静脉应用小剂量红霉素防治早产儿喂养不耐受的Meta分析

目的对静脉应用小剂量红霉素防治早产儿喂养不耐受的疗效和安全性的相关文献进行Meta分析,为早产儿喂养不耐受的治疗提供参考依据。方法检索Cochrane图书馆、PubMed、EMBASE、在研试验数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库等。检索红霉素防治早产儿喂养不耐受的RCT文献。按Cochrane系统评价方法进行文献质量评价,采用RevMan5．0．17软件进行Meta分析。结果共纳入18篇RCT文献,文献质量评价A级1篇,B级3篇,C级14篇。共纳入1200例早产儿。Meta分析结果显示：①达到全肠内喂养时间：红霉素预防组加权均数差值（WMD）=-4．18（95％CI：-6．29～-2．08）,红霉素治疗组WMD=-4．69（95％CI：-6．38～-3．00）,两组均可较早实现全肠内喂养;胎龄≤32周亚组WMD=-5．15（95％CI：-12．60—2．30）,与对照组差异无统计学意义。剔除低质量文献行敏感度分析,WMD=～5．48（95％CI：-11．66～0．69）,红霉素治疗组与对照组差异无统计学意义。②红霉素预防组住院时间（WMD=-1．10,95％CI：-3．65～1．37）和NEC发生率（OR=1．01,95％CI：0．24～4．22）与对照组差异无统计学意义;红霉素治疗组13均体重增加（WMD=4．29,95％CI：-2．06～10．64）和NEC发生率（OR=0．68,95％CI：0．18—2．56）与对照组差异无统计学意义;红霉素治疗组恢复至出生体重时间（WMD=-2．45,95％CI：-2．87～-2．04）、症状消失时间（WMD=-1．22,95％CI：-1．33--1．11）及住院时间（WMD=-9．70,95％CI：-11．92～-7．49）与对照组差异有统计学意义。结论对于喂养不耐受高危儿及胎龄≤32周的喂养不耐受早产儿,静脉应用小剂量红霉素的证据尚不足;对于胎龄〉32周的喂养不耐受早产儿,今后研究应确定是否存在一个最佳剂量以缩短静脉营养时间及住院时间,在改善喂养不耐受的症状中红霉素可能起一定的作用。     

早产儿喂养不耐受的胃肠内喂养方法研究

目的探讨改良微量胃肠内喂养法对喂养不耐受早产儿的临床效果。结论将符合纳入标准的喂养不耐受70例早产儿随机分为对照组和观察组,对照组采用常规微量胃肠道喂养法,观察组按照3h的间隔分别给予温开水、5%葡萄糖水和稀释奶（根据体重稀释）各喂养6次后,如无不耐受给予全奶喂养,比较两组患儿喂养不耐受各项观察指标的变化以及相关并发症的发病率。结果观察组患儿的黄疸持续时间、恢复出生体重时间、胃潴留消失时间、胎便排尽时间、平均出院时间分别为（14.6±2.5）d、（10.1±1.8）d、（5.1±1.2）d、（14.2±2.3）d、（19.2±2.3）d;对照组分别为（19.5±2.1）d、（13.5±1.3）d、（7.4±1.3）d、（18.7±2.5）d、（25.4±2.1）d,两组比较差异均有统计学意义（P〈0.001）。在吸吮出现时间和坏死性小肠结肠炎（NEC）、吸入性肺炎等并发症发病率方面,两组比较差异均无统计学意义（P〉0.05）。结论与常规微量胃肠道内喂养法相比,改良微量胃肠道内喂养法更能有效地缓解早产儿喂养不耐受症状。     

早产儿喂养不耐受早期小剂量补钾安全性探究

目的 分析研究我院喂养不耐受早产儿静脉营养进行早期小剂量补钾安全性的相关性研究.方法 选择2018年1月至2020年1月在我院收治的200例符合纳入标准的早产儿,随机分为观察组和对照组,均为100例.观察组采用静脉补钾的方法,在早期小剂量[1 mmol/(L·kg·d)]静脉补钾.对比一般资料,分析对比两组患儿第3天、...     

