不同HIV感染状态儿童体格发育的系统评价

目的系统评价不同艾滋病病毒（HIV）感染状态儿童的体格发育状况。方法计算机检索Pubmed、Google Scholar、万方数据库、中国期刊全文数据库（CNKI）、博硕士学位论文全文数据库、中文科技期刊数据库（维普）中,2008年1月1日至2012年12月31日期间发表的文献,采用定性的方法对纳入的文献进行归纳与分析。结果按照纳入标准与排除标准最终纳入12篇文献。定性分析结果显示,HIV感染儿童的体重、身高低于或在个别月龄低于HIV暴露儿童,两组儿童的头围比较无差异;HIV暴露儿童的体重、身高、头围低于或者在个别月龄低于正常儿童,个别文献显示,暴露儿童的体重高于正常儿童;HIV感染儿童的体重、身高低于或在个别月龄低于正常儿童,头围无差异或在个别月龄低于正常儿童。结论不同HIV感染状态儿童的体格发育状况不同,但需更多设计严谨的研究提供证据。     

江西省HIV抗体阳性孕产妇所生婴儿体格生长状况分析

目的了解江西省艾滋病病毒(HIV)抗体阳性孕产妇所生婴儿体格生长状况,为进一步采取干预措施提供依据。方法自行设计问卷,收集2011-2015年在江西省各级医疗保健机构产检及分娩的HIV抗体阳性孕产妇及其所生婴儿的基本信息,并在3、6、9、12个月月龄时随访,收集婴儿身长、体重等信息。采用t检验比较婴儿的体格生长指标。结果 2011-2015年共有111名HIV抗体阳性孕产妇所生的婴儿纳入本研究。HIV抗体阳性孕产妇所生婴儿出生体重低于世界卫生组织(WHO)标准及我国九市标准(P0.05);男婴3月龄体重低于我国九市标准,6月龄、9月龄及12月龄体重高于WHO标准,且差异具有统计学意义(P0.05),其余月龄体重与相关标准比较差异无统计学意义;女婴3月龄、6月龄体重低于九市标准,12月龄体重高于WHO标准,差异具有统计学意义(P0.05),其余月龄体重与相关标准比较差异无统计学意义(P0.05)。男婴出生身长低于我国九市标准(P0.05),但与WHO标准比较差异无统计学意义(P0.05),其余月龄身长与相关标准比较差异均无统计学意义(P0.05);女婴出生身长与相关标准比较差异无统计学意义(P0.05),3月龄、6月龄身长低于九市标准,且差异有统计学意义(P0.05);女婴3月龄身长低于WHO标准,且差异有统计学意义(P0.05),其余月龄身长与相关标准比较差异均无统计学意义(P0.05)。结论江西省HIV抗体阳性孕产妇所生婴儿的出生体重或身长低于相关标准,但追赶生长明显,到一定月龄时身长及体重能达到甚至超过相关标准。需要加强合理喂养及安全护理指导,以保证该类婴儿健康成长。     

HIV感染产妇分娩新生儿体格及妊娠疾病相关分析

目的通过对艾滋病病毒(HIV)感染产妇分娩的新生儿的出生体格情况及其相关影响因素进行分析,为HIV感染产妇孕期保健服务提供指导。方法回顾性分析2005年3月至2016年6月11年期间HIV感染产妇分娩的新生儿出生体格的发育情况,与同期普通产妇分娩的新生儿进行比较。结果共调查11 129名新生儿,HIV感染产妇的新生儿310人,普通产妇的新生儿10 819人。HIV感染产妇平均分娩孕周[(38.6±1.4)周]低于普通产妇[(39.2±1.3)周],差异有统计学意义(P0.05)。普通产妇所生新生儿体格发育情况优于HIV感染产妇所生新生儿(P0.05),HIV感染产妇所生新生儿体重(2 988.9±275.5)g,头围(29.3±2.7)cm,胸围(28.5±2.3)cm,身长(49±1.9)cm;普通产妇所生新生儿体重(3 250.5±424.8)g,头围(32.3±1.9)cm,胸围(31.6±1.9)cm,身长(50.1±1.7)cm。HIV感染产妇在妊娠并发症发生率,以及妊娠并发肝炎、胎膜早破、妊娠并发性传播疾病、胎儿宫内窘迫、早产、妊娠并发贫血、妊娠并发甲状腺疾病、妊娠并发肝脏疾病和胎儿生长受限等情况均高于普通产妇,差异有统计学意义(P0.05)。胎膜早破羊水细菌培养感染率HIV感染产妇高于普通产妇,差异有统计学意义(P=0.042)。结论 HIV感染会对孕产妇的孕周及新生儿出生体重产生影响,对于HIV感染孕产妇应加强孕期保健服务,规范抗病毒治疗、预防药物不良反应,安全助产,指导新生儿科学喂养,提高HIV产妇和婴儿的生存质量。     

