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??The physiological characteristics of children determine their own particularity of their needs for the quality and quantity of proteins. Proteins not only play an important role in the development of children’s growth and development??cognitive function and immune function??but also have important effects on the long-term health of children.In this paper??the dietary protein reference intakes??amino acid patterns??dietary amino acid reference intakes??sources of high quality protein??and harm of deficiency and excess of protein in children were discussed in detail.     

Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience

Background and Objectives

A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience.

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

婴幼儿膳食营养与生长发育指标调查

目的确定当前3岁以下儿童主要的营养问题，为制定营养改善对策提供科学依据。方法对在本院儿童保健中心定期进行体检的386例6—36个月儿童进行体格测量及智力发育检测，并同时进行膳食分析。结果膳食中能量、蛋白质、视黄醇、硫胺素、抗坏血酸及铁、钙的摄入均达到膳食营养素参考摄入量（DRIs）标准，膳食锌平均摄入量未达到DRIs的80％。Logistic回归分析提示碳水化合物摄入量过高是婴幼儿肥胖的一个危险因素。能量和碳水化合物摄入越多，智力发育指数越高。结论婴幼儿生长发育和膳食状况良好，父母要注意培养婴幼儿科学的膳食习惯。     

Perinatal and neonatal use of sedation and analgesia

Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus. Although experimental data raise concerns, human data are reassuring and future research may focus on neuroprotective adjuncts in the setting of repeated or prolonged anesthetic exposures. Opioid analgesia is standard of care for preterm infants undergoing major procedures including invasive surgery and endotracheal intubation. The use of opioids for agitation resulting from mechanical ventilation is controversial, but prevalent. Randomized and retrospective studies detect short-term toxicity with inconclusive long-term impact, suggesting the need to explore alternative therapies.     

Prenatal and postnatal administration of prebiotics and probiotics

Colonization of the neonatal gut by beneficial bacteria is important for the establishment and maintenance of the mucosal barrier, thus protecting the neonate from enteric pathogens and local and systemic inflammation. The neonatal microbiome is influenced by infant diet, environment, and the maternal microbiome. Dysbiosis in pregnancy increases the risk of pre-eclampsia, diabetes, infection, preterm labor, and later childhood atopy. Dysbiosis of the neonatal gut plays an important role in colic in the term infant, in the disease processes which plague preterm infants, including necrotizing enterocolitis and sepsis, and in the long-term outcomes of neonates. Administration of enteral prebiotics, probiotics, and synbiotics during pregnancy, lactation, and postnatal life appears to be a safe and feasible method to alter the maternal and neonatal microbiome, thus improving pregnancy and neonatal outcomes.     

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??Bronchiolitis has been one of the hot spots in the researches on diseases of respiratory system nowadays. However?? the concepts and classifications of this disease remain unclear. In this paper?? the denotative and connotative concepts of bronchioles and bronchiolitis were analyzed from the views of anatomy and development biology?? and the classification changes of adult bronchiolitis were introduced. These content can be used as references for the systematic studies of pediatric bronchiolitis.     

Recrudescence and relapse of meningococcal meningitis and septicaemia

Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient.     

Caring for the health and medical and emotional needs of children of migrants and asylum seekers

Political turmoil, military conflicts and other international sociological upheavals are causing significant immigration of large numbers of people, including infants and children, in Europe. Many of these young migrants are refugees. These youngsters have significant health needs, and medical conditions (such as infectious diseases) and mental health problems due to their previous stressful situations and the difficulties that they often experience while settling, even temporarily, into their new environments. Government authorities must screen for transmissible diseases and ensure that vaccine-preventable infections are adequately covered. Paediatricians must give the best possible care for these children and act as their advocates. This can be enhanced by collaborating with national and international paediatric societies and with international non-government agencies. This problem is not confined to Europe; world-wide, it occurs on a massive scale and causes huge burdens for poorer countries that have serious difficulties in coping with the extra financial, personnel and infrastructure needs imposed by massive, uncontrolled migration of populations that are often unhealthy and inadequately nourished. However, this should not be used as a pretext to deny safe refuge to children and their families who need it.

Conclusion: Massive movements of infant and child immigrants and refugees across European borders over recent years have brought challenges to paediatricians because of the needs for the health and medical and mental health care of these young people. Paediatricians have an important role in their care and by acting, wherever possible, as their advocates. This is a massive problem, world-wide, in which paediatricians can have a potentially significant positive impact.     

Diagnosis and Assessment of Valve Stenosis and Regurgitation and Coarctation of the Aorta with Doppler Ultrasound

ABSTRACT. With the use of Doppler ultrasound localized increases in blood flow velocities can be recorded and used to diagnose obstructions to blood flow. From the increase in maximal velocities the pressure drop across an obstruction can be calculated, both the peak instantaneous and the mean pressure drop. Regurgitations are diagnosed by recording reversal of blood flow across the valve. Semi-quantitative evaluation of the degree of regurgitation can be made by using both jet width, extension and intensity, as well as increase in forward flow velocity, reversal of flow in great vessels and influence on pressures. In coarctation of the aorta localized increase in velocity in the descending aorta can be shown and the pressure drop can be calculated. In some, more than one level of obstruction can be shown. In neonates the presence of a patent ductus arteriosus may mask the obstruction and a significant pressure drop may become apparent only when narrowing or closure of the duct occurs.     