益生菌联合小剂量红霉素治疗极低出生体重儿喂养不耐受疗效分析

目的：探讨益生菌联合小剂量红霉素治疗极低出生体重儿喂养不耐受的临床疗效。方法将40例胎龄28~36w喂养不耐受的极低出生体重儿,随机分为两组,对照组20例在常规治疗的同时给予小剂量红霉素治疗,治疗组20例在对照组治疗的基础上加用益生菌,记录每次胃残余量、喂奶量、临床症状及消失时间,达全胃肠喂养时间,出院时间。每日记录体重,计算体重增长速度,并观察其体重恢复至出生体重时间。结果治疗组患儿腹胀消失时间、恢复出生体重时间、达全胃肠营养及出院时间与对照组比较,差异均有统计学意义(<0.05);治疗组平均增加体重量与对照组比较有统计学意义(<0.05)。结论口服小剂量红霉素联合益生菌治疗极低出生体重儿喂养不耐受明显优于单纯给予小剂量红霉素组,益生菌可明显提高极低出生体重儿喂养耐受性,增加耐受奶量,且安全有效,值得临床推广应用。     

小剂量红霉素与吗丁啉治疗早产儿喂养困难疗效比较

目的探讨小剂量红霉素对早产儿喂养困难的疗效.方法将两年间于住院期间出现喂养困难的早产儿随机分成两组,治疗组38例用小剂量红霉素3～5mg(g.d)治疗,对照组36例用吗丁啉治疗.结果两组显效率分别为76.32%和72.22%,υ=0.40(<1.96),P>0.05;总有效率分别为96.74%和91.67%,υ=0.53(<1.96),P>0.05,均无显著差异.两组呕吐、奶量不增和胃潴留的症状缓解天数亦无显著性差异(P<0.05).结论临床上对喂养困难的早产儿可以采用小剂量红霉素治疗,以促进胃肠动力,提高喂养的耐受性.     

益生菌和婴儿抚触联合治疗早产儿喂养不耐受疗效观察

目的 观察益生菌和婴儿抚触治疗早产儿喂养不耐受的疗效.方法 所有病例随机分两组,治疗组22例,男13例,女9例;对照组19例,男12例,女7例.两组均给予间歇鼻胃管喂养;采用同一种早产儿特别配方奶粉喂养;早开奶,于生后12～36h开始喂养,从小量开始,开始1～2 ml /次,1次/2h,每天每次增加1～2 ml,辅助静脉营养,生后第一天输注5%葡萄糖液,第二天输注小儿氨基酸、脂肪乳剂,剂量从0.5g/kg·d开始,每天增加0.5g/kg,逐渐增至3g/kg·d,静脉入液量两组无差异,总液体量第一天50ml/kg,按10～15 ml/ kg·d增加,直至120～150ml/ kg·d;出现不耐受常规处理:排除坏死性小肠结肠炎,奶量应减少2～4 ml或停喂1～2次,排便不畅者予灌肠通便,有晚期代谢性酸中毒者予纠酸处理.治疗组在常规治疗的基础上加用益生菌口服:0.5g/kg·次,一天三次,联合婴儿抚触治疗(包括腹部按摩和小儿捏脊治疗),每天两次,每次30min.这种治疗持续到患儿能耐受肠道营养1周以后.结果 监测腹胀消失时间、胃潴留消失时间、恢复到出生体重所需日龄、4周末奶量、足量胃肠营养日龄.治疗组和对照组比较差异有显著性(P均＜0.01).所有患儿治疗前、治疗后无异常哭闹.结论 本研究对喂养不耐受的早产儿给予益生菌和婴儿抚触治疗(包括腹部按摩和小儿捏脊治疗),原有的加奶困难、呕吐、腹胀等临床症状有明显改善,提高了喂养耐受性,恢复到出生体重所需日龄、4周末奶量、停止胃肠外营养达足量胃肠营养时间,与对照组比较差异有显著性(P均＜0.01),促进了早产儿的生长发育.这两种方法 简单易行,值得在基层医院推广.     

98例早产儿喂养不耐受的临床分析

早产儿由于胃肠功能不成熟等因素的影响,在开始喂养后,经常出现呕吐、腹胀、胃潴留等问题,影响早产儿的存活和生存质量,喂养不耐受是临床上早产儿最常见的问题.     

