凝结芽孢杆菌活菌制剂在手足口病中的应用

目的观察和评价凝结芽孢杆菌活菌制剂治疗手足口病的临床疗效。方法将64例手足口病患儿随机分为治疗组(31例)和对照组(33例),两组均给予对症支持治疗,其中治疗组同时加用凝结芽孢杆菌活菌片,≤1岁,0.70 g/次,>1岁,1.05 g/次,3次/d。对两组患儿的疱疹、食欲、体温等变化情况进行统计和分析。结果治疗组患儿疱疹好转、消失时间,食欲和体温恢复正常时间均显著短于对照组;痊愈率、总有效率高于对照组,差异均有统计学意义(P均<0.05)。结论凝结芽孢杆菌活菌片辅助治疗手足口病疗效显著。     

儿童菌血症蜡样芽孢杆菌的分离及耐药性分析

目的了解儿童菌血症蜡样芽孢杆菌的感染状况、耐药性与耐药趋势。方法对临床送检标本进行分离培养,采用API 50 CH试验条进行菌株鉴定,采用K-B法测定细菌药物敏感性。结果 2006年1月—2010年3月从血液标本中分离蜡样芽孢杆菌共83株,其中儿童患者61株,占73.5%,61株中配方奶喂养新生儿为49例,占80.3%。蜡样芽孢杆菌对13种临床常见药物抗菌活性较好,对除青霉素、氨苄西林、一二代头孢菌素以外的抗菌药物耐药率均低于25%。结论蜡样芽孢杆菌引起人工喂养的儿童菌血症发病率较高,需严防漏检而贻误治疗时机,尤其应重视准确分离、鉴定菌株,测定其耐药谱,可为临床合理应用抗生素提供理论依据。     

长双歧杆菌与婴幼儿肠道健康的研究进展

长双歧杆菌是一种对肠道有益的共生菌,与婴幼儿肠道健康密切相关。文章介绍了长双歧杆菌的生理特性与基因组学、代谢组学和蛋白组学水平的生物学特性,在治疗或缓解婴幼儿胃肠道疾病方面的益生功能,及其在国内外的研究进展与应用发展前景。分析了不同菌株的长双歧杆菌治疗婴幼儿功能性便秘、肠易激综合征和炎症性肠炎的功效作用和可能机制。以期为长双歧杆菌应用于临床治疗或缓解婴幼儿胃肠道疾病提供科学依据,为长双歧杆菌功能性菌株的开发及其用于促进肠道健康的深入研究提供思路。     

急性淋巴细胞白血病患儿反复解脲寡源杆菌感染1例报道并文献复习

目的提高对白血病患儿化疗中并发罕见细菌感染诊断及治疗的认识。方法报道1例急性淋巴细胞白血病患儿化疗中先后发生解脲寡源杆菌败血症和颅内感染的诊治经过并文献复习。结果诊断为急性淋巴细胞白血病(L1型,BⅢ型,标危),化疗中相隔数月发生同一细菌(解脲寡源杆菌)3次感染,前两次为败血症,第三次为颅内感染并脑积水,随着自身免疫力的恢复,并联合抗感染及手术治疗治愈出院。相关文献示解脲寡源杆菌感染主要发生于全身或局部免疫功能低下的患者,全身系统性感染罕见,随着自身免疫力的提高,疾病似有自限性。结论不明原因长期发热的病例应警惕条件致病菌导致的特殊部位感染;治疗除了以体外药敏试验为依据,自身免疫功能的恢复也是感染控制的重要因素。     

口服普萘洛尔对婴幼儿血管瘤患儿血糖影响的初步研究

目的探讨口服普萘洛尔治疗血管瘤患儿血糖的变化情况。方法我院2013年1月-{2014年12月69例婴幼儿血管瘤患儿,口服普萘洛尔治疗,将普萘洛尔均分为3份在三餐餐后短时间内服用,服药1h后监测血糖,梯度加量,连续监测3d,直至2mg/(kg·d)的维持剂量。结果服药前,所有患儿血糖在正常范围。服用不同剂量的普萘洛尔对血糖无明显影响。1例患儿服药第2d血糖下降至3.8 mmol/L,低血糖发生率为1.4%。结论通过连续性监测,口服普萘洛尔治疗的血管瘤患儿血糖未发现有显著性差异的变化,初步提示我们的临床用法相对安全,但仍需进一步深入研究。     

