04–2.87), “moving head frantically from side to side” (OR = 2.07, 95% CI: 1.19–3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure. Conclusion EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

Neonatal asphyxia is a leading cause of neonatal death that is largely preventable with neonatal resuscitation techniques. In July 2004, China launched a 15-year, three-stage Neonatal Resuscitation Programme (NRP) with stages in 2004-2009, 2011-2016, and 2017-2021 ( 1). The objective of China's NRP was to ensure the presence of at least one trained attendant proficient in neonatal resuscitation at every delivery. With consistent effort, both incidence and mortality from neonatal asphyxia decreased remarkably during 2003-2020: incidence decreased from 6.32% to 1.42% and mortality decreased from 0.76‰ to 0.19‰ ( 1- 2). China's empirical experience shows that widespread promotion of high-quality neonatal resuscitation techniques can reduce preventable neonatal deaths and provide important insight into "ending preventable deaths in newborns by 2030," as proposed in the United Nations Sustainable Development Goal's third target ( 3).

目的 了解我国12省高危儿管理项目试点区高危儿风险因素现状,为各地推进高危儿管理服务提供参考依据.方法 以12省48个区/县妇幼保健机构2020年第4季度发现的高危儿为研究对象,采用高危儿风险分类筛查表调查东中西部地区4类风险因素的发现情况.结果 48个试点区/县共发现高危儿9792例,发现率21.58％,其中东、中、西部发现率分别为24.71％、12.70％和23.10％,城市和农村分别为16.98％和27.22％.纳入高危儿管理的风险因素中,个体生物学因素和家庭生物学因素的发现率分别为14.08％和10.11％,家庭环境因素发现率仅为0.01％.不同地区多数风险因素的发现率有显著差异(P<0.05),呈东部高于西部、中部的趋势.按高危儿分级分类管理要求,试点地区发现的高危儿总转诊率为54.37％,其中区县级转诊率64.43％,市级以上机构转诊率2.27％.结论 项目试点结果提示存在高危因素的儿童在人群中占一定比例,有必要制定政策开展公共卫生管理.不同地区和城乡间高危儿发现率存在差异,且对于不同类型风险因素的发现能力不同,建议通过培训等形式提高和加强重点地区、重点类型高危儿的发现和管理,因地制宜地制定转诊策略.

目的 了解湖南省医疗保健机构新生儿早期基本保健服务现状,为开展有针对性的新生儿保健干预提供依据.方法 采用随机抽样方法,于2017年11-12月抽取湖南省长沙市和株洲市各4所助产机构的住院产妇进行问卷调查,收集分娩期间新生儿早期基本保健服务措施的开展情况.采用SPSS 23.0统计软件进行数据分析,比较不同级别医院服务措施开展率的差异.结果 720例产妇中41.8％的产妇表示在新生儿出生后立即进行了母婴皮肤接触,但仅有28.1％的皮肤接触持续时间在90 min及以上.新生儿出生24 h后洗澡的占42.3％.86.1％的新生儿在停止皮肤接触前完成首次母乳喂养,71.5％的新生儿出院前喂养方式为纯母乳喂养.接受延迟断脐(断脐时间不早于生后1 min)的新生儿占94.8％.市级机构大多数干预措施的实施率均高于县级机构.结论 湖南省助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应加强宣传和培训,促进医务人员对新生儿早期基本保健措施相关知识和技能的了解与应用.

What is already known about this topic? The Early Essential Newborn Care (EENC) intervention package recommended by World Health Organization (WHO) is shown to prevent and treat the leading causes of newborn illness and death. China has begun widespread implementation of the EENC. What is added by this report? Among the 14 core interventions, including using antibiotics for mothers with premature rupture of membranes, immediate skin-to-skin contact of mother and baby, delayed umbilical cord clamping, kangaroo mother care for preterm newborn, and neonatal sepsis and pneumonia management, were not sufficiently implemented in health facilities in western China. What are the implications for public health practice? There are gaps between the implementation situation and WHO recommendations in terms of EENC capacities in western China. Targeted interventions developed accordingly can ensure quality child health care and decrease newborn mortality in China.

