小于胎龄儿血生化营养指标研究

为提高小于胎龄儿今后的生活质量,探讨其出生后即刻血生化指标的变化,以正确评价小于胎龄儿出生时营养状况,对我科2000年1月～2005年5月出生的早产小于胎龄儿、足月小于胎龄儿、足月适于胎龄儿的血生化营养指标进行比较,现将结果总结如下。1资料与方法1.1临床资料早产小于胎龄儿(A组)27例,胎龄30～36(33.04±1.51)周,体重1020～1565(1235.67±145.57)g;足月小于胎龄儿(B组)35例,胎龄37～41(38.33±1.06)周,体重1500～2000(1801.67±123.99)g;足月适于胎龄儿(C组)30例,胎龄37～41(38.87±1.31)周,体重2595～3885(3331.94±363.20)g。出生时…     

早产儿血中血小板活化因子水平的研究

目的研究早产儿血中血小板活化因子(PAF)水平的变化,探讨PAF在早产儿发育、成熟中的作用。方法采用ELISA方法测定35例早产儿和15例健康足月儿血中PAF水平,并分析早产儿血中PAF水平与早产儿胎龄、体重之间的相关性。结果早产儿血中PAF水平[(9·44±3·31)pg/ml]比足月新生儿[(44·1±12·0)pg/ml]低,血PAF水平与早产儿胎龄呈显著正相关(r=0·557,P<0·001),与出生体重呈显著正相关(r=0·536,P<0·001)。结论在生理情况下PAF可能与早产儿发育、成熟有关。     

Safety,tolerability, and effectiveness of oral zonisamide therapy in comparison with intramuscular adrenocorticotropic hormone therapy in infants with West syndrome

West syndrome is a distinct, infantile onset, epileptic encephalopathy, associated with poor neurodevelopmental outcome. The present study was designed as a randomized, open-label, pilot study to evaluate the safety, feasibility, and effectiveness of oral zonisamide therapy in comparison with adrenocorticotropic hormone therapy in infants with West syndrome. Thirty infants with West syndrome were randomized to receive treatment with either synthetic, intramuscular adrenocorticotropic hormone (30–60 IU) or oral zonisamide (4–25 mg/kg/day). The study participants had a long treatment lag and preponderance of male sex (90%). The primary effectiveness outcome measure was the cessation of epileptic spasms at 2 weeks of initiation of therapy and persistent till 6 weeks as per West Delphi consensus statement recommendations. Comparison of efficacies of zonisamide versus adrenocorticotropic hormone was as following: the cessation of epileptic spasms (27% vs. 40%, p = 0.70), resolution of hypsarrhythmia at 14 days (20% vs. 33%, p = 0.68) and resolution of hypsarrhythmia at 6 weeks (36% vs. 71%, p = 0.14). Overall, the study observed a poor efficacy of both adrenocorticotropic hormone and zonisamide therapy, which is probably due to long treatment lag and a high proportion of structural aetiology. However, oral zonisamide appeared to be safe and tolerable in the study.     

基于常规和三元整合教育方案对超低出生体重儿住院期间父母焦虑抑郁影响的历史对照研究

目的 评价专业人员-父母-住院早产儿三元整合教育方案(三元整合教育方案)在超低出生体重早产儿(ELBW)中的临床应用效果。方法 选取复旦大学附属儿科医院2个年度ELBW的连续样本,对照组常规护理教育方案,实验组三元整合教育方案,采用贝克焦虑量表 (BAI)和贝克抑郁量表第2版(BDI-Ⅱ)作为评价焦虑和抑郁的工具,比较不同教育方案父母的焦虑、抑郁程度的差别和父母入院时和出院前焦虑、抑郁水平。结果 实验组79对父母、对照组64对父母进入本文分析。实验组ELBW平均孕周小于对照组,试管婴儿比例高于对照组,机械通气时间长于对照组,但住院时间并不长于对照组,母乳喂养率也较对照组明显增高,差异均有统计学意义。入院时实验组和对照组BAI粗分[(18.9±9.8)vs (17.1±10.2)]和BDI-Ⅱ评分[(17.2±8.8)vs (16.0±9.0)],中重度焦虑[(37/128) vs (36/158)]和中重度抑郁的例数[(38/128) vs (51/158)],差异均无统计学意义;实验组和对照组出院时较入院时BAI粗分下降了(11.0±6.5)分和(8.5±2.3)分,BDI-Ⅱ评分下降了(11.3±8.1)分和(9.1±7.9)分,中重度焦虑和中重度抑郁的例数均有明显下降,差异均有统计学意义;实验组焦虑和抑郁评分改善值好于对照组,差异有统计学意义。入院时父亲焦虑和抑郁评分均较高于母亲,差异均有统计学意义。结论 三元整合教育方案明显降低了ELBW父母焦虑、抑郁的水平,在单中心的历史对照研究中得到较好的验证。     

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.     

Which advises for primary food allergy prevention in normal or high‐risk infant?

In the last decades, international guidelines proposed different strategies of complementary foods introduction during weaning to prevent allergy. Avoidance measures, such as late introduction of allergenic foods, failed to show a significant preventive effect towards allergy. Recently, prospective randomized controlled studies suggested that the early introduction of solid foods ‐ rather than the late introduction ‐ could be a strategy to prevent allergic sensitization and food allergy. However, at today clear evidence of effectiveness and safety of early introduction are not yet available to recommend a radical change in the current clinical practice. A realistic advice for the general population could be to begin the weaning at 4–5 months with the progressive introduction of different foods. The advices for introduction of solid foods during weaning should also take in consideration the global development of child to chose the better timing of introduction of foods.     

Perspective of parents and caregivers on the influence of full-time day-care attendance on young children

The aim of this study was to explore the experience of parents and caregivers regarding young children in day care. The tiredness of children after day-care attendance was explored. In the autumn of 2009, 41 parents and 35 caregivers of children aged 1.5 years or younger living in the city of Trondheim and nearby communities were assessed using a semi-structured qualitative interview. There was agreement among parents and caregivers that children became very tired after full-time care. In spite of the good quality of the care, with a relatively low child/adult ratio and very experienced caregivers with high educational qualifications, most children became very tired at the end of the stay. Tiredness in children also seemed to accumulate during the week and reached its peak on Fridays. The children adjusted well to care; however, they got very tired when the stay lasted a full day. Children who were picked up somewhat earlier did not exhibit the same level of tiredness.