上海郊区婴幼儿蛋白质营养的研究

运用营养调查和干预试验的方法对上海市郊区５０８名３岁以下小儿进行蛋白质营养的研究。结果表明，６个月以下小儿的蛋白质和热量摄入量均接近推荐供给量，６个月以后逐渐减少。其血清前白蛋白水平、必需氨基酸、支链氨基酸、蛋氨酸和赖氨酸平均水平明显低于营养良好儿组，非必需氨基酸与必需氨基酸的比率明显高于营养良好儿组。血清中促生长因子平均水平明显低于营养良好儿组。蛋白质添加干预试验的结果显示，干预试验组的氨基酸图谱中非必需氨基酸与必需氨基酸的比率在干预试验后明显下降而趋于正常，与干预前比较差异有非常显著意义（Ｐ＜０．０１），对照组则无明显变化（Ｐ＞０．０５）。提示郊区小儿实际上存在亚临床状态的蛋白质营养不足。     

230例婴幼儿肺炎克雷白杆菌肺炎临床特点与抗菌治疗研究

目的 探讨小儿肺炎克雷白杆菌肺炎的临床特点及应用抗生素的耐药性和敏感性.方法通过对230例小儿肺炎克雷白杆菌肺炎的临床分析,探讨小儿此类肺炎的临床特点,并对肺炎克雷白杆菌的耐药性和敏感性进行分析.结果(1)230例均为3岁以内的婴幼儿,以1～3月龄发病最多.(2)院内感染占较大比例(44.8％,103/230).(3)患儿的临床特征主要有气促,面色发绀,喉头痰鸣,肺部可闻及广泛的湿哕音、痰鸣音和哮鸣音.(4)辅助检查:白细胞升高占33.9％(78/230),正常占53.9％(124/230),降低12.2％(28/230).201例X线胸片提示大叶性肺炎25例,小叶性肺炎112例,肺间质改变和肺纹理增粗52例.(5)大部分菌株产生超广谱β内酰胺酶(56.6％,129/228).(6)最敏感的抗生素为亚胺培南-西司他丁钠、环丙沙星、哌拉西林/他唑巴坦等.225例患儿临床治疗有效,最常使用的抗生素为哌拉西林/他唑巴坦.结论肺炎克雷白杆菌肺炎好发于小婴儿,起病急,病情重;应对肺炎克雷白杆菌进行耐药性监测,根据药物敏感性试验合理选择抗生素,绝大多数患儿治疗有效,预后较好.     

轻度缺铁性贫血对婴幼儿智能及行为发育影响的研究

目的　了解轻度缺铁性贫血 (MIDA)对婴幼儿智能、行为发育的影响。方法　应用多元回归分析确定影响婴幼儿智能发育的独立危险因素后采用t检验分析病例组与对照组之间的智能、运动发育水平及各行为因子的差异。结果　血红蛋白水平、父母受教育程度、早期教育情况、小儿月花费是影响婴幼儿智能发育的独立危险因素 (P <0 0 5 ) ;MIDA婴幼儿的血红蛋白水平与智能发育指数及精神运动发育指数呈正相关 (P <0 0 1) ;病例组与对照组之间的智能发育水平存在显著性差异 (P <0 0 1) ;MIDA患儿与背景资料相同的同龄儿相比 ,存在社交退缩、不快乐、注意持续时间短、易疲劳、手指及手腕的精细运动协调性差等行为问题 (P <0 0 5 )。结论　MIDA是影响儿童智能发育的独立危险因素 ;MIDA可引起婴幼儿的行为发育异常。     

硫酸镁治疗婴幼儿重症肺炎呼吸困难的研究

目的研究硫酸镁治疗婴幼儿重症肺炎呼吸困难的疗效。方法在综合治疗的基础上对20例重症肺炎出现喘憋性呼吸困难应用硫酸镁治疗并与既往应用多巴胺、酚妥拉明治疗的18例比较。结果　治疗组紫绀消失,喘憋缓解,肺部喘鸣音消失和转安静均较对照组快(P<0.01)。结论硫酸镁治疗婴幼儿重症肺炎喘憋性呼吸困难疗效显著,值得临床推广。     