目的 筛选我国儿童发育里程碑评价指标,构建适用于中国的儿童发育筛查量表.方法 采用专家咨询法,通过确定咨询专家、设计咨询表征求意见及整理分析初步筛选出我国儿童发育里程碑的评价指标.结果 在全国范围内17位专家参与咨询,专家权威系数均在0.8以上,专家权威程度的均值为0.89.筛选出满足均数≥4,变异系数＜0.25的儿童发育里程碑指标327条,涉及大运动、精细运动、认知、语言、社交及情绪5个能区.结论 本次研究咨询的专家具有较好的代表性,指标筛选的一致度高,初步建立了儿童发育里程碑评价指标体系,为进一步开发儿童发育评估工具奠定了基础.

目的 了解我国西部四省县乡助产机构新生儿早期基本保健技术能力现状,为制定有针对性的干预措施提供依据.方法 采用信函调查方式,于2017年6月-2018年9月收集贵州、青海、四川、宁夏4省(区)21个县的助产机构数据,采用描述性统计方法分析各省新生儿早期基本保健干预措施的开展情况,采用x2检验比较不同级别机构的干预措施实施率.结果 233所县、乡级助产机构参与调查.1)孕产妇相关干预措施:高危孕妇管理率(98.9％)、梅毒孕妇治疗率(97.9％)、孕妇叶酸服用率(88.8％)等均处于较高水平,早产儿胎膜早破母亲使用抗生素治疗的比例较低(60.1％).2)新生儿分娩后相关于预措施:出生后进行90 min母婴皮肤接触的比例为41.8％,生后1h内完成首次母乳喂养的比率为77.7％,开展早产儿袋鼠式护理的机构比例为24.7％.3)新生儿疾病相关干预措施:可开展新生儿败血症和新生儿肺炎疾病诊疗的机构分别为33.5％和47.8％,接受肌肉注射维生素K1的新生儿比例为69.8％.结论 我国西部4省县乡级助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应针对这些不足和差距开展干预.

Objective To explore the changes in childbirth care practices and health outcomes of newborns after the introduction of early essential newborn care (EENC). Design A pre-comparison and post-comparison study. Setting The study was conducted in December 2016 and December 2018 in 18 counties in four western provinces of China. Participants 46 hospitals that provide delivery services participated in the study. Interventions EENC practices were introduced and implemented in the 46 hospitals. Outcome measures The changes of hospital indicators such as incidence of birth asphyxia and neonatal mortality were compared in 2016 and 2018. EENC coverage indicators, such as skin-to-skin (STS) contact, and time of first breast feeding were also compared before and after the intervention via interview with 524 randomly selected postpartum mothers (320 in 2016 and 204 in 2018). Results 54 335 newborns were delivered in the pre-EENC period (2016) and 58 057 delivered in the post-EENC period (2018). According to hospital records, the proportion of newborns receiving immediate STS contact increased from 32.6% to 51.2% (Risk Ratio (RR)=1.57,95% CI 1.55 to 1.59) and the percentage of newborns receiving prolonged STS contact for more than 90 min increased from 8.1% to 26.8% (RR=3.31, 95% CI 3.21 to 3.41). No statistically significant changes were found in neonatal mortality, although slight decreases in birth asphyxiate and neonatal intensive care unit admission rates were detected. Among the mothers interviewed, the proportion of newborns receiving immediate STS contact increased from 34.6% to 80.0% (RR=2.31, 95% CI 1.69 to 3.17). The exclusive breastfeeding rate increased from 43% to 73.4% (RR=1.71, 95% CI 1.43 to 2.04). The average length of the first breast feeding increased from 15.8 min to 17.1 min. Conclusions The introduction of EENC has yielded significant improvements in newborn care services at the pilot hospitals, including enhanced maternal and newborn care practices, improved STS contact quality and early breastfeeding performance. Further studies are needed to evaluate the long-term impact of EENC on newborn health outcomes.

