早产儿母亲生活方式 疾病因素病例对照研究

目的：对早产儿和足月儿母亲生活方式和疾病因素进行问卷调查，分析早产的相关危险因素，为降低早产发生率提供依据。方法：选取严格配对的病例和对照共600例作为研究对象，对母亲进行生活方式、疾病因素和膳食（Knowledge-Attitude-Practice, KAP）等的问卷调查，对新生儿的一般资料进行收集，用条件logistic回归等进行统计分析。结果：①早产儿母亲身高、孕前体重和孕前体重指数均低于足月儿母亲，早产儿出生身长、体重、Apgar评分总和均低于足月儿(P<0.05)；②早产儿母亲的KAP以及总评分都明显低于足月儿母亲(P<0.05)；尤其是早产儿母亲的膳食行为不合理、不科学尤其突出。③经多因素logistic回归分析发现早产的危险因素有反复流产病史和此次妊娠有胎膜早破；保护因素有母亲膳食KAP总评分和母亲孕前体重(P<0.05)。结论：早产的高危人群为孕前体重低、营养知识态度行为评分低、有反复流产史及此次发生胎膜早破者。应强调定期产前检查，加强营养教育，在孕前和孕期尽量避免或消除以上危险因素。     

早产儿及其母亲体内钙 铁 镁含量的研究

目的：研究早产儿母亲孕前孕期钙、铁、镁摄入情况,早产儿及其母亲体内钙、铁、镁含量,从早产儿的营养影响因素方面初步探讨早产的发病机制,并为预防早产提供依据。方法：选取严格配对的病例和对照共240例作为研究对象,对母亲怀孕前和怀孕期间钙、铁、镁的摄入情况进行膳食调查,ICP-OES法对血浆、羊水、胎盘、母乳、胎粪多种生物样本中钙、铁、镁的水平进行检测和统计分析。结果：怀孕期间,早产儿母亲铁和镁的摄入量亦均显著低于足月儿母亲（P<0.05）,怀孕前铁和钙的摄入量亦均显著低于足月儿母亲（P<0.05）。多元方差分析结果显示早产儿母亲体内的钙、铁含量显著低于足月儿母亲（P<0.05）;早产儿体内铁、镁含量明显低于足月儿（P<0.05）。母亲和新生儿的血浆钙、铁和镁水平都呈显著正相关（P<0.05）。结论：早产儿母亲体内钙、铁含量低于足月儿母亲,早产儿体内的铁、镁含量低于足月儿。有关反映钙、铁和镁含量的指标与母亲在孕前孕期摄入情况的关系还有待进一步研究。     

早产儿和小于胎龄儿发生的危险因素的比较分析

目的 比较早产儿和小于胎龄儿发生的危险因素.方法 选择1 270例排除明确孕母疾病和产科危险因素的新生儿,自制调查问卷调查母亲身高、体重、被动吸烟和不良孕产史等因素,将研究对象分类为早产儿和足月儿、小于胎龄儿和适于胎龄儿,采用多因素logistic 回归分析比较早产儿和小于胎龄儿发生的危险因素.结果 孕期增重<9 kg使早产(OR=1.63,95%CI:1.12~2.07)和小于胎龄儿(OR=1.92,95%CI:1.56~2.58)发生的危险性均增高;母亲既往流产史(OR=1.46,95%CI:1.09~1.93)和早产史(OR=2.63,95%CI:1.81~3.92)是早产儿发生的的独立危险因素;孕母身高<1.55 m(OR=2.46,95%CI:1.78~3.48)、孕前BMI<18.5(OR=2.16,95%CI:1.53~3.16)、被动吸烟(OR=2.24,95%CI:1.65~2.98)是小于胎龄儿发生的的独立危险因素.结论 早产儿和小于胎龄儿的危险因素不同,针对两类特征孕妇应采取不同的预防措施,有针对性地减少两类不良妊娠结局的发生.     