婴幼儿轮状病毒肠炎的体液免疫功能研究

目的　探讨婴幼儿轮状病毒 (RV)肠炎体液免疫状况。方法　测定 44例婴幼儿RV肠炎大便分泌型IgA(sIgA)及血清免疫球蛋白 ,与同期 45例正常婴幼儿作对照。结果　 1.RV肠炎患儿恢复期较急性期sIgA和血清免疫球蛋白明显增加 ;重度RV肠炎患儿较轻、中度患儿sIgA明显减少 ,差异有显著性 (P均 <0 .0 1)。 2 .血清IgG在RV肠炎与对照组比较无显著差异 (P均 >0 .5) ;IgA、IgM较对照组明显减少 (P分别 <0 .0 0 5、 <0 .0 5) ;但病情轻重患儿间无差异。结论　婴幼儿RV肠炎免疫功能受到抑制 ,从而使全身和局部B细胞增殖及抗体的分泌减少 ,降低对RV感染的保护中和作用 ,提示在治疗RV肠炎时可合理应用免疫球蛋白 ,以达到减轻症状、缩短疗程的作用     

Clinical manifestations of Bacillus cereus meningitis in newborn infants

Bacillus cereus (B. cereus) meningitis sometimes occurs in patients with risk factors, which are associated with central nervous system (CNS) anomalies, surgical or anaesthetic access to CNS. We observed two cases of B. cereus meningitis in neonates without such risk factors. The clinical courses of both neonates were fulminant, and routine antibiotic therapy failed. Intracranial haemorrhage was evident at autopsy. According to the previous neonatal case reports and our experience, we found that six of seven neonates were premature babies admitted to the neonatal intensive care unit, five died within a week of onset of the disease, and six had intracranial haemorrhage. We speculate that B. cereus meningitis may occur in neonates, even without any of the risk factors previously described in adult case reports, and that the clinical manifestations of the meningitis might be characterized by the high incidence of intracranial haemorrhage and poor mortality.     

口服双歧杆菌对极低出生体重儿免疫功能的影响

目的：探讨口服双歧杆菌对极低出生体重儿免疫功能的影响。方法：将50例住院极低出生体重儿随机分为观察组和对照组（n=25）。观察组在一般治疗的基础上给予口服双歧杆菌14 d,观察临床指标和外周血相关免疫学指标。结果：观察组需生理盐水灌肠次数较对照组明显减少(P0.05)。观察组外周血CD4+T细胞比例和CD4+/CD8+比值高于对照组(P0.05);观察组外周血IgA水平高于对照组(P0.05)。结论：双歧杆菌可以改善极低出生体重儿的消化道症状,促进极低出生体重儿免疫功能的成熟和发展。     

Effects of formula supplementation in breast-fed infants with failure to thrive

Background:  The aim of the present study was to assess whether formula supplementation of infants with failure to thrive can improve underweight without jeopardizing breast-feeding.
Methods:  In a prospective intervention study 31 term exclusively breast-fed infants were studied, who were admitted to hospital at an age of 28–99 days with failure to thrive (≤40% expected weight gain for age and/or bodyweight ≤10th percentile for age) without underlying disease. Infant formula was offered ad libitum after each breast-feeding, while continued breast-feeding was supported.
Results:  Energy intake per day increased from 352 ± 111 kJ/kg (mean ± SD) at study start to 587 ± 115 kJ/kg ( P  < 0.001, days 1–3 of supplementation) and 501 ± 99 kJ/kg (days 29–31; P  < 0.001 vs study entry). Twenty-five infants continued to be partially ( n  = 21) or fully ( n  = 4) breast-fed. Human milk intake decreased from 476 ± 163 g/day (study days 1–3) to 349 ± 285 g/day (study days 29–31; P  < 0.01). The contribution of breast milk to total milk intake decreased from 100% to 42 ± 35% ( P  < 0.001). Supplementation over 31 days led to increased weight (0.98 [0.70], standard deviation scores [SDS]), length (+0.40 [0.41] SDS) and head circumference (+0.59 [0.93] SDS).
Conclusions:  One month of formula supplementation successfully improved growth in 72% of infants with failure to thrive on human milk feeding. Breast-feeding was maintained in 81% of infants.     