OBJECTIVES:The aim of this study was to explore health professionals' perception of risk factors related to child maltreatment in China. DESIGN:Qualitative research. SETTING:The study was conducted in November and December 2014 in Hunan, Zhejiang, Shaanxi and Guangdong provinces in China. PARTICIPANTS:Five urban communities and five rural communities were randomly selected in each province, and interviews were conducted in maternal and child health hospitals, children's hospitals, community health service centres and township hospitals in the selected areas. Doctors, nurses and administrators involved in child healthcare services were selected for in-depth-interview. RESULTS:A total of 102 health professionals were approached but 95 completed the interview. From their perspective, risk factors causing child maltreatment were categorised into four domains: (1) cultural factors, including parents' absolute authority over their children and son preference; (2) social factors, including a fast-paced and stressful lifestyle, children left behind by migrant worker parents and lack of quality child care and education; (3) family factors, including economic status, family structure, parents' inability to provide parental care, experience of maltreatment and parents' illnesses; (4) children's factors, including gender, temper, disabilities and poor awareness of self-protection. CONCLUSIONS:The results indicate that health professionals in China are aware of certain risk factors for child maltreatment; however, some views are outdated and wrong. Based on the perception of health professionals, targeted training courses are needed to enable them to correctly identify and deal with suspected cases of child maltreatment.

Objectives: As a part of the process of implementing Early Essential Newborn Care (EENC) in China, which are evidence-based interventions recommended by the World Health Organization (WHO), we sought to understand whether current hospital policies are consistent with WHO-recommended standards and what factors influence their use. Data from the study will help inform policy changes needed to support the introduction of evidence-based childbirth and early newborn care practices effectively and to inform further scale up of EENC nationwide. Methods: Ten randomly selected hospitals in 4 early-introducing provinces participated in the study. We collected data from 20 simulated delivery scenario observations and focus group discussions and individual interviews with 10 hospital management staff. Policies, protocols, and guidelines related to childbirth and newborn care practice were also collected and reviewed at each hospital. Additionally, a survey was emailed to 15 childbirth and newborn experts from the 4 selected provinces and completed by 13. Data were compared with WHO EENC evidence-based standards to calculate the agreement rates. Barriers to introducing evidence-based guidelines were identified in focus groups and key informant interviews, then combined into common categories. Findings: Hospital policies were not consistent with WHO recommendations in 10 (59%) of the 17 delivery and early newborn care practices. Delayed cord clamping was recommended by 30% of hospital protocols and prolonged skin-to-skin contact by 13%, neither of which were observed in the delivery simulations. Kangaroo mother care (KMC) for stable preterm babies was required in only 17% of the hospitals; no preterm babies had KMC initiated, with all immediately separated from their mothers and admitted to neonatal intensive care units. Newborn resuscitation equipment was required to be placed within 2 meters of the delivery bed in 84% of hospital protocols, but was prepared in only 40% of cases. Immediate drying after birth was required in 48% of hospital protocols, but was initiated in only 20% of observed cases. Conclusions: Current childbirth and early newborn care policy and practice in China is not aligned with WHO recommendations for some major interventions. To make it easier and safer for hospital workers to practice EENC, expert working groups and national policies must be established to address inconsistencies and cultural beliefs and provide a strong, evidence-based set of guidelines for hospitals and health workers to follow.

