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??Conventional mechanical ventilation??CMV?? is the one of the commonest modes applied in neonates. pressure control ventilation??PCV?? is still the most frequently used in clinics though volume targeted ventilation??VTV?? has shown better therapeutic effects and less adverse effect than pressure limited ventilation??PLV??. Early intervention needs clear and definite indication combined with consideration of pending respiratory failure. Setting and adjusting parameters on ventilator should be based on gestational age of the baby??pulmonary dynamic and blood-gas in relation with particular disease.     

儿童哮喘控制测试在哮喘病情评估中的应用

多年来的国内外研究证明,经过合理诊断、评估及治疗,哮喘可以得到有效的管理和控制,其中,对哮喘患儿病情的准确评估成为哮喘控制管理中的重要环节。1儿童哮喘病情评估方法的发展1.1哮喘严重度自1991年美国哮喘教育和预防项目     

Early concurrent and longitudinal symptoms of ADHD and ODD: relations to different types of inhibitory control and working memory

BACKGROUND: The aim of the present study was to investigate how three different types of inhibitory control - interference control within task, interference control outside task, and prepotent response inhibition - and two types of working memory - verbal and spatial - would relate to early symptoms of attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), both concurrently and longitudinally. METHODS: Seventy-two preschoolers, 1/3 who had been identified as being at risk for developing ADHD and/or ODD, completed neuropsychological tasks designed to measure inhibitory control and working memory. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and ODD. RESULTS: Our results suggest distinct types of inhibitory control as being good predictors of concurrent and longitudinal symptoms of ADHD, rather than ODD. However, no associations were obtained between working memory and ADHD or ODD symptoms either concurrently or longitudinally. CONCLUSIONS: This study emphasizes the need to isolate complex executive processes and break them down into components in order to properly understand the neuropsychological roots involved in ADHD and ODD.     

Evaluating the Role of Birth Weight and Gestational Age on Acute Lymphoblastic Leukemia Risk Among Those of Hispanic Ethnicity

High birth weight is an established risk factor for childhood acute lymphoblastic leukemia (ALL), especially in children younger than 5 years of age at diagnosis. The goal of this study was to explore the association between being born large for gestational age and the risk for ALL by race/ethnicity to determine if the role of this risk factor differed by these characteristics. The authors compared birth certificate data of 575 children diagnosed with ALL who were younger than 5 years and included in the Texas Cancer Registry, Texas Department of Health, between the years 1995 and 2003 with 11,379 controls matched by birth year. Stratified odds ratios were calculated for risk of ALL by birth weight for gestational age, categorized in 3 groups, small, appropriate, and large for gestational age (SGA, AGA, and LGA, respectively), for each race/ethnicity group. The risk of developing ALL was higher among Hispanics who were LGA (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.34–2.68) compared with LGA non-Hispanic whites (OR = 1.27, 95% CI: 0.87–1.86) after adjusting for infant gender, year of birth, maternal age, birth order, and presence of Down syndrome. However, the difference was not statistically significant. These results suggest that there may be differences in the association between higher growth in utero and risk of childhood ALL among Hispanics versus non-Hispanic whites.     

Fear, Anxiety and Perceived Control in Children of Agoraphobic Parents

Sixteen children ( M = 11 years) of agoraphobic parents were compared with no children of parents with no history of psychopathology, matched on age. gender and socioeconomic status The majority (68%) of children of agoraphobic parents met DSM-III-R diagnostic criteria, anxiety disorders being must common. They reported more fear and anxiety and less control over various risks than did comparison children. Groups' perceptions of the prevalence and their vulnerability to these risks did nut differ. Agoraphobic mothers reported more separation anxiety than did comparison mothers, and maternal separation anxiety was negatively correlated with children's perceived control. Results are related to models of anxiety transmission.     

Maturation of cardiac control in full-term and preterm infants during sleep

ECG and respiration were recorded from 13 full-term and 8 preterm infants at 2–5-week intervals during sleep at home in the first year of life. Average pulse interval in both quiet and active sleep was minimum at postnatal ages between 4 and 10 weeks, with the minimum during quiet sleep being significantly smaller for preterm (409 ±22 (SE) msec) than for full-term (445 ±9 msec) infants. The minimum average pulse interval of preterm infants was smaller than the pulse interval of full-term infants at any postconceptional age, and a smaller average pulse interval and smaller variations in pulse interval in preterm infants during quiet sleep persisted until a postnatal age of 7 months. The pulse interval variations attributable to respiration varied substantially with age. The results indicate that developmental changes in cardiac rate control are functions of both postnatal and postconceptional age, with the post-conceptional age at birth setting the mean level of pulse interval, a level which is then altered by development linked to postnatal age.     