早产儿的围产因素及防治对策探讨

目的：研究早产的围产因素及寻求相应的预防措施。方法：将我院近5年出生的新生儿2 567例,分为早产儿、足月儿两组,对照分析孕母年龄、胎膜早破、多胎妊娠、前置胎盘、妊高征、胎盘早剥、产前检查等围产因素,同时分析早产儿的并发症。结果：早产儿发生率为6.62%,早产儿组与足月儿组对比,除母亲孕龄差异无显著性外,胎膜早破、多胎妊娠、前置胎盘、妊高征、胎盘早剥,产前检查等因素差异均有显著性(P<0.01 或 0.05)。早产儿的并发症主要是新生儿肺炎、硬肿症、高胆红素血症和颅内出血。胎龄越小,体重越低,死亡率越高。结论：减少早产是降低围产儿死亡的关键,减少早产的发生应加强围产期保健,定期产前检查,对产前并发症采取各种防治措施,提高早产儿的成活率。     

产前糖皮质激素对晚期早产儿呼吸系统疾病的影响

目的探讨产前激素应用对晚期早产儿呼吸系统疾病的影响。方法回顾性分析2016年1月至2020年6月娩出的晚期早产儿及其母亲的临床资料。根据母亲产前地塞米松应用情况分为激素组和对照组,比较不同胎龄晚期早产儿呼吸系统疾病发生情况。采用logistic回归分析模型分析晚期早产儿生后呼吸系统疾病发生的危险因素。结果在胎龄36～36~(+6)周组,激素组剖宫产率高于对照组;在胎龄35～35~(+6)周和36～36~(+6)周组,激素组母亲分娩前胎膜早破率低于对照组,差异均有统计学意义(P0.05)。多元logistic回归分析显示,剖宫产、窒息是晚期早产儿呼吸系统疾病发生的危险因素;胎龄越大,呼吸系统疾病的发生风险越低(P0.05)。结论为减少晚期早产儿呼吸系统疾病的发生,应尽量延长孕周,降低剖宫产率,减少窒息的发生。     

父母超重/肥胖与子代孤独症谱系障碍的关系

目的 探讨母孕前父母超重/肥胖与子代孤独症谱系障碍（ASD）发生的关系。方法 选取ASD儿童36名（ASD组）及性别、年龄与之相匹配的72名正常儿童（对照组）纳入研究。采用问卷调查的方式收集母亲孕前两组儿童父母身高、体重以及母亲孕期增重等信息,采用单因素和多因素logistic回归法分析母孕前父母超重/肥胖与子代ASD的关系。结果 ASD组母孕前父亲超重/肥胖的检出率高于对照组（56% vs 32%,P=0.018）。单因素和多因素logistic回归分析均显示母孕前父亲超重/肥胖是子代发生ASD的危险因素（分别OR=2.66、2.58,P < 0.05）。结论 母孕前父亲超重/肥胖是子代罹患ASD的独立危险因素,因此在母亲妊娠前,父亲的体重指数应控制在正常范围内,以减少子代ASD的发生。     

早产婴儿骨密度及其影响因素分析

目的：了解早产儿骨矿发育的情况及影响因素。方法：随机选取儿保门诊随访的早产儿与足月儿各90例,采用定量超声技术测量6月龄时（早产儿为纠正胎龄6月龄）的胫骨骨密度,结果以超声波声速度（SOS）值和Z值表示;同时采用回顾性问卷调查影响骨矿发育的相关因素。结果：足月儿6月龄的SOS值和Z值明显高于纠正胎龄6月龄的早产儿。在早产儿组中,不同出生体重、胎龄婴儿的SOS值和Z值,不同断母乳时间婴儿的SOS值差异有统计学意义（P<0.05）;早产儿女婴的Z值明显高于男性婴儿,差异有统计学意义(P<0.05)。多元线性回归分析显示,断母乳时间及每天户外活动时间是早产婴儿SOS值的影响因素。结论：适时断母乳或延长每天户外活动时间可能有利于促进早产婴儿骨矿发育。     