出生体重＜2000g早产儿喂养不耐受的原因分析及对策

目的总结早产儿胃肠喂养的临床特点,分析喂养不耐受的相关因素,探讨有利于喂养成熟的要点.方法我们对2002年9月～2004年7月年我院住院的167例出生体重＜2000g的早产儿进行了回顾分析.结果63例出现喂养不耐受,占37.7%,主要表现开始喂奶时间延迟;呕吐;腹胀;胃内有咖啡样物;残余奶、胃排空减慢;排便不畅,需灌肠通便.结论早产儿发生喂养不耐受者多与胃食管返流、早产儿胃肠道功能不成熟有关,早期微量喂养缓慢加奶谨慎禁食促进排便和促胃肠动力药物有利于促进喂养耐受性.     

早产儿经口微量喂养与鼻胃管喂养的临床研究

目的探讨早产儿早期经口微量奶瓶喂养和鼻胃管喂养两种喂养方式相关并发症的发生情况。方法将50例早产儿随机分成治疗组和对照组。治疗组25例,经口微量奶瓶喂养;对照组25例,经鼻胃管喂养。观察两种喂养方法中合并呕吐、腹胀、腹泻、呼吸暂停、吸入性肺炎、窒息、胃出血等喂养相关并发症发生情况。结果与对照组比较,治疗组喂养相关并发症发生率明显降低。结论早期经口奶瓶微量喂养可早日建立经口喂养,使患儿减少相关喂养并发症。     

早产儿经口微量喂养与鼻胃管喂养的临床研究

目的 探讨早产儿早期经口微量奶瓶喂养和鼻胃管喂养两种喂养方式相关并发症的发生情况.方法 将50例早产儿随机分成治疗组和对照组.治疗组25例,经口微量奶瓶喂养:对照组25例,经鼻胃管喂养.观察两种喂养方法中合并呕吐、腹胀、腹泻、呼吸暂停、吸入性肺炎、窒息、胃出血等喂养相关并发症发生情况.结果 与对照组比较,治疗组喂养相关并发症发生率明显降低.结论 早期经口奶瓶微量喂养可早日建立经口喂养,使患儿减少相关喂养并发症.     

早期护理干预对预防早产儿脑瘫的作用

目的观察并评价早期护理干预对降低早产儿脑瘫发生率的作用。方法选取采用早期护理干预以前的46例早产儿作为常规护理组（对照组）,将采用早期护理干预以后的55例早产儿作为实验组,实验组早产儿除接受常规护理指导外,还采取视听触觉及按摩刺激,并接受体操及被动运动训练。随访并评价患者一年后脑瘫的发生率及两组幼儿的智力发育指数（MDI）和运动发育指数（PDI）,结果早期护理干预组的脑瘫发生率（1例,1.82%）明显低于对照组（7例,15.22%）,两组早产儿的智力发育指数及运动发育指数比较,早期护理干预组的智力发育指数（96.75±9.65）及运动发育指数（99.80±9.84）明显高于对照组（88.64±8.63,91.56±6.93）。数据差异具有统计学意义（P〈0.05）。结论采用早期护理干预措施有助于降低早产儿脑瘫的发病率,提高早产儿的智力发育指数级运动发育指数。     

Antibody-dependent cell-mediated cytotoxicity to beta-lactoglobulin-coated cells with sera from children with intolerance of cow''s milk protein.

The capacity of serum antibodies against beta-lactoglobulin to mediate antibody-dependent cell-mediated cytotoxicity (ADCC) was analysed in sera from children with cow's milk protein intolerance (CMPI). The children with CMPI were divided into three groups according to clinical features: delayed-onset CMPI with gastrointestinal symptoms (n = 8); immediate-onset CMPI with gastrointestinal and skin symptoms (n = 8); and immediate-onset CMPI with skin symptoms only (n = 8). The CMPI groups were compared with children with untreated (n = 9) or treated (n = 8) coeliac disease and a control group (n = 22). Sera from the children were examined for cytotoxic effects using lymphocytes from healthy adults as effector cells and radiolabelled beta-lactoglobulin-coated erythrocytes from the same donor as target cells. In addition, IgG and IgA serum antibodies against beta-lactoglobulin were determined with ELISA. Sera from children with CMPI and gastrointestinal symptomatology showed a significantly increased capacity to induce ADCC reactivity as compared with controls. This increased capacity was seen in sera from those with immediate as well as delayed onset of the gastrointestinal symptoms. In contrast, sera from children who had an immediate-onset CMPI with only skin symptoms mediated no such increase in ADCC reactivity. Moreover, children with coeliac disease with a few exceptions, demonstrated low ADCC reactivity, despite the fact that they had high levels of antibodies against beta-lactoglobulin. ADCC may be an immunopathogenic mechanism in certain cases of CMPI with gastrointestinal symptoms.     

