新生儿药物动力学特点及药物的临床应用

新生儿机体发育不成熟 ,对药物的代谢有其特殊性。药物动力学和药物的毒性反应也与年长儿不同 ,且受胎龄、日龄和病理改变的影响 ,因此不能将成人或年长儿的药物动力学资料用于新生儿。为使新生儿安全有效地用药 ,必须熟悉新生儿药物动力学特点。１新生儿药物动力学特点１ １药物的吸收新生儿尤其生后最初几天内 ,容易发生呕吐 ,口服药有一定困难。如必须口服应选用溶液或混悬液制剂 ,每次容量要少 ,并使药物可口。因新生儿味觉已发育 ,服苦味药易发生呕吐。药片经压散后虽可吸收 ,但吸收速度和程度均不如液体药物。一方面 ,新生儿胃排空较…     

新生儿心律失常临床特征及治疗进展

新生儿心脏解剖结构及其生理功能尚不成熟,心脏传导系统的结构及功能仍处于发育阶段,故新生儿心律失常发病率较高.新生儿心律失常的病因、类型、治疗及预后与年长儿及成年人均有所不同.笔者拟就新生儿心律失常的发生率、病因、临床类型、治疗及预后进行综述如下,旨在提高新生儿科临床医师对新生儿心律失常的认识.     

我国儿科药物临床试验开展现状分析

目的了解我国儿科药物临床试验的开展现状及面临的问题, 为促进我国儿科药物临床试验健康开展提供参考。方法以"儿科""儿童""年度报告""儿童用药研发""政策"等为关键词, 在药物临床试验机构备案管理信息平台及政府相关部门网站, 检索截至2023年10月我国儿科药物研发相关政策法规、儿科药物临床试验机构及儿科药物临床试验专业备案情况、儿科药物临床试验项目注册情况等信息, 并对收集到的信息进行描述性分析。结果我国已发布9项儿科药物研发相关政策法规, 支持开发符合儿童生理特征的儿童用药品新品种、剂型和规格, 并对儿童用药品予以优先审评审批;已发布477个药品技术指导原则, 但其中仅有14个是专门针对儿科人群用药的。截至2023年3月20日, 共有272家备案儿科药物临床试验专业的药物临床试验机构, 占备案总机构数的20.72%;备案机构数量排名前5的省份为广东省(34家)、河南省(21家)、浙江省(20家)、北京市(20家)和江苏省(18家);共对26类儿科药物临床试验专业进行了备案, 备案数量较多的为小儿呼吸(143家)、小儿血液病(72家)、儿科-其他(71家)、小儿内分泌(68家)和小儿...     

儿童支原体肺炎的临床特征分析

目的了解儿童支原体肺炎的临床特征。方法回顾分析2008年1月—2010年4月平舆县人民医院儿科病房确诊为支原体肺炎211例住院患儿的临床资料,分析总结支原体肺炎患儿年龄、临床症状体征、胸部X线以及实验室检查等特征。结果支原体肺炎男性患儿104例,女性患儿107例;5岁以下儿童占71.1%;咳嗽率98.6%,发热率75.4%,喘息率51.2%,婴幼儿喘息率明显高于年长儿(62.4%vs 39.2%,P0.01),呕吐腹泻率明显高于年长儿(35.8%vs 14.7%,P0.01),皮疹发生率明显高于年长儿(14.7%vs 5.9%,P0.05)。结论小儿支原体肺炎发病年龄呈低龄化趋势,以咳嗽、发热、喘息为主要表现,婴幼儿较年长儿更易出现喘息,呕吐、腹泻及皮疹。     

新生儿心律失常40例临床分析

新生儿心律失常在临床中不少见,近年来由于新生儿心电监护和24小时动态心电图(Holter)的应用,新生儿心律失常的发现率明显增加,有人报道可达13%[1].新生儿心律失常的表现、类型、治疗及预后与年长儿和成人不尽相同.现将我院1997-2002年收治的新生儿发生心律失常40例临床报告如下.     

小儿用药要注意些什么

儿童的身体尚未发育成熟,各组织器官的功能都还很不健全,解毒、排毒功能当然也极其低下,所以,儿童用药不能与成人相同,新生儿及婴幼儿用药,更应特别注意,以确保安全。首先是小儿的用药量和成年人大不相同,要比成人少得多,但是按每公斤体重计     

家庭药物储存及儿童用药行为现况研究

目的 调查居民家庭药物储存及儿童用药行为,分析存在的问题,提出合理建议。方法 采用方便抽样的方法,随机在全国20家儿童医院门诊就诊的患儿家长进行问卷调查,并对调查结果进行描述性分析。结果 共回收13 940份完整问卷,结果显示,98.33%的中国居民有家庭药箱储备,家庭药箱中儿童药物储备种类排在前三位的分别为儿童感冒药（73.95%）、儿童内服止痛退热类药（48.01%）和儿童皮肤外用药（41.10%）;居民购买家庭儿童常备药的途径主要是根据医生的处方和指导（71.18%）;238个（1.71%）家庭曾发生过儿童药物中毒事件,过量服药为首位原因（44.96%）;22.33%的家长用药前不重视说明书;儿童用药不规范行为主要有服用成年人药物（32.70%）、不按时服药（30.90%）、孩子发热就用退热药（26.35%）。结论 中国家庭中儿童用药储备以小儿常见病的治疗药物为主,购买途径以医师处方为主,较为关注药物有效性和安全性。但儿童用药不规范行为较多,应充分发挥临床药师的咨询功能,从多个途径指导和改善儿童安全用药。     