人类免疫缺陷病毒感染母亲分娩新生儿生长发育状况分析

目的探讨人类免疫缺陷病毒（HIV）感染产妇分娩新生儿生长发育状况。方法收集HIV感染产妇分娩病历,对新生儿体质量、身长与同期本地新生儿进行比较分析。结果 HIV感染产妇分娩新生儿平均出生体质量为2792.86g,为本地同期单胎新生儿平均出生体质量3109.30g的89.82%。HIV感染产妇足月分娩新生儿平均出生体质量为2991.67g,为本地同期单胎新生儿平均出生体质量3128.00g的95.64%。人类免疫缺陷病毒感染产妇分娩新生平均出生身长为49.29cm,为本地同期单胎新生儿身长99.92%。人类免疫缺陷病毒感染产妇足月分娩新生儿6例平均出生身长为49.33cm,为本地同期单胎新生儿身长的98.58%。结论 HIV感染产妇对新生儿生长发育有一定的影响,本研究病例少,其影响程度尚有待进一步研究。     

燃煤污染型氟中毒孕妇对新生儿体格发育与智力发育的影响分析

目的探讨燃煤污染型氟中毒孕妇对新生儿体格发育与智力发育的影响。方法选取本地区燃煤污染型地方性氟中毒病区孕妇分娩的68例新生儿作为观察组,再选择常健康孕妇分娩的50例足月新生儿作为对照组,比较两组新生儿出生后1h生长发育指标,并比较两组婴幼儿出生3、6、9、12个月后体重发育、身长发育与智能发育指数(MDI)和运动发育指数(PDI)。结果观察组新生儿其体重、身长、头围、胸围、上臂围以及顶臂长均显著低于对照组新生儿,差异具有统计学意义(P0.05);两组婴幼儿出生3、6、9、12个月后,对照组婴幼儿体重发育、身长发育等级评价显著优于观察组(P0.05);两组婴幼儿出生3、6、9以及12个月后,观察组MDI、PDI指数均显著低于对照组(P0.05)。结论燃煤污染型氟中毒孕妇可对其新生儿的体格发育及智力发育造成一定的影响,应高度重视燃煤型氟中毒地区孕妇的保健工作,采取积极的氟中毒防治措施,以减少氟中毒对新生儿的不良影响。     