Adverse reactions to food additives in children with atopic symptoms

In a multicenter study conducted at four Danish hospital pediatric departments, the parents of 472 consecutive children were informed of this project to determine the incidence of intolerance of food additives among children referred to an allergy clinic with symptoms of asthma, atopic dermatitis, rhinitis, or urticaria. After a 2-week period on an additive-free diet, the children were challenged with the eliminated additives. The food additives investigated were coloring agents, preservatives, citric acid, and flavoring agents. Carbonated "lemonade" containing the dissolved additives was used for the open challenge. Two doses were used: a low dose and a 10-fold higher dose. Gelatin capsules were used for a double-blind challenge. The children were 4–15 years old, and they were attending an outpatient pediatric clinic for the first time. Of the 379 patients who entered the study, 44 were excluded and 335 were subjected to open challenge. A total of 23 children developed positive reactions after the open challenge. Sixteen of these patients accepted the double-blind challenge, and six showed a positive reaction to preservatives (atopic dermatitis, asthma, rhinitis), coloring agents (atopic dermatitis, asthma, urticaria, gastrointestinal symptoms), and citric acid (atopic dermatitis, gastrointestinal symptoms). The incidence of intolerance of food additives was 2% (6/335), as based on the double-blind challenge, and 7% (23/335), as based on the open challenge with lemonade. Children with atopic skin symptoms had a statistically increased risk of a positive reaction. This may have consequences for the future clinical investigation of children with atopic cutaneous symptoms.     

Non-nutritive sucking evaluation in preterm newborns and the start of oral feeding: a multicenter study

OBJECTIVES:

The assessment of early sucking by preterm infants provides information on the ability of these infants to efficiently and safely receive nutrients via an oral route (oral feeding). To analyze the application and reliability of an instrument in assessing non-nutritive sucking that indicates a capacity for oral feeding in the routine care of different neonatal units.

METHODS:

A multicenter, prospective cohort study was conducted in seven neonatal units. A non-nutritive sucking assessment with a formulary validated by Neiva et al (2008) (variables evaluated: rooting reaction; easy initiation of sucking; labial sealing; tongue central groove; peristaltic tongue movements; jaw raising and lowering movements; labial, tongue and jaw coordination; sucking strength; sucking rhythm; bites; excessive jaw excursion; stress signals) was applied to 199 pre-term newborns, who had a chronological age ≥ 2 days and were clinically stable. These infants were divided into two groups based on their corrected gestational age at the first assessment, as follows: Group I-infants with a gestational age ≤ 33 weeks and Group II-infants with a gestational age between 34 and 36 6/7 weeks.

RESULTS:

The mean gestational age was 31.66±2 weeks, and the mean birth weight was 1494 ± 373 g. The mean scores on the non-nutritive sucking assessment were 46 ± 25 in Group I and 49 ± 24 in Group II. The beginning of oral feeding was successful in 43 (67.2%) infants in Group I and 64 (81%) infants in Group II (p = 0.089).

CONCLUSION:

The method identified preterm infants who were able to feed orally based on 33 points in the non-nutritive sucking assessment and a corrected gestational age of 32 weeks or more. The corrected gestational age was the most important factor in predicting the success of oral feeding.     

Increased intestinal sugar permeability after challenge in children with cow's milk allergy or intolerance

The diagnosis of cow's milk allergy or intolerance (CMAI) is based on clinical improvement on exclusion diet and relapse after challenge with milk. The aim of this work was to investigate the value of the cellobiose/mannitol (C/M) sugar permeability test, performed before and after cow's milk challenge, as a tool for the diagnosis of CMAI. Thirty-two patients underwent milk challenge at a median age of 13 months (range 3–84 months). A dual sugar (C/M) permeability test with an iso-osmolar solution was performed before and 24 h after challenge. Of the 10 patients who developed symptoms after challenge, nine showed increased postchallenge C/M ratio, whereas such an increase was observed in only one of the 22 nonrelapsed subjects. The postchallenge C/M ratio increase in relapsed subjects is to be attributed to both higher cellobiose and lower mannitol urinary excretion. These results suggest the use of the sugar permeability test, in addition to clinical observation, as an aid in the evaluation of provocation tests in infants with suspected CMAI.     

