极低/超低出生体重早产儿代谢性骨病危险因素的全国多中心调查

目的 分析极低/超低出生体重（very/extremely low birth weight,VLBW/ELBW）早产儿代谢性骨病（metabolic bone disease of prematurity,MBDP）的发生率及危险因素。方法 回顾性调查2013年9月1日至2016年8月31日全国多中心61 786例新生儿资料,符合纳入标准的VLBW/ELBW早产儿504例,其中诊断MBDP 108例,纳入MBDP组,其余396例纳入非MBDP组。收集两组孕母及早产儿基本资料、住院期间主要疾病、营养支持策略和其他治疗情况并进行统计学比较分析;采用多因素logistic回归分析MBDP发生的危险因素。结果 VLBW早产儿MBDP发生率为19.5%（88/452）,ELBW早产儿MBDP发生率为38.5%（20/52）。极早产儿、超早产儿MBDP发生率分别为21.7%和45.5%。单因素分析结果显示,MBDP组患儿胎龄、出生体重均小于非MBDP组,住院时间更长,出院时宫外发育迟缓发生率更高（P < 0.05）;MBDP组新生儿呼吸窘迫综合征、败血症、贫血、低钙血症、早产儿视网膜病变发生率较非MBDP组高（P < 0.05）;MBDP组较非MBDP组平均加奶速度更慢、达全肠内喂养日龄更大、肠外营养使用时间更长（P < 0.05）;MBDP组患儿枸橼酸咖啡因使用比例高于非MBDP组、促红细胞生成素使用比例低于非MBDP组（P < 0.05）。多因素logistic回归分析结果显示,胎龄 < 32周、低钙血症、出院时宫外发育迟缓、败血症是MBDP发生的危险因素（P < 0.05）。结论 低胎龄、低钙血症、出院时宫外发育迟缓、新生儿败血症可能增加VLBW/ELBW早产儿MBDP发生的风险,应加强围生期孕期保健,避免早产,提高新生儿科医师对MBDP的防治意识,对早产儿采取积极合理的营养策略和综合管理措施,以改善VLBW/ELBW早产儿的近远期临床结局。     

新生儿经外周置入中心静脉导管操作及管理指南（2021）

新生儿经外周置入中心静脉导管（PICC）近年来已广泛应用于新生儿重症监护室，但在应用过程中存在并发症的风险。该指南基于国内外相关证据，采用证据推荐分级评估、制定与评价方法（GRADE），制定新生儿PICC操作及管理指南，旨在帮助新生儿科医护人员规范PICC的操作及管理。     

新生儿坏死性小肠结肠炎临床诊疗指南（2020）

坏死性小肠结肠炎（NEC）是新生儿尤其是早产儿的严重胃肠道疾病,其发病率和病死率高。存活的患儿可能遗留消化系统和神经系统后遗症。因此,防治NEC对提高新生儿存活率及生存质量具有重大意义。该指南基于目前国内外相关研究,采用证据推荐分级评估、制定与评价方法（GRADE）,制定NEC临床诊疗循证指南,旨在为NEC的诊断和防治提供证据和参考。     

新生儿低血糖临床规范管理专家共识（2021）

新生儿低血糖高危因素众多,严重持续的低血糖会导致不可逆的神经系统损伤,给家庭及社会带来极大负担。早期规范的预防及临床管理可有效降低新生儿低血糖及低血糖所致脑损伤的发生率。然而,目前国内尚无统一的新生儿低血糖临床管理指南,不同医疗机构借鉴不同的国外指南对新生儿低血糖进行临床管理,差异性较大。为进一步规范新生儿低血糖临床管理,由中华医学会儿科学分会新生儿学组制定了该共识。该共识针对胎龄35周及以上新生儿低血糖的预防、监测和管理的相关临床问题提出了21条推荐意见。     

早产儿喂养不耐受临床诊疗指南（2020）

早产儿喂养不耐受是目前新生儿最常见的临床问题之一,常导致达全肠内营养时间延迟,住院时间延长。防治早产儿喂养不耐受对提高早产儿存活率有重要意义。该指南基于目前国内外研究,采用证据推荐分级的评估、制定与评价方法（GRADE）进行证据分级制定早产儿喂养不耐受的临床诊疗指南,旨在帮助新生儿科医生、护理人员、营养治疗师等对早产儿喂养不耐受进行早期识别与规范管理。     