经LT4治疗的妊娠期亚临床甲状腺功能减退症对子代0～36月龄生长发育及神经心理影响的队列研究

目的评价经LT4治疗的妊娠期亚临床甲状腺功能减退症(甲减)对子代0～36月龄生长发育及神经心理的影响。方法招募孕前无甲状腺病史的20～45岁单胎妊娠健康妇女建立母婴队列, 对妊娠期发生亚临床甲减的妇女给予LT4治疗。纵向收集子代0～36月龄的体重、身长、头围等生长发育检查结果。通过问卷调查母婴营养、家庭经济水平和婴儿照护等情况。应用《0～6岁儿童神经心理发育量表》评价子代6月龄和12月龄的神经心理发育水平。结果最终将186对母子纳入研究队列, 依据孕期甲状腺功能将研究对象分为甲状腺功能正常组(136例)和亚临床甲减组(50例)。亚临床甲减组子代出生时的体重、身长、体重/身长Z评分, 1月龄体重/身长Z评分, 6月龄头围Z评分, 8月龄身长Z评分, 24月龄体重/身长Z评分, 以及12月龄的语言评分均低于甲状腺功能正常组(P<0.05)。经LT4治疗的妊娠期亚临床甲减对早产、低出生体重、发育商<85分均未呈现显著影响, 但可降低巨大儿的发生风险(AOR 0.206, 95%CI 0.046～0.929,P=0.040)。结论妊娠期亚临床甲减经LT4治疗后仍可能对子代0～36月...     

脐带血瘦素水平与胎儿宫内生长发育的关系

目的探讨瘦素在胎儿宫内生长发育中的作用,为代谢疾病的早期干预提供实验依据。方法连续入选2009年7月至2010年1月在北京协和医院出生的单胎足月新生儿266名（男婴140名,女婴126名）,留取脐带血,出生后立即测量新生儿体重、身长、头围及胎盘重量。根据出生体重将新生儿分为低出生体重组（n=58,男婴25例,女婴33例）、正常出生体重组（n=180,男婴99名,女婴81名）和高出生体重组（n：28,男婴16例,女婴12例）。采用放射免疫分析法测定脐带血瘦素水平。采用独立样本t检验、Pearson相关分析、多元线性回归分析进行数据统计。结果与正常出生体重组[（9±5）μg/L]相比,低出生体重组脐带血瘦素水平[（7±5）μg/L]明显降低（t=3．216,P〈0．05）,高出生体重组[（15±7）μg／L]明显升高（t=-4．026,P〈0．01）。女婴脐带血瘦素水平[（11±6）μg/L]明显高于男婴[（8±5）μg／L,t=一3．800,P〈0．01]。Pearson相关分析显示,脐带血瘦素水平与新生儿出生体重、身长、体质指数和胎盘重量呈显著正相关（r值分别为0．391、0．280、0．361、0．323,均P〈0．01）。校正母亲年龄、妊娠前体质指数、新生儿性别和胎龄后,脐带血瘦素水平仍与出生体重呈直线正相关（r2=0．289,P〈0．01）。结论脐带血瘦素水平与新生儿出生体重呈正相关,有望作为反映新生儿宫内生长发育的一个客观指标。     

Pit-基因突变致先天性垂体功能减退及前脑垂体发育不全

先天性垂体机能减退是威胁生命的异种基因病变。报道了一例２０个月男孩,因Ｐｉｔ１基因突变致严重生长发育障碍,而其垂体大小和解剖正常。病例　患儿系第一胎,父母健康,非近亲婚配。母孕期健康。患儿足月经阴道自然分娩,生后１、５、１０ｍｉｎ阿氏评分分别为６、７、８分。出生体重３．０８ｋｇ,身长４８．５ｃｍ。生后６ｈ出现短暂低血糖（１．６ｍｍｏｌ／Ｌ）。食欲差,持续便秘,生长发育轻度延迟。患儿２０个月时就诊内分泌科,表现严重生长发育障碍（身长－６．９ＳＤ,体重－４．７ＳＤ,头围－０．７ＳＤ）,甲状腺功能低…     

凉山彝族感染HIV孕产妇所生婴幼儿死亡状况分析

目的了解彝族感染艾滋病病毒(HIV)孕产妇所生婴幼儿的死亡状况,为提高彝族感染HIV孕产妇所生儿童的生存质量提供依据。方法对昭觉县2008年以来死亡的彝族感染HIV孕产妇所生的活产婴幼儿进行回顾性调查,并对结果进行统计和分析。结果昭觉县彝族感染HIV孕产妇所生婴幼儿的死亡率(15.8%,53/336)明显高于当地婴幼儿的死亡率(1.1%,47/4227),死亡年龄多在2岁以内,死亡的主要原因为肺部感染、消化道感染、新生儿窒息。多因素Logistic回归分析显示,母亲分娩前已知感染HIV、母亲孕产期使用过抗病毒药物,是减少感染HIV孕产妇所生婴幼儿死亡的保护因素。结论昭觉县彝族感染HIV孕产妇所生婴幼儿,经母婴传播途径感染HIV的风险较大,死亡原因与HIV感染状态的相关性有待进一步分析和探讨。     

