Neonatal abstinence syndrome and neurodevelopmental health outcomes: A state of the science

Despite the alarming increase in the numbers of infants born with neonatal abstinence syndrome (NAS), little is known about the effect on the children past the age of four. Clinical findings associated with NAS are found in the literature to have a negative effect on neurodevelopmental health outcomes. The purpose of this review is to examine the current evidence regarding NAS and neurodevelopmental outcomes, identify gaps in the literature, and discuss the possible association between NAS symptoms and neurodevelopmental disorders. A comprehensive literature review of quantitative research and review articles identified human and animal studies to clarify the current knowledge on the long-term effects of opioid exposure and NAS on neurodevelopmental outcomes. The analysis found that infants exposed to opioids in utero are at risk for poorer neurodevelopmental outcomes in early childhood; however, there is a lack of empirical evidence on the effect of NAS as children age.     

家庭干预在新生儿窒息伴急性呼吸窘迫综合征复苏后的应用价值

目的 探讨家庭干预在新生儿窒息伴急性呼吸窘迫综合征(ARDS)复苏后的应用价值.方法 将80例新生儿窒息伴ARDS患儿随机分为治疗组和对照组,每组40例.2组均给予机械通气结合肺表面活性物质(PS)进行复苏干预,复苏后对照组采用常规日常护理,治疗组在此基础上给予家庭干预.测定干预前后2组呼气流速(PEF)和达峰时间(TPTEF)及干预后6、24、72 h的氧合指数(OI),并观察并发症发生情况.结果 干预后6、24、72 h,组内OI呈明显下降趋势,其中干预后72 h降低最为显著(P＜0.01).干预后,2组PEF均较干预前明显降低,而TPTEF明显升高,其中治疗组降低和升高幅度均显著大于对照组(P＜ 0.05或P＜0.01).治疗组并发症总发生率显著低于对照组,差异有统计学意义(P＜0.05).结论 机械通气结合PS治疗后,采用积极的家庭干预有利于新生儿窒息伴ARDS患儿肺功能的改善,减少并发症的发生.     

Natural history of arterial and venous thrombosis in children treated with low molecular weight heparin: a longitudinal study by ultrasound1

Summary. Low molecular weight heparin (LMWH) is efficacious in preventing recurrent thromboembolic events (TEs) in children. The efficacy of LMWH in resolving thrombus in children is, however, unknown and may differ from what has been observed in adults due to known differences in the hemostatic system. We reviewed the ultrasound (US) scanning reports of children treated with LMWH in order to determine the rate and predictors of thrombus resolution. Of 245 children consecutively treated for a non‐cerebral TE with enoxaparin (Lovenox, Aventis Pharma Inc., QC, Canada) for at least 5 consecutive days, 190 (78%) had serial ultrasound available for analysis. The mean follow‐up time was 7 months (median 3 months, range 3 days to 6.6 years). The rate of complete thrombus resolution was 101/190 (53%, 95% confidence interval 46.2–60.2%). On univariate analysis, arterial and non‐occlusive thrombus had an increased rate of resolution when compared with venous and occlusive thrombus. Age at time of TE (neonates vs. non‐neonates), location of TE, initial treatment (unfractionated heparin vs. LMWH) and dose of enoxaparin were not related to outcome. On multivariate analysis, type of vessel (vein vs. artery) and occlusion (occlusive vs. non‐occlusive thrombus) independently predicted outcome. In children, the rate of complete thrombus resolution is similar to the rate in adults. The clinical significance of residual abnormal vessels, specifically to the occurrence of post‐thrombotic syndrome and for the diagnosis of recurrence, needs to be explored in prospective studies.     

不同胎龄新生儿呼吸窘迫综合征早产儿血细胞分析指标及临床特点

目的 探讨不同胎龄新生儿呼吸窘迫综合征(NRDS)早产儿母婴血细胞分析指标及临床特点.方法 选取本院2019年1月-2020年6月收治的128例NRDS早产儿,根据胎龄分为极早早产儿组56例、中期早产儿组32例、晚期早产儿组40例.回顾性分析3组的母婴血细胞分析指标、围生期高危因素、临床特征、并发症、转归情况.结果 极...     

Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study

Although a relationship between headache and sleep disturbances has been reported in adults, only few data have been available in children. Accordingly, we performed a survey to determine the prevalence of sleep disturbances in children with migraine and tension-type headache. A questionnaire of history and clinical data and of sleep disturbances was given to parents of 283 headache subjects (164 with migraine and 119 with tension-type headache). Results were compared to a normative group comparable for age and sex of 893 normal healthy subjects. Migraine subjects showed a higher prevalence of sleep disturbances during infancy as well as 3-month colic. In both headache groups, more parents had sleep disturbances and there was a higher occurrence of co-sleeping and napping. A high frequency of sleep disturbances involving sleep quality, night awakening, nocturnal symptoms and daytime sleepiness was reported in headache children. No statistical differences were found in the prevalence of sleep disturbances between migraine and tension-type headache. However, the migraine group tended to have "disturbed sleep" more often with increased prevalence of nocturnal symptoms such as sleep breathing disorders and parasomnias. Our results give further support to an association between sleep and migraine that may have a common intrinsic origin.     

Outcome in children under 5 years of age with constipation: a prospective follow-up study

Constipation in the pre-school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long-term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one-year period with idiopathic constipation. We now report outcome data after 18 months of follow-up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre-school children who do not improve may benefit from a more intensive psychological approach to management.     

Screening for feeding difficulties in the neonatal unit: Sensitivity and specificity of gestational age vs. medical history

BackgroundStudies to inform feeding interventions on neonatal units are lacking. This study aims to compare gestational age and medical history as methods of identifying infants at higher risk of developing feeding difficulties by 40 weeks gestational age.MethodA retrospective case note analysis was conducted on a level 3 neonatal unit. Infants were given a severity category based on gestational age at birth and medical history. Feeding outcomes were analysed for sensitivity, specificity, and positive and negative predictive values.Results233 infants were included. Medical history at severity level 2 provided a high level of sensitivity (84.62%) and specificity (87.92%) for feeding difficulties at 40 weeks gestational age.ConclusionMedical history can be used as a simple method to identify infants at highest risk of feeding difficulties prior to commencing oral feeding, enabling the targeting of preventative therapeutic interventions and caseload prioritisation.     

猪肺磷脂注射液联合枸橼酸咖啡因注射液治疗新生儿呼吸窘迫综合征的临床效果

目的 探讨猪肺磷脂注射液联合枸橼酸咖啡因注射液治疗新生儿呼吸窘迫综合征的临床效果.方法 选择2017年1月至2019年1月入院的82例新生儿呼吸窘迫综合征患儿为研究对象,根据随机数字表法将其分为对照组和研究组,各41例.对照组仅采用猪肺磷脂注射液进行治疗,研究组采用猪肺磷脂注射液联合枸橼酸咖啡因注射液进行治疗.比较两组...     

Laparoscopic Roux‐en‐Y duodenojejunostomy for superior mesenteric artery syndrome in a 6‐year‐old girl: A case report of a new minimally surgical technique for children

We present the first case report of laparoscopic Roux‐en‐Y duodenojejunostomy utilizing minimally invasive surgery to treat superior mesenteric artery syndrome in a child. A 6‐year‐old girl presented with a 3‐year history of intermittent postprandial epigastric pain and anorexia. An upper gastrointestinal series revealed dilatation of the first and second parts of the duodenum and an abrupt vertical cut‐off at the third portion. Despite conservative treatment for 7 weeks, there was no resolution of her symptoms, so the decision was made to proceed with a laparoscopic Roux‐en‐Y duodenojejunostomy. On follow‐up 9 months later, there had been no recurrence of her symptoms.     