新知快递

我国将加强孕产妇及儿童临床用药管理 日前从卫生部获悉,为保障孕产妇及儿童临床用药安全,我国将针对孕产妇及儿童临床用药建立药物遴选制度,加强处方权及调剂资质管理,规范药物临床应用管理,加强处方和医嘱点评工作。     

婴幼儿支原体肺炎与年长儿支原体肺炎的临床分析

目的探讨婴幼儿支原体肺炎与年长儿支原体肺炎的临床特征及治疗方法。方法选取我院自2012年4月至2015年7月收治的100例支原体肺炎患儿为研究对象,将其按照年龄分为两组:0~3岁的婴幼儿组及3~15岁的年长儿组,对比分析两组患儿的临床症状、X线表现。确诊后均给予不同浓度阿奇霉素治疗。结果两组患儿的咳嗽症状无明显差异(P>0.05),伴喘鸣音、湿啰音、体温有统计学差异(P<0.01)。胸部X线显示婴幼儿组间质浸润、小叶实质浸润、肺段实质浸润性病变与年长儿比较具有统计学差异(P<0.01)。支原体检测发现两组的血清MP-Ig M抗体阳性率具有统计学差异(P<0.01),肺炎支原体DNA无统计学差异(P>0.05),婴幼儿胸片以小叶实质浸润性病变为主,年长儿以肺段实质浸润性病变为主。治疗结束后,对所有患儿进行随访,两组患儿治愈87例,好转12例,1例患儿临床症状好转但胸部X线片仍有异常。所有患儿平均住院天数为9.5 d。结论不同年龄儿童的支原体肺炎临床症状不同,胸部X线存在差异,临床医生要确定合理的诊断标准,制定有针对性的治疗方案,使患儿症状得到明显改善。     

药物热40例临床分析

目的研究药物热的诊断及避免方法.方法分析40例药物热的临床特点.结果根据用药史、临史表现、停用药物、激发试验等综合判断诊断药物热,并应遵循合理应用抗生素原则,以减少与避免药物热发生.结论临床医师应熟悉并应足够重视.     

Paediatric infections: prevention of transmission and disease--implications for adults

Congenital and neonatal viral infections usually display their acute manifestations in highly recognisable ways, for example, congenital rubella, cytomegalovirus (CMV), varicella, human immunodeficiency (HIV) and herpes simplex virus (HSV) infection. By contrast, congenital hepatitis B virus (HBV) infection may go undetected for years. Some of these are preventable, but what is not immediately apparent is that the long-term consequences are being prevented as well. The long-term consequences of congenital and neonatal infections include endocrine, immunological and cardiovascular disease, deafness, visual problems, intellectual handicap and cerebral palsy. With the survival of HIV-infected infants into adulthood the long-term consequences will soon be described. Maternally and neonatally transmitted HBV infection predisposes to carriage, liver cirrhosis and hepatocellular carcinoma in young adults. Neonatal HBV vaccination prevents adult cancer. Acquired viral infections may predispose to subsequent lung disease, malabsorption, fertility problems or neurological disability. In the prevention of acquired rubella, varicella, HBV, influenza, poliovirus, measles and hepatitis A, one should mention the added bonus of preventing secondary cases by preventing transmission from infants and children to other children and adults. Preventing paediatric HSV, HBV and HIV infection in females may even be preventing subsequent transmission to future generations. Turning to paediatric bacterial infections, vaccinating infants and young children against pertussis could not only prevent transmission to older children and adults but also break the cycle, which then transmits from adults back to infants and young children. There is evidence that disease in older age groups, including adults, has been prevented by virtue of herd immunity from paediatric vaccination, e.g. Neisseria meningitidis Group C and Streptococcus pneumoniae. The add-on benefits for other generations, including for adults, arising from the prevention of paediatric infections are considerable.     

Survival and cerebral palsy in low birthweight infants: implications for perinatal care

Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight, recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them. This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths, neonatal deaths and survivors to address the issues of increased survival, cerebral palsy and timing of brain damage. The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants. The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care. The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote. Further studies of low birthweight infants with cerebral palsy are urgently required. They should include antenatal factors, investigating the various aetiological pathways to preterm birth, randomised controlled trials of neonatal interventions and searching for better neonatal predictors of brain damage.     