蛲虫感染与个人和社会因素的关系及其对儿童生长发育的影响

目的 探讨蛲虫感染与个人和社会因素的关系及其对儿童行为和体格发育的影响,为控制蛲虫病寻找更有效的途径。方法 采用透明胶纸粘贴法对陕西省11所城镇幼儿园的6岁以下儿童进行蛲虫抽样检查,同时对儿童卫生习惯、父母知识水平、当地经济条件、幼儿园卫生状况、儿童临床症状、体格发育状况等方面进行问卷调查。结果 陕西地区儿童蛲虫感染率为15．99％,男性（18．54％）高于女性（12．55％）,陕南（19．56％）略高于关中（15．77％）和陕北（15．28％）;蛲虫感染与儿童饭前便后不洗手、不常剪指甲、不洗澡、喝生水等不良卫生习惯呈正相关,而与父母亲（尤其是母亲）的文化程度、当地经济条件、幼儿园的卫生状况呈负相关;全托幼儿园儿童蛲虫感染率（47．06％）明显高于日托（14．14％）和散居儿童（16．67％）;感染蛲虫后,肛周瘙痒和夜间磨牙症状比较突出;轻中度感染对儿童的体格发育,如身高、体重、头围、胸围无明显影响,而重度感染组除头围外儿童的身高、体重、胸围明显低于对照组儿童。结论 蛲虫感染与个人卫生习惯、父母文化程度和社会经济状况密切相关;长期重度感染可使儿童体格发育稍滞后于同龄人。     

Growth of infants born to HIV-infected women in South Africa according to maternal and infant characteristics

Objective To evaluate growth parameters assessed by weight and length in HIV‐infected and HIV‐uninfected infants born to HIV‐infected mothers in South Africa from birth to 6 months of age. Methods We calculated z‐scores for weight‐for‐age (WAZ), length‐for‐age (LAZ) and weight‐for‐length (WLZ) among a cohort of 840 mother–infant dyads. Multivariable Cox proportional hazards models with time‐varying covariates were used to estimate the risk of falling z‐scores for WAZ, LAZ, and WLZ as a function of infant and maternal characteristics. Results By 6 months after birth, a fifth of infants had WAZ P < 0.001). The risk of WAZ falling 相似文献   

Early growth of infants of HIV-infected and uninfected Zambian women

OBJECTIVE: Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health. METHODS: HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n = 184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2-4 years (n = 85). RESULTS: Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy. CONCLUSIONS: Early growth of infants of HIV-infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.     

Early surgical closure of a large ventricular septal defect: influence on long-term growth.

The pre- and postoperative growth patterns of 52 otherwise normal infants undergoing primary surgical closure of a large ventricular septal defect before 7 months of age were reviewed. Serial measurements of weight, length and head circumference were compiled for all patients preoperatively and in 46 long-term survivors and were expressed as Z scores (in standard deviations from the mean for age and gender). By the time of surgery at a mean age of 0.33 year, the mean weight, length and head circumference Z scores of all 52 infants were -2.9, -0.9 and -0.6, respectively, and were all significantly below normal (p less than 0.001). At a mean age of 5.7 years, the mean weight, length and head circumference Z scores of 35 patients of normal birth weight were normal or varied only marginally from those of the reference population (-0.4, -0.1 and +0.5, respectively; p less than 0.02, p greater than 0.05 and p = 0.008, respectively) and did not differ significantly in any variable from those of 44 normal siblings. However, among 11 infants with a low birth weight, all three variables remained abnormal at long-term follow-up when compared with the reference population (-1.7, -1.7 and -0.9, respectively; p less than 0.001 for each) and 22 normal siblings (p less than or equal to 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV-specific gag responses in early infancy correlate with clinical outcome and inversely with viral load