Puberty and prognosis of asthma and bronchial hyper-reactivity

It is a commonly held view that pediatric asthma frequently abates during puberty. However, little data are available that associate the stage of puberty with the prognosis of asthma and bronchial hyper‐reactivity (BHR). In this study, 155 children with active asthma at 10 years of age (60 girls [38.7%], 95 boys [61.3%]) were followed‐up until they reached 14 years of age. The stage of puberty was assessed by parental questionnaire; in addition, serum 3‐α‐androstanediolglucuronide, as an endocrinological marker for peripheral androgen status, was measured in 107 subjects. Persistence of asthma was determined via questionnaire, lung function testing, and bronchial provocation (hyperventilation of cold, dry air). At 14 years of age, 73.3% of girls were reported to have had menarche and 40.8% of boys a voice change, and only 35.5% of the subjects had experienced acute asthma symptoms during the last 12 months, with an almost unchanged gender ratio (19 girls [34.5%], 36 boys [65.5%]) vs. that recorded at 10 years of age. The level of androstanediolglucuronide was higher in the children who reported puberty (mean ± SD): 3.03 ± 2.13 nmol/l vs. 1.89 ± 1.26 nmol/l, p = 0.003. No statistically significant relationship was found between the reported signs of late puberty and loss of asthma or BHR. Likewise, no significant association was found between asthma persistence and the level of androstanediolglucuronide (2.39 ± 1.75 nmol/l vs. 2.44 ± 1.82 nmol/l, p = 0.84), or BHR and the level of androstanediolglucuronide (3.02 ± 1.97 nmol/l vs. 2.28 ± 1.67 nmol/l, p = 0.13), at 14 years of age, in girls or boys. At 14 years of age, no change in the gender ratio of children with active asthma had occured. These results may indicate that the change in gender predominance of asthma through the second decade of life is not caused by increased loss of established asthma in boys between 10 and 14 years of age.     

Embolization and Transcatheter Retrieval of Coils and Devices

Embolizations of coils and devices are well-known complications of transcatheter procedures performed in order to occlude extracardiac or intracardiac shunts. A review of the literature and of our experience was performed to provide a succinct review of existing transcatheter retrieval techniques. After embolization of a coil or device, the appropriate initial procedure involves repositioning of the coil or device using a snare or bioptome to a location where harm to the patient is minimized. The subsequent retrieval technique depends on the characteristics of the coil or device involved. Coils may be retrieved using a bioptome or a snare. Devices must be snared, often in specific places. Both may be pulled into long or short, appropriately sized retrieval sheaths. To minimize potential morbidities associated with these retrievals and to maximize efficacy of retrieval, operators performing transcatheter coil or device occlusions must be familiar with retrieval techniques.     

Effects of bilirubin and phototherapy on osmotic fragility and haematoporphyrin-induced photohaemolysis of normal erythrocytes and spherocytes

AIM: To study the effects of phototherapy on erythrocyte haemolysis in vitro and to determine possible differences in sensitivity to phototherapy between normal erythrocytes and spherocytes. METHODS: Erythrocytes from four normal healthy donors and two donors with hereditary spherocytosis were treated with bilirubin (160 microM) in the presence of human serum albumin in the molecular ratio bilirubin/albumin 0.8. Treated cells were maintained either in the dark or in blue light (450 nm, 8 mW/cm2, 30 min). The experimental light dose was comparable to 2 h of clinical phototherapy. The osmotic fragility of the treated cells was measured by scoring haemolysis in hypo-osmolar solutions (0.10-0.90% NaCl). The sensitivity to photohaemolysis of cells pre-treated with bilirubin (BR) and/or phototherapy was tested by exposing the cell suspensions to haematoporphyrin and UVA radiation. The delayed (18 h) photohaemolysis was measured by spectrophotometry. RESULTS: Osmotic fragility, expressed as percentage haemolysis, of normal erythrocytes was more than doubled in the presence of BR combined with phototherapy (n = 6, p < 0.05). In contrast, osmotic fragility of spherocytes was unaffected by either treatment (n = 8, p < 0.05). Increased photohaemolysis was seen in spherocytes treated with BR (n = 13, p < 0.05), phototherapy (n = 13, p < 0.05) and a combination of the two agents (n = 13, p < 0.05) compared with spherocytes without BR in the dark (n = 6). CONCLUSION: Bilirubin may make the plasma membrane of normal erythrocytes more fragile. Newborns with hereditary spherocytosis may be sensitive to phototherapy.     

发作性睡病的延迟诊断及与癫痫的鉴别诊治

发作性睡病是临床少见的睡眠-觉醒节律障碍性疾病,表现为白天反复发作的不可遏制的睡眠,常伴猝倒发作、睡眠瘫痪及入睡前幻觉。临床医师对发作性睡病的认识不足是导致误诊和延迟诊断的主要原因之一。癫痫发作类型复杂多样,与发作性睡病易混淆,二者需相互鉴别,且当二者共患病时,诊断和治疗会更加困难。现通过对发作性睡病的临床特征与延迟诊断原因进行分析,总结发作性睡病与癫痫的鉴别要点及共患病的诊治经验,以提高临床医师对发作性睡病及其与癫痫共患病的认识,改善患者的预后及生活质量。