儿童哮喘病情评估的方法研究和应用进展

建立儿童哮喘病情评估的方法是防治哮喘的重要一环.目前已有多种评估方法应用于临床,但由于患几年龄、遗传、环境、发病机制、治疗等因素的影响,现有的儿童哮喘病情评估方法尚存在诸多缺陷,不能够客观反映哮喘病情和气道炎症的情况.该文就现有的哮喘评估方法包括症状评分、肺功能检测、气道反应性检测、NO检测等的原理、应用方法等进行综述,分析其优缺点,旨在更合理地应用这些方法,在儿童哮喘诊断、病情检测、用药指导和预后判断等方面发挥重要作用,并为探讨更有效、方便的儿童哮喘评估方法建立基础.     

Comparison of different indices of dietary control in phenylketonuria

Ten different indices of dietary control (IDCs) applied frequently to investigate compliance of phenylketonuric patients were calculated for a set of blood phenylalanine levels for 98 patients in the German Collaborative Study of Children Treated for Phenylketonuria during their first 9 years of life. The results were compared for similarities and differences. Cluster analysis of longitudinal phenylalanine data was introduced to analyse phenylalanine blood levels independent of a priori defined criteria of classification. Three groups of good, intermediate and poor long–term dietary control were identified. Internal validation of the IDCs was corroborated by the high inter–correlations of the indices. External validity was determined by the inter–relations of the WISC–RIQ and the IDCs. The different algorithms of IDCs suggest different clinical conclusions. To facilitate comparisons of results of future research, IDCs should be standardized.     

Control of Japanese encephalitis in India: A reality

Japanese encephalitis is considered as a serious disease due to the complexity of the disease and lack of specific treatment. A secular trend towards declining of JE has been brought in China, Korea, and Japan with widespread use of JE vaccine. In India, the actual JE burden could be estimated only by strengthening diagnostic facilities for JE confirmation in hospitals. However, the available records at present indicate a rising trend in JE-occurrence and expansion of the disease into JE non-endemic areas, which cannot be ignored. JE control through vector control methods has limitations owing to sustainability and cost effectiveness of the programs. Under these circumstances, feasibility of JE vaccination in India has to be considered as a preventive measure, for which identification of risk areas, target populations to be immunized, cost-evaluation of immunization is emphasized. Since, JE vaccine is produced in India, extension of the availability of this vaccine into routine JE-immunization programs is not remote. China has proved that countries with limited sources can produce safe and effective JE vaccines.     

Prevalence of childhood obesity from 1978 to 2007 in Japan

Background: There are few cross‐sectional and longitudinal studies on identification of the age of onset of obesity. The purpose of the present study was therefore to investigate 30 years of cross‐sectional and longitudinal changes in the prevalence of obesity from 1978 to 2007 in Japanese children and adolescents between 5 and 17 years of age, using population‐based samples. Methods: Subject data were obtained from the Annual Reports of the School Health Survey published by the Ministry of Education, Culture, Sports, Science and Technology, Japan. Obesity was defined as a body mass index (BMI) at or above the 95th percentile for age and gender based on the reference years from 1979 to 1981 in Japan. The BMI was calculated as weight in kg/(height in m)². Results: Cross‐sectional analysis of 5‐, 8‐, 11‐, 14‐, and 17‐year‐olds showed that the prevalence of obesity has gradually decreased since the early 2000s, with the highest prevalence in the late 1990s to early 2000s, except for in 17 year‐old boys. Longitudinal studies showed that the critical periods for developing obesity were in late infancy (between 5 and 6 years of age) and in the high school period in boys, and mainly in late infancy in girls. Conclusions: Intervention to prevent obesity should be focused on late infancy in both genders and male adolescents in Japan.     