95例麻疹病例流行病学及临床分析

目的分析麻疹病例的流行病学和临床特征,为进一步控制麻疹流行提供依据。方法收集95例住院麻疹患者病历资料,进行流行病学和临床分析。结果95例患者中,年龄<8个月的患儿13例(13.68%),8个月~5岁患儿19例(20.00%),成人40例(42.11%);流动人口60例(63.16%);麻疹疫苗接种者24例(25.26%),有疫苗接种史者临床症状轻,无并发症,与无接种史者差异有显著性(P<0.01);冬春季发病79例,占83.16%。结论麻疹发病人群有趋于成人和学龄前婴幼儿倾向,流动人口为高危人群,发病季节以冬春季发病为主;坚持计划免疫和麻疹疫苗普遍复种对控制麻疹流行有重要意义。     

Compared effectiveness of the 7-valent pneumococcal conjugate vaccine in children with the 13-valent vaccine in adults

13-valent-pneumococcal conjugated vaccine was recently approved in the USA and Europe for adults 50 years of age or more. But this approval was followed by recommendations limiting its use to immunocompromised and asplenic patients. The extension of indications to adults was based on the well-demonstrated clinical effectiveness in infants less than 2 years of age, and on a better immune response either quantitatively or qualitatively with conjugated vaccines compared to the immunogenicity of plain polysaccharide vaccines. Nevertheless, the issue was to know whether results observed with the 7-valent pneumococcal conjugate vaccine in children are reproducible in adults with the 13-valent. The answer was given by comparing the epidemiological and physiopathological data, and the immunological response of the two populations. Very few clinical effectiveness studies in adults are available. We had for aim to assess these various issues in infants and adults. A lot of questions remain, such as the unknown impact of serotype replacement with the 13-valent pneumococcal conjugated vaccine on the clinical epidemiology and emergent Streptococcus pneumoniae pathogenicity, while waiting for the CAPITA study results expected in 2014.     

Could we care for Amillia in rural Australia?

Extremely premature and very low birth weight infants have multiple, costly and complex health and developmental issues. After the neonatal period, the best chance for these children to avoid extreme disability and dependence, and thereby reach their potential, is with timely and intensive early intervention by appropriate allied health services, such as speech, occupational and physiotherapy. However, currently in rural Australia, such children are further disadvantaged by their relative lack of access to appropriate types and levels of services, compared with their urban counterparts.     

Maternal obesity and glucose intolerance during pregnancy among Mexican-Americans

Low birthweight is uncommon among Mexican-American infants, despite the substantial proportion of mothers who live in poverty. This apparent paradox has generated studies of factors protecting fetal growth, but may have masked other important health problems in the Mexican-American community. Obesity, impaired glucose tolerance and diabetes are common among Mexican-American women of childbearing age and during pregnancy. Prevalence of these conditions is two to four times higher in Mexican-American than in non-Hispanic white women. As obesity and glucose intolerance during pregnancy are associated with fetal overgrowth and increased risk of subsequent obesity and type 2 diabetes in mother and child, the adequacy of birthweight as a measure of maternal and infant risk may be obscured in populations with a high prevalence of these conditions. Their possible contribution to the increasing incidence of obesity and type 2 diabetes in Mexican-American children, adolescents and young adults has not been examined. Appropriate preconception, prenatal and follow-up care may identify high-risk women, improve weight and metabolic status and reduce the severity and impact of diabetes and its complications. However, late or no prenatal care is common among Mexican-American women and the frequency of follow-up care is unknown. As low birthweight is a major public health indicator of maternal and neonatal health, perceived 'good birth outcomes' have reduced health policy, programme and research attention to Mexican-American mothers and infants. Studies of the impact of obesity and glucose intolerance during pregnancy on the birthweights of Mexican-American infants should be undertaken, along with systematic assessment of the subsequent health status and preventive health-care needs of women and children in this population.     

新生儿疾病对早产儿智能发育的影响及对策

目的 研究新生儿疾病对早产儿智能发育的影响.方法 应用麦卡锡智能量表对283名4～9岁早产儿进行追踪研究.结果 患不同程度新生儿疾病的早产儿IQ值存在显著差异(P<0.0001),经多元逐步回归分析显示:NRDA、核黄疸、窒息程度和时间、化脓性脑膜(化脑)、惊厥、呼吸暂停、高血糖、肺炎等新生儿疾病,对早产儿智能发育有显著影响.结论 临床医师对影响早产儿智能发育的高危疾病应提高预见性,及早采取预防措施,并对存活早产儿尽早施行干预措施.     

新生儿操作性疼痛治疗指南的临床护理应用

目前已有越来越多的临床病例显示若婴儿在新生儿期经历疼痛,其今后的行为及神经系统发育会受到影响,但对新生儿期疼痛是否需要人为干预目前仍存在争议。本文对目前形成的全球性镇痛干预措施,例如药物干预、非药物干预、行为与环境方法来预防和干预新生儿的操作性疼痛等方面进行简单论述。至今,已有大量证据表明蔗糖或母乳能缓解侵入性操作带来的疼痛,而对气管插管等带来的疼痛则需结合药物进行镇痛。但是,对于其他疼痛性操作（如筛查及治疗早产儿视网膜病,或者术后疼痛）,预防及干预措施暂无文献支持,仅根据临床实践经验以及专家的意见。