重症监护病房新生儿皮肤管理指南（2021）

新生儿皮肤屏障功能弱,极易受损而导致局部或全身感染,增加死亡风险。保护新生儿皮肤完整性、预防皮肤损伤是新生儿重症监护病房管理的重要内容之一。该指南基于国内外相关证据,采用证据推荐分级的评估、制定与评价方法进行证据分级,制定新生儿重症监护病房新生儿皮肤管理指南,对皮肤常规管理、医源性皮肤损伤的预防及处理给出推荐意见,旨在帮助医护人员为新生儿提供预防及处理皮肤损伤的参考建议。     

早产儿喂养不耐受临床诊疗指南（2020）

早产儿喂养不耐受是目前新生儿最常见的临床问题之一，常导致达全肠内营养时间延迟，住院时间延长。防治早产儿喂养不耐受对提高早产儿存活率有重要意义。该指南基于目前国内外研究，采用证据推荐分级的评估、制定与评价方法（GRADE）进行证据分级制定早产儿喂养不耐受的临床诊疗指南，旨在帮助新生儿科医生、护理人员、营养治疗师等对早产儿喂养不耐受进行早期识别与规范管理。     

2013临床试验方案规范指南（SPlRlT）及其解读

临床试验旨在确定某种干预措施是否与疾病的自然史相关,是否能够提高某项有效治疗方法的疗效,或与其他治疗方式相比有哪些不可接受的不良反应等。这种干预措施可以是药物、手术、矫正疗法,或兼而有之［1］。而临床试验方案是研究计划制定、实施、汇报和评估的基础,其规范化将会使研究质量更高,也可为研究者、受试者、申办者、赞助者、研究伦理委员会/机构审查委员会、同行评议专家、期刊社、试验注册者、决策者、监管者和其他各种试验相关人员带来便利。现有的相关指南对临床试验方案的建议差异较大,并且存在较多缺陷,例如方法学不够系统、参与制定指南的利益相关者有限、指南中所给出的推荐缺乏证据［2］。因而,临床试验方案规范指南（ standard protocol items：recommendations for interventional trials,SpIRIT）的制定十分必要,SpIRIT 2013［3,4］的系统性形成过程十分严谨,值得称道,为临床试验方案的制定提供了基本的指导方针。     

早产儿支气管肺发育不良营养管理专家共识

早产儿出生早期营养供给不足是支气管肺发育不良（BPD）发生的重要影响因素，并与其发生发展和最终临床结局密切相关。优化营养支持对降低BPD发生率和严重程度，促进患儿肺发育和神经系统预后至关重要。现基于国内外相关研究，采用证据推荐分级的评价方法（GRADE），制定BPD营养管理专家共识，从营养在BPD中的重要性、液体量、能量、肠内营养、肠外营养、出院后营养、营养监测和评估等7个方面进行阐述，旨在为临床医师提供BPD高危儿和确诊患儿的营养管理建议，以期减少BPD的发生及改善BPD患儿的近远期预后。     

中国0至5岁儿童病因不明的急性发热诊断处理指南（标准版）

1指南的制定过程1．1计划目标人群0～5岁儿童病因不明的急性发热（肛门测温≥38％，发热时间≤1周）。1．2计划应用人群儿科医生、急诊科医生和护理人员。1．3制定原则确定具有儿科临床工作经验和循证医学研究背景的专家作为主要制定人员，参照国际儿童发热的相关指南及规范，制定过程中广泛征询了儿科临床医生、护理和药剂等相关人员意见。对指南中重要或不确定的临床问题，     

早产儿代谢性骨病

早产儿代谢性骨病是由于体内钙磷代谢紊乱等因素导致的骨矿物质含量的异常,临床表现为类似佝偻病的症状甚至骨折等.早产儿代谢性骨病的病因包括钙、磷、维生素D和相关蛋白摄入不足或代谢异常等.早产是代谢性骨病的最重要的危险因素,代谢性骨病的风险与胎龄及出生体质量均呈负相关.其诊断主要依靠临床表现、影像学表现、生化指标以及骨密度测定.通过合理的营养支持、适度锻炼等可以预防和治疗代谢性骨病.     