三个时段感染防治措施对新生儿呼吸机相关肺炎干预效果

目的 探讨NICU不同时段的防治措施对呼吸机相关肺炎（VAP）的效果,为临床提供有效的防治策略。方法 以2008年6月复旦大学附属儿科医院搬迁至新院为分时段标志,第1时段：搬迁前1年,老医院NICU环境（防治措施：零散和经验性的）,2006年2月1日至2007年1月31日;第2时段：搬迁后第1年,新医院NICU环境（防治措施：逐渐从单项防治措施向综合防治措施过渡）,2008年8月1日至2009年7月31日;第3时段：搬迁后第2年,新医院NICU环境（防治措施：综合防治措施产生良性循环）,2010年1月1日至2010年12月31日。以NICU使用气管插管呼吸机通气≥48 h并在NICU住院时间≥5 d的新生儿为研究对象,以VAP发生率为主要结局指标,比较3个时段VAP发生率和病原菌分布情况。结果 3个时段共入选491例新生儿,总的VAP发生率为27.3/1 000呼吸机使用日。3个时段VAP发生率（/1 000呼吸机使用日）分别为48.8、25.7和18.5,差异有统计学意义(P<0.001)。VAP病原菌以革兰阴性杆菌为主,占95.5%（63/66）,最主要致病菌是鲍曼不动杆菌（65.2%,43/66）;其次是肺炎克雷伯菌（15.2%,10/66）;大肠埃希菌及铜绿假单胞菌各占6.1%（4/66）。结论 NICU环境改善的同时,逐步建立健全综合防治措施并形成良性循环能有效并且持续的降低VAP的发生率。     

Well‐directed inclusion of hematology in African national cancer control plans

In the context of a convergent call for noncommunicable disease integration in the global agenda, recognizing cross‐cutting needs and opportunities in national strategies across disease fields with shared priorities in low‐ and middle‐income settings can enhance sustainable development approaches. We reviewed publicly available cancer control plans in Africa to evaluate for inclusion of hematology needs and shared service priorities. Pediatric data remain sparse in cancer control plans. While continental Africa represents incredible diversity, recognizing shared priorities and opportunity for collaboration between oncology and hematology services and across age groups may guide prioritized cancer control efforts and reduce programmatic redundancies in resource‐limited settings.     

Autonomic cardiovascular control in hypotensive critically ill preterm infants is impaired during the first days of life

Background

The first days after preterm birth are a critical period of cardiovascular instability, where hypotension is common. We assessed autonomic cardiovascular function by measuring heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) and hypothesised that these would be impaired in preterm infants born at younger gestational ages. In addition, we speculated that impaired cardiovascular control could be used as a marker of circulatory failure such as is manifest as hypotension.

Methods

23 preterm infants (11 M/12 F) born between 23 and 35 weeks (mean 27 ± 0.6 weeks) gestational age with indwelling arterial catheters were recruited. Infants were studied over the first 3 days of life with heart rate and blood pressure (BP) analysed beat to beat in the frequency domain in 2 minute epochs of artefact free data during active sleep. Data were compared with one way ANOVA.

Results

Gestational age was correlated with all HRV indices but not BPV or BRS. 9 babies received inotropes. Gestational age between the inotrope group and the non-inotrope group was not different. BP and RR interval were lower in the inotrope group (40.7 ± 1.5 vs 47.1 ± 1.5 mm Hg, p < 0.05 and 395 ± 14 vs 426 ± 11 ms, p < 0.08). BRS was also lower in the inotrope group (3.8 ± 0.9 vs 6.9 ± 1.6 ms/mm Hg) as was LF/HF HRV (5.7 ± 1.3 vs 13.6 ± 2.8, p < 0.05).

Conclusions

In the first 3 days after birth, infants receiving inotropes had significantly impaired cardiovascular control compared to those who did not receive treatment, indicating that these infants maybe predisposed to increased vulnerability to circulatory instability.     

Enuresis in hyperthyroidism: a temporary lack of central control mechanism leads to nocturnal enuresis

We report on a 9-year-old boy who suffered from hyperthyroidism and a new appearance of enuresis. Bedwetting ceased and prepulse inhibition (PPI) – measured as a parameter of central control – increased during the course of therapy.
Conclusion:  The increase in PPI is an indication that enuresis in hyperthyroidism could be as a result of a temporary loss of central control on brainstem reflexes. The case conveys new insights into the correlation between thyroid hormones and micturition patterns and the aetiology of enuresis.