骨定量超声技术在早产儿骨发育评价中应用和影响早产儿骨发育因素的研究

目的探讨定量超声(QUS)技术评价早产儿骨发育的作用及早产儿骨发育的影响因素。方法选取2009年2～7月本院NICU住院的早产儿为观察组,按2∶1比例随机选择同期出生的足月儿为对照组,用定量超声仪测量生后2d之内胫骨声波速度(SOS),同时检测出生24h内血钙、镁、磷和碱性磷酸酶,分析不同胎龄、体重、性别、母妊娠期高血压疾病及生化指标等因素对SOS值的影响,对有意义的因素进行多元回归分析。结果(1)胫骨SOS值早产儿低于足月儿;胎龄≤30周早产儿低于胎龄34～36周早产儿和足月儿,胎龄31～33周早产儿低于胎龄34～36周早产儿和足月儿;出生体重<1500g新生儿低于1500～2500g和>2500g的新生儿,P均<0.05;不同性别之间SOS值差异无统计学意义(P>0.05);早产适于胎龄儿低于早产小于胎龄儿,P<0.001;母妊娠期高血压疾病组早产儿高于非妊娠期高血压疾病组,P<0.05。(2)SOS值与胎龄(r=0.347,P<0.001)、母妊娠期高血压疾病(r=0.215,P=0.016)、宫内发育迟缓(r=0.367,P<0.001)、血钙(r=0.259,P=0.004)和血镁(r=0.234,...     

骨定量超声技术在早产儿骨发育评价中应用和影响早产儿骨发育因素的研究

目的 探讨定量超声(QUS)技术评价早产儿骨发育的作用及早产儿骨发育的影响因素.方法 选取2009年2～7月本院NICU住院的早产儿为观察组,按2:1比例随机选择同期出生的足月儿为对照组,用定量超声仪测量生后2 d之内胫骨声波速度(SOS),同时检测出生24 h内血钙、镁、磷和碱性磷酸酶,分析不同胎龄、体重、性别、母妊娠期高血压疾病及生化指标等因素对SOS值的影响,对有意义的因素进行多元回归分析.结果 (1)胫骨SOS值早产儿低于足月儿;胎龄≤30周早产儿低于胎龄34～36周早产儿和足月儿,胎龄31～33周早产儿低于胎龄34～36周早产儿和足月儿;出生体重<1500 g新生儿低于1500～2500 g和>2500 g的新生儿,P均<0.05;不同性别之间SOS值差异无统计学意义(P>0.05);早产适于胎龄儿低于早产小于胎龄儿,P<0.001:母妊娠期高血压疾病组早产儿高于非妊娠期高血压疾病组,P<0.05.(2)SOS值与胎龄(r=0.347,P<0.001)、母妊娠期高血压疾病(r=0.215,P=0.016)、宫内发育迟缓(r=0.367,P<0.001)、血钙(r=0.259,P=0.004)和血镁(r=0.234,P=0.008)正相关,与血磷(r=-0.201,P=0.025)负相关:多元回归分析发现胎龄、宫内发育迟缓和镁是影响SOS的重要因素(P<0.001).结论 QUS可以准确的评价胎儿骨营养状态,胎龄、宫内生长迟缓和镁是胎儿骨发育的重要影响因素.     

足月儿呼吸窘迫综合征发病相关因素分析

目的探讨足月儿呼吸窘迫综合征(RDS)的危险因素。方法选择2006—2009年本院新生儿科诊断RDS的足月儿为观察组,同期住院未合并RDS的足月儿为对照组。对两组胎龄、出生体重、分娩方式、宫内窘迫、窒息、脐带绕颈、母亲糖尿病、多胎等高危因素进行单因素方差分析和多因素Logistic回归分析。结果 (1)两组胎龄、母亲糖尿病、多胎、脐带绕颈差异无统计学意义(P>0.05),观察组体重低于对照组[(2713±375)g比(2994±473)g],男性比例和剖宫产率高于对照组(73.1%比56.7%,97.0%比66.4%),宫内窘迫率低于对照组(17.9%比31.3%),差异有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示,体重、剖宫产、男性、窒息、宫内窘迫、母亲糖尿病、多胎与足月儿RDS的发生有相关性(P<0.05)。结论剖宫产、男性、窒息、母亲糖尿病是足月儿RDS发生的危险因素,高出生体重、宫内窘迫、多胎是足月儿RDS发生的保护因素。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.