Responses to partial nasal obstruction in sleeping infants

Partial nasal obstruction was performed during a morning of quiet sleep (QS: non-REM) and active sleep (AS: REM) at ages 1 week, 2 weeks, 1, 2, 3, 4 and 6 months on 12 normal infants, 15 subsequent siblings of victims of the Sudden Infant Death Syndrome (SIDS) and 12 infants admitted for investigation of infant apnoea ('near-miss' SIDS). In all three groups the numbers failing to arouse after 240 s (FTA-240) in QS were significantly greater than those in AS. After 2 months of age all groups showed a decrease in the number FTA-240 in AS, whereas in QS the number did not change significantly. Subsequent siblings of SIDS had a significantly higher number FTA-240 in QS than controls. There was no significant difference in FTA-240 in QS between controls and infant apnoeas, although there was a trend for this to be higher in subsequent siblings of SIDS than infant apnoeas.
It was concluded that arousal from AS is more marked than from QS, that after 2 months of age the ability to arouse from AS increases, and that in relation to SIDS, QS is the sleep state in which the infant is less able to arouse. Furthermore, subsequent siblings of SIDS differ from normal infants in their ability to arouse from QS.     

幽门螺杆菌毒力基因与致病性研究进展

幽门螺杆菌(H. pylori)感染是人类最常见的慢性细菌感染,感染了全球超过50%的人口。大部分H. pylori感染是在儿童期获得,与慢性萎缩性胃炎、消化性溃疡、胃黏膜相关淋巴组织(MALT)淋巴瘤、胃癌等疾病密切相关。此外,还可能参与多种胃肠外疾病,如缺铁性贫血、生长发育迟缓、特发性血小板减少性紫癜等。H. pylori感染给儿童健康带来极大的危害,其致病性的差异主要与其毒力基因型的多态性有关。文章综述H. pylori毒力基因的特征与致病性。     

Temperament in Australian infants

A convenience sample of 240 infants aged 4–8 months was studied to evaluate the suitability of a revised version of Carey's Infant Temperament Questionnaire (ITQ) for an Australian population. Data analyses indicated all item/dimension correlations significant at P <0.01 or better, satisfactory internal consistency of the instrument as measured by alpha coefficients, and test retest reliability of 0.79. Infants rated as having a 'difficult' temperament were significantly more likely to be reported as having problem behaviours. Significant differences were found between Australian and American inlants on three of the nine temperament dimensions — rhythmicity, activity and intensity. The results of this study indicate that this revised ITQ is suitable for use with Australian infants.     

Late death of very low birthweight infants

The causes of 59 postneonatal deaths of very low birthweight infants were determined. Bronchopulmonary dysplasia (BPD) was the cause of 19 deaths. It also coexisted in 12/20 deaths from infection and 9/20 deaths from other causes. Improvement will be best achieved by advances in the prevention and treatment of BPD.     

Reappraisal of the SIDS enigma: An epidemiological and clinicopathological approach

Abstract The possibility that most cases of sudden infant death syndrome (SIDS) are caused by a transmissible agent is explored. A hypothesis of causation is developed using pathological and epidemiological data and our microbiological findings. The nature and distribution of vascular damage together with the consistent finding of liquid blood, in addition to the epidemiological features of SIDS, form the basis of the hypothesis that a bacterial toxin is a likely single cause of most cases of the syndrome. Future research ideas and a new definition of SIDS are proposed.     

重度子痫前期极早产小于胎龄儿临床特点分析

目的 回顾性分析并总结因重度子痫前期剖宫产娩出的极早产小于胎龄儿的临床特点.方法 选取2017年8月至2018年7月收治的因重度子痫前期娩出的42例极早产小于胎龄儿作为观察组,以同期健康母亲单纯因宫缩不能抑制娩出的极早产儿40例作为对照组,分析两组围生期特点、感染方面的临床表现、并发症、临床结局等.结果 观察组生后6 ...