Many HIV-infected infants progress to AIDS during the first year of life when antiretroviral therapy (ART) is not given. The immune determinants of progression to AIDS are not known. We hypothesized that distinct HIV-specific T cell responses correlate with viral load and survival over the first year of life. Whole blood of infants at 3, 6, 9, and 12 months of age was incubated with HIV antigens Gag and Env. The frequency of specific T cells producing interferon (IFN)-γ was then measured by flow cytometry. Viral load and CD4% in HIV(+) infants were determined at each time point. ART was not available for this population at the time of sample collection. Those infants who survived to 12 months of age (n=12) had lower viral loads and higher Gag-specific CD8(+) T cell responses at 3 months, compared with infants who died (n=8). Furthermore, the frequency of Gag-specific CD4(+) T cells correlated inversely with viral load at 3 and 6 months of age. Together these data indicate that the early presence of quantitatively higher Gag-specific T cell responses in HIV-infected infants is associated with lower viral loads and decreased mortality in the first year of life. Our data support the design of a vaccine that preferentially elicits Gag responses, which may result in lower levels of viremia and possibly improve outcome.     

艾滋病高发地区预防HIV母婴传播项目实施效果分析

目的了解艾滋病高流行的4省（自治区）的6个县（市、区）,预防艾滋病病毒（HIV）母婴传播项目的实施效果。方法通过全国预防艾滋病母婴传播信息管理系统,收集2007年1月至2010年9月研究地区艾滋病病毒（HIV）感染孕产妇个案卡及其所生儿童的随访登记卡,分析预防HIV母婴传播干预措施落实情况及效果。结果2007-2010年,研究地区HIV感染孕产妇抗病毒药物应用比例和孕期抗病毒药物应用比例,分别从78.4%和27.8%增加至93.7%和78.8%（趋势χ2=17.636,P〈0.01;趋势χ2=76.835,P〈0.01）;HIV感染孕产妇应用三联抗病毒药物方案的比例自19.8%增加至89.9%（趋势χ2=161.757,P〈0.01）。满18月龄艾滋病感染孕产妇所生儿童接受HIV抗体检测比例为84.8%（318/375）,13例儿童抗体检测阳性,艾滋病母婴传播水平为4.1%（95%可信区间：2.98%-5.20%）。结论研究地区预防HIV母婴传播干预措施落实指标逐年提高,HIV母婴传播水平显著下降,孕产妇及早抗病毒用药以及儿童随访检测仍为工作中的薄弱环节。     

Analysis of HIV tropism in Ugandan infants

HIV-infected infants may have CXCR4-using (X4-tropic) HIV, CCR5-using (R5-tropic) HIV, or a mixture of R5-tropic and X4-tropic HIV (dual/mixed, DM HIV). The level of infectivity for R5 virus (R5-RLU) varies among HIV infected infants. HIV tropism and R5-RLU were measured in samples from HIV-infected Ugandan infants using a commercial assay. DM HIV was detected in 7/72 (9.7%) infants at the time of HIV diagnosis (birth or 6-8 weeks of age, 4/15 (26.7%) with subtype D, 3/57 (5.3 %) with other subtypes, P=0.013). A transition from R5-tropic to DM HIV was observed in only two (6.7%) of 30 infants over 6-12 months. Six (85.7%) of seven infants with DM HIV died, compared to 21/67 (31.3%) infants with R5-tropic HIV (p=0.09). Higher R5-RLU at 6-8 weeks was not associated with decreased survival. Infants with in utero infection had a higher median R5-RLU than infants who were HIV-uninfected at birth (p=0.025).     