Background West China exhibits poorer newborn health outcomes than in other parts of mainland China. Therefore, we aimed to investigate the effect of the Early Essential Newborn Care (EENC) on neonatal outcomes in west China. Methods We did an observational study of 14 counties in three west provinces of China. Licensed doctors, nurses from obstetrics and paediatrics, and midwives in each county were trained by experienced EENC facilitators. 3 months after the first EENC coaching, we did a quality control assessment to examine the effects of the EENC coaching. We examined hospitals that had the highest number of births in each county and selected post-partum mothers to be interviewed and have their medical records checked by convenience sampling. Institutional ethics approval to do this study was obtained from the Institutional Review Boards at National Centre for Women and Children's Health Care, Chinese Center for Disease Control and Prevention. We obtained written informed consent from all participants. Findings Between March 25, 2018, and May 5, 2018, we examined 14 hospitals with the highest number of births in each county, of which we selected 126 post-partum mothers. EENC has turned out to be a useful and practical tool in west China. Out of the core interventions, some practices were relatively easy to implement, such as no routine suctioning for newborn babies (increasing from 0 at baseline to 100% after EENC coaching) and bathing after 24 h of birth (from 24% to 85%). However, hospitals encountered different kinds of difficulties in the EENC implementation. For example, 90 min of skin-to-skin contact was often interrupted because of inadequate facility resources (increasing from 0 to 62%). It was also noticed that hospitals that could guarantee 90 min of skin-to-skin contact could ensure early breastfeeding initiation (p=0·002), and successful first-time breast milk intake is associated with exclusive breastfeeding from birth till interview time (p=0·001). Interpretation Hospitals need to remove all the obstacles and emphasise on the EENC recommended practices, including receiving 90 min of uninterrupted skin-to-skin contact within 1 min of birth, initiation of early and exclusive breastfeeding, and the use of neonatal nasal intermittent positive pressure ventilation. Additional communications should be encouraged among medical professionals from different regions, so ideas could be shared. Funding Hong Kong Committee for UNICEF.

近年来,我国在降低5岁以下儿童死亡率方面取得了显著成效,但其中新生儿死亡所占比例仍高于全球平均水平.为改善新生儿健康状况,进一步降低新生儿死亡率,原国家卫生和计划生育委员会于2015年引入世界卫生组织新生儿早期基本保健技术(Early Essential Newborn Care,EENC),在我国选择部分地区进行试点研究.

目的 了解阻碍医务人员报告处理可疑儿童虐待案例的因素,为儿童虐待的进一步规范性管理提供依据.方法 选取湖南、浙江、陕西、广东的妇幼保健院、儿童医院或综合医院的儿科、社区卫生服务中心和乡镇卫生院中的医务人员,采用定性研究方法,面对面进行个人深入访谈.结果 阻碍医务人员报告处理可疑儿童虐待案例的因素分为四大主题:①管理方面:缺乏对儿童虐待的完善的管理机制;②能力方面:缺乏儿童虐待的相关知识和识别处理能力;③态度方面:不认可自己须进行儿童虐待案例的报告处理;④担忧方面:担忧报告对儿童、家庭、医务人员带来不良影响.结论 《中华人民共和国反家庭暴力法》填补了儿童虐待管理机制的空白,但为促进医务人员对儿童虐待案例的报告处理,还需提高医务人员能力、打消其顾虑.