红霉素衍生物抑制体外培养的人T淋巴细胞株增殖

目的：观察红霉素（EM）及其衍生物对人T淋巴细胞增殖及细胞凋亡的影响，探讨红霉素衍生物抗炎作用的部分机制。方法：用MTT法检测4种无抗菌活性的红霉素衍生物对人T淋巴细胞增殖的作用，从中选出活性突出的化合物，利用流式细胞仪和TUNEL方法观察其对细胞凋亡的影响。结果：红霉素衍生物-Ⅰ抑制T淋巴细胞增殖活性优于红霉素，其IC50值分别为（425.6±32.1）μmol/L和（606.3±35.4）μmol/L（P<0.01）；红霉素衍生物-Ⅰ（3-30 mg/L）和红霉素 （30-100 mg/L）可诱导T淋巴细胞凋亡，与剂量呈正相关。红霉素衍生物-Ⅰ在100 mg/L时引起细胞死亡。结论：无抗菌活性的红霉素衍生物的抗炎活性与其抑制T淋巴细胞增殖和诱导细胞凋亡的作用可能有一定关联。     

Regulation of feeding behavior in the prepubertal female rat.

Responses to challenges of long-term regulation of feeding behavior were compared between adult and weanling female rats. Adulteration of a high fat diet with NaCl caused both adult and weanling rats to reduce their food intake, but neither group refused to eat. Food deprivation for 24 hr was followed by an increase in feeding for both adult and weanling animals during a period when food intake is normally very low. Continued limited food access to 2 hr during the light period was compensated for by an increase in the normal food intake for this period for both adult and young female rats. It was observed that both adult and weanling rats showed a marked preference for the more dilute glucose solution when given a choice. In addition, both groups maintained a constant caloric intake during presentation of the glucose solutions by adjusting their intake of a solid food source. In each challenge of long-term regulation of feeding behavior, the response of weanling animals was as good or superior to that shown by adults. It is concluded that weanling female rats regulate their feeding just as adults to maintain long-term energy balance. It was also observed that bilateral lesions placed in the ventromedial hypothalamus (VMH) at 21 days of age resulted in reduced daily food intake and retarded body weight gain. Furthermore, young rats with VMH lesions failed to respond to 24 hr of food deprivation or limited food access. These data suggest an important role for the VMH in the long-term regulation of feeding in young rats.     

Effect of erythromycin on bronchial hyperreactivity and inflammation in ovalbumin-sensitized brown Norway rats

To evaluate the effect of erythromycin on bronchial hyperreactivity, inflammation, and T-cell related cytokine mRNA expression in rats sensitized to ovalbumin, three experimental groups of 10 brown Norway rats each were sensitized by breathing aerosolized ovalbumin. From day 1 to day 15, one group was given oral erythromycin 80 mg/kg/day, another group oral erythromycin 20mg/kg/day, and the third group oral saline only. A fourth control group of 10 rats breathed aerosolized saline. After sensitization, the three experimental groups were provoked by breathing ovalbumin, with the controls again breathing saline. The rats were then anesthetized and paralyzed, and pulmonary function tests were performed at baseline and after varying doses of acetylcholine. Bronchoalveolar lavage (BAL) fluid and lung tissues were examined for expression of mRNA for T-cell cytokines. Our results showed that erythromycin had no beneficial effects on pulmonary function and lung inflammation in the two erythromycin-treated experimental groups compared with the saline experimental group. Th2-related cytokines and their mRNA expression in the three experimental groups were higher than in controls but did not differ among the experimental groups. In conclusion, erythromycin does not prevent bronchial hyperreactivity or an inflammatory response in ovalbumin-sensitized rats.     

Learning and behavioral--emotional problems of children born preterm at second grade.

A longitudinal prospective study examined the question, "which child and family factors discriminate between children born preterm who are characterized by the presence or absence of learning or behavioral-emotional problems at second grade?" Assessments were completed during the child's hospital stay at birth, at 4, 8, and 24 months, and 8 years of age for 68 children born preterm and their mothers. Discriminant analyses identified the variables that statistically maximized the differentiation between two groups of children defined to exhibit or not exhibit school age problems. Three categories of discriminators were used in the analyses: infant status, family interactive quality, and family context. The three significant discriminators were variables from the family categories. The results of this study highlight the importance of understanding the presence or absence of school age problems from a multivariate model of development that takes into account the quality of the child's interactions within the family during early childhood and school age and the current stress levels in the family context.