Longitudinal growth during the first 2 years of life in children born to HIV-infected mothers in Malawi, Africa

To evaluate the longitudinal growth patterns of infants born to HIV-infected and uninfected mothers in Malawi, Africa, 92 HIV-infected infants, 270 uninfected infants born to HIV-infected mothers, and 686 infants born to uninfected mothers between birth and 24 months of life were studied. Weight and length were evaluated longitudinally utilizing generalized estimating equations. HIV-infected children were compared with uninfected children born to HIV-infected and uninfected mothers, and to United States National Center for Health Statistics (NCHS) growth standards. Median weight and length-for-age of seronegative infants born to either seronegative or seropositive mothers approximated the NCHS median from birth to approximately 4 months of age. Median weight and length of HIV-infected infants deviated from the NCHS median at an earlier age, and the deviation was more pronounced than was observed for uninfected infants. Mean growth curves constructed by generalized estimating equations indicated that HIV-infected and uninfected infants born to HIV-infected mothers weighed less and were smaller than infants born to HIV-uninfected mothers initially. Mean weight and length of uninfected infants attained the median of infants born to uninfected mothers by 24 months of age, while HIV-infected infants remained below this median. The difference in mean weight-for-age for HIV-infected and uninfected infants born to HIV-infected mothers was statistically significant from birth. The difference in mean length-for-age was statistically significant after 5 months of age. Thus, although infants born to HIV-infected mothers were smaller and weighed less initially, uninfected infants caught up, while HIV-infected infants remained below the median, and the deficit in weight occurred earlier in life than the deficit in length.     

The management of breast feeding among infants with phenylketonuria

Summary Treatment for phenylketonuria (PKU) involves using low phenylalanine or phenylalanine-free formulas and supplementation with sufficient phenylalanine for normal growth and development. Eighteen infants with phenylketonuria who received breast milk as their primary phenylalanine source were compared with ten other infants with PKU who received their phenylalanine primarily from infant formulas. There were no significant differences between breast-fed and formula-fed infants for serum phenylalanine, serum tyrosine, length, weight, head circumference, haematocrit, haemoglobin, serum iron, total iron binding capacity, percentage iron saturation, ferritin, plasma zinc and total calorie intake. Breast-fed infants did show lower mean corpuscular volume at 3 months and 6 months of age. Breast-fed infants had lower phenylalanine intake at 2, 4, 5 and 6 months of age. Breast-fed infants at 1, 2, 3, 4, 5 and 6 months of age had lower protein intake. Breast feeding may be continued in the newly diagnosed phenylketonuric infant without any apparent adverse nutritional consequences.     

Making a working clinical diagnosis of HIV infection in infants in Zimbabwe

Objectives Clinical algorithms can be helpful in decisions about treatment and feeding options in infancy, but have had limited exposure to real data. This analysis uses data from a large clinical trial to test such algorithms, and thereby develop a successor which performs usefully in poor countries with high HIV‐prevalence. Methods The ZVITAMBO trial followed 14 110 mother‐baby pairs through infancy. 32% of mothers were HIV‐positive. Infants were HIV tested regularly using DNA PCR. Clinical signs were evaluated in terms of identifying HIV‐infection at 6 weeks, 6 and 12 months, using Zimbabwean, South African, and WHO generic adaptations of the WHO integrated management of childhood illness HIV algorithm. A modification, in which HIV‐exposed infants are first divided into being at least or less than median weight‐for‐age, was derived and evaluated. Results At 6 weeks 65% of all infected babies are less than median weight‐for‐age. Adding at least two clinical signs reduces sensitivity to 20% but those identified are 1.5 (95% CI 1.1–2.1) times more likely to die by 6 months than other infected infants. At 6 months, 86% of uninfected babies of HIV‐infected mothers can be identified by selecting those whose weight is greater than median or, if less than median, who exhibit <2 clinical signs. Conclusions In poor settings a simple clinical algorithm can identify children with probable HIV infection, especially those at risk of early death, who can then be referred for further testing and care, including highly active antiretroviral therapy. Most infants who are HIV‐uninfected can be identified at 6 months and provided with support to maintain infection‐free survival, including focussed infant‐feeding counselling.