Objective To evaluate the effects of the second phase of Neonatal Resuscitation Program (NRP) in China. Methods A mail survey and an onsite assessment were conducted to collect data. (1) Mail survey: Different levels of domestic hospitals (except those in Tibet, Hong Kong, Macao and Taiwan) were randomly selected to collect information on in-hospital NRP training, resuscitation equipments, incidence of birth asphyxia and neonatal mortality caused by birth asphyxia from year 2010 to 2014. (2) Onsite assessment: One provincial level, two prefecture level and two county level hospitals or healthcare institutions were randomly selected in four provinces. A questionnaire survey was conducted among randomly selected health workers including midwives, obstetricians and pediatricians. Megacode performance of those health workers was evaluated. Trend Chi-square test was used for statistical analysis. Results (1) Questionnaires were gathered from 347 hospitals via the mail survey with a response rate of 74.6% (347/465). In the 347 hospitals, 97.5% (10410/10674) of the obstetricians, paediatricians, and midwives received in-hospital training, and 72.7% (7765/10674) of them received training from county or above level. (2) In the onsite assessment of the four provinces, 205 health workers were randomly selected and completed the questionnaire survey. Among them, 85.4%(175/205) received training more than three times, 52.7% (108/205) received over two days of training in the previous training workshops, but only 62.0% (127/205) could share one set of training manikin with less than eight trainees in training workshops. Megacode performance of 96 health workers was evaluated. The results showed that all of the health workers were qualified in terms of total score and achieved an average score of over 1.5 in the performance of every primary resuscitation skill. Health workers attained relatively high scores in performing initial steps in resuscitation and tracheal intubation, and in identifying the indication of chest compression and epinephrine administration. However, their average scores in preparation for resuscitation, positive pressure ventilation and teamwork were relatively low. (3) Over 90% of the 347 hospitals had basic resuscitation equipment such as neonatal bag and mask, devices for tracheal intubation and radiation warmer. But fewer were equipped with umbilical venous catheter, T-piece or oxygen-air blender, especially at the county level hospitals. The incidence of neonatal asphyxia decreased from 2.33%(7810/335190) in 2010 to 1.79%(9227/515481) in 2014. The mortality from asphyxia at birth decreased from 2.41 to 1.64 per 10000 live births [(81/335190) and (85/515481)]. Trend analysis revealed that the incidence of neonatal asphyxia (χ2trend=20.56, P<0.01) and the mortality at birth (χ2trend=77.34, P<0.01) declined over time. Conclusions The second phase of NRP has promoted the generalization of the neonatal resuscitation technology and resulted in decreased incidence of asphyxia and asphyxial mortality. Future programs should focus on measures to improve practical skills and teamwork, to increase the allocation of resuscitation equipment and to strengthen trainings among obstetricians and midwives.

Objective To study on application and effects of coaching in popularizing early essential newborn care guideline and provide clinical training with new idea and method.Methods One province level and one district level maternal and child health hospital in Beijing,Shaanxi and Sichuan were chosen as pilot hospitals.Healthcare professionals were coached during 2 days.The effects were analyzed by comparing the score of theoretical knowledge,practice on washing hands and delivery practice for the breathing baby and non-breathing baby before and after coaching.3 months after coaching,10 maternal were randomly sampled for interviews every hospital to analyze the implementation of neonatal health care measures after intervention.Results Total healthcare professionals got higher score after coaching(16.82±1.00) than before (11.90± 2.68)(P＜0.001).Heahhcare professionals in Beijing,Shaanxi and Sichuan all improved the skills of washing hands,and cleanliness of hands improved significantly(P＜0.001).The median score of delivery practice for the breathing baby and non-breathing baby was 41 and 58.After 3 months,87％ (52/60) of mothers had skin-to-skin contact with newborns after childbirth,and the mother to child skin contact rate was 55％ (33/60) within one minute after childbirth,and skin contact continued for 90 minutes accounting for 47％ (28/60);breastfeeding rate before discharge reached 77％ (46/60),exclusive breastfeeding rate was 48％ (29/60).Conclusions Coaching can be effectively used in early essential newborn care and can help healthcare professionals understand and use early essential newborn care guideline well.Coaching should be populated in future clinical practices.

Although China has advanced as a leading economic world power since World War II, its perinatal health outcomes, including neonatal mortality, have lagged behind those of other rapidly developing countries. Some factors behind the relatively high neonatal mortality rate include geographic challenges to providing health care in rural regions and disparities in care across different levels of hospitals. To tackle the problem of neonatal mortality, specifically to reduce birth asphyxia, key stakeholders have worked to implement the Neonatal Resuscitation Program and Helping Babies Breathe initiatives across China in the past decade. These efforts have already borne fruit in improving clinical care and are likely to provide further benefit in improving long-term outcomes.

通过查阅医院病历和问卷调查，采用发病率法测算全国新生儿出生窒息的直接经济负担，为评价相关政策的成本效果提供理论依据。结果显示，出生窒息带来的疾病经济负担巨大，推广新生儿复苏技术、降低出生窒息的发生率和死亡率具有良好的经济效益。