The natural history of speech impairment of 8-year-old children in the Avon Longitudinal Study of Parents and Children: Error rates at 2 and 5 years

This prospective longitudinal population study observed the speech of 741 children at the ages of 2, 5 and 8 years. At the age of 8, 132 children were categorized as speech impaired. There was strong evidence of differences between the case and control groups in speech sound error rate at the two earlier age points. The pattern of the proportion of errors was similar for cases and controls. There was evidence of a strong relationship between the child's error rate and expressive language at age 2 and between the child's error rate and sentence length at age 5. In multivariable analyses, adjusting for expressive language, parent's social status, maternal age, gender and child's exact age, the increase in odds of being a case as the proportion of errors increased disappeared at 2 years but remained at 5 years. At 5 years, the proportion of speech errors was predictive of ongoing speech errors at the age of 8 years; the adjusted odds of having speech errors at 8 years increased by between 21 and 44% with every 10% rise in the proportion of errors in the target patterns.     

6-month CPAP-treatment in a young male patient with severe obstructive sleep apnoea syndrome — A case study from the couple''s perspective

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is independently associated with an increased risk for hypertension and cardiovascular disease. Continuous positive airway pressure (CPAP) can reduce mortality and morbidity, but low compliance rates are seen. AIM: To explore and describe the experiences of CPAP-treatment in a young male patient with severe OSAS during a 6-month period from the couple's perspective. METHODS AND THE CASE: A single case study with a phenomenographic approach was employed. Diagnostic procedures of OSAS and initiation of treatment with Auto-CPAP, humidifier and a nasal mask were performed during 4 visits. Conceptions were collected at 4 different occasions during the 6-month period (before, and 2 weeks, 3 months, and 6 months after treatment initiation) by means of interviews with a 33-year old male patient and his female partner. FINDINGS: Totally 17 different structural aspects were found to fluctuate during the 6-month period in relation to; influence of stressors, social reactions and adaptation to increase compliance. CONCLUSION: An increased knowledge about the influence of stressors, the social reactions, and the adaptation can help healthcare personnel to identify and better understand concerns of other patients and spouses during different time phases of the initial 6-month period of CPAP-treatment.     

Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development

Aims and objectives. The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long‐term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs. Background. Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner. Design. This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development. Methods. This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates. Results. Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter‐professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team. Conclusions. There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors. Relevance to clinical practice. A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi‐disciplinary teams. A greater level of day‐to‐day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.     

10岁以上儿童、青少年急性淋巴细胞白血病的临床研究

目的 研究大年龄急性淋巴细胞白血病(ALL)患儿的临床与预后特征.方法 2005年5月1日至2009年4月30日采用ALL-2005方案治疗10岁以上的ALL患儿共67例,根据细胞形态学、免疫学、细胞遗传学和分子生物学特点进行临床分组,并按分组治疗.对患儿进行临床特点、疗效及生存分析.结果 在67例大年龄ALL患儿中男40例(59.7％),女27例(40.3％),平均年龄12.3岁,中位年龄12.2(10.0～17.8)岁,进入中危和高危组的患儿分别为48例和19例.在诱导缓解治疗中,泼尼松窗口试验反应好和治疗第19天骨髓达M1的比例分别为83.6％和86.6％.有59例(88.1％)患儿在诱导第30～ 35天达骨髓形态学缓解,达缓解时间为(31.8±2.9)d,有微量残留病(MRD)标志的58例患儿中,42例(72.4％)在1个疗程后MRD ＜0.01％,在治疗过程中有7例患儿出现MRD阳性,2例患儿接受骨髓移植治疗.共15例患儿复发,持续完全缓解至复发时间为(14.9±9.9)个月.大年龄ALL患儿的5年无事件生存(EFS)和总生存(OS)率分别为(64.4±6.3)％和(74.1±6.1)％.单因素分析发现初诊时的高血清铁蛋白水平、伴有bcr-abl融合基因、窗口治疗反应差、第19天骨髓形态学非M1状态、第1个疗程结束时的骨髓形态学不缓解和MRD阳性与患儿预后不良呈显著相关性.多因素分析发现第1个疗程结束时骨髓MRD阳性与患儿预后不良呈显著相关性(RR =2.20,95％CI1.26 ～3.84,P＜0.01).结论 ALL-2005方案对大年龄ALL患儿疗效良好,初诊时的血清铁蛋白水平、融合基因检测、早期治疗反应以及治疗过程中的MRD监测可以作为判断患儿预后的指标.