Home oxygen therapy after hospital discharge

Home oxygen therapy is increasingly prescribed for various conditions in the neonatal period, particularly for infants with bronchopulmonary dysplasia. Due to limited evidence on indication, minimal target oxygen saturation, monitoring, application and discontinuation of home oxygen therapy clinical practice varies widely throughout the world. International guidelines provide recommendations mostly on the basis of nonsystematic clinical observations. Most relevant points for the clinical management of home oxygen therapy include a minimal target oxygen saturation of equal to or greater than 93%, the provision of a home monitoring of oxygen saturation ideally with a memory function, and the conduct of continuous overnight oximetry or polysomnography during weaning from supplemental oxygen. This review summarizes relevant literature as well as existing guidelines and recommendations on home oxygen therapy to aid clinicians in the management of these patients and identifies areas for future research.     

NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population

Data from many studies have suggested a rise in the prevalence of food allergies during the past 10 to 20 years. Currently, no curative treatments for food allergy exist, and there are no effective means of preventing the disease. Management of food allergy involves strict avoidance of the allergen in the patient's diet and treatment of symptoms as they arise. Because diagnosis and management of the disease can vary between clinical practice settings, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored development of clinical guidelines for the diagnosis and management of food allergy. The guidelines establish consensus and consistency in definitions, diagnostic criteria, and management practices. They also provide concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions. The original guidelines encompass practices relevant to patients of all ages, but food allergy presents unique and specific concerns for infants, children, and teenagers. To focus on those concerns, we describe here the guidelines most pertinent to the pediatric population.     

静脉输注免疫球蛋白在儿童川崎病中应用的专家共识

川崎病是一种好发于5岁以下儿童的急性自限性血管炎性疾病。静脉输注免疫球蛋白（intravenous immunoglobulin,IVIG）已经成为一种有效的治疗方案,可以有效减少心血管并发症的发生率,但目前国内外尚无儿童川崎病IVIG应用共识或临床指南。该共识是基于目前国内外关于儿童川崎病中IVIG应用的研究进展,同时参考国内外川崎病的诊疗指南,并经过制定专家充分讨论而形成。该共识对IVIG在儿童川崎病中的临床应用策略及其不良反应的防治提出了具体建议。 引用格式:     

Diagnosis and management of acute otitis media

This evidence-based clinical practice guideline provides recommendations to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM). The American Academy of Pediatrics and American Academy of Family Physicians convened a committee composed of primary care physicians and experts in the fields of otolaryngology, epidemiology, and infectious disease. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to AOM. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific definition of AOM. It addresses pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures. Decisions were made based on a systematic grading of the quality of evidence and strength of recommendations, as well as expert consensus when definitive data were not available. The practice guideline underwent comprehensive peer review before formal approval by the partnering organizations. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.     

Expert consensus on childhood management of bronchopulmonary dysplasia北大核心CSCD

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿常见的慢性肺部疾病。在儿童期,BPD患儿更容易出现反复下呼吸道感染、喘息、心血管疾病、体格发育迟缓和神经发育迟缓等问题,给患儿、家庭及社会带来沉重负担。为进一步规范BPD患儿在婴儿期、儿童期以及青春期的管理,中华医学会儿科学分会呼吸学组与中华医学会儿科学分会新生儿学组联合,参考欧洲呼吸学会,澳大利亚、新西兰以及美国胸科学会发布的BPD患儿在新生儿期后的管理建议和国内外相关文献,并结合临床实践经验,制定了《支气管肺发育不良的儿童期管理专家共识》。本共识主要内容包括BPD的定义、病理生理学、近远期预后、儿童期BPD的识别、鉴别诊断、常见感染、治疗、监测评估及多学科随访管理等方面。     

Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. The GER Guideline Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated a clinical practice guideline for the management of pediatric GER. The GER Guideline Committee, consisting of a primary care pediatrician, two clinical epidemiologists (who also practice primary care pediatrics) and five pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. The Committee examined the value of diagnostic tests and treatment modalities commonly used for the management of GERD, and how those interventions can be applied to clinical situations in the infant and older child. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management and indications for consultation by a specialist. The guideline also provides recommendations for management by the pediatric gastroenterologist. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology and Nutrition on the evaluation and treatment of gastroesophageal reflux in infants and children. The American Academy of Pediatrics has also endorsed these recommendations. The recommendations are summarized in a synopsis within the article. This review and recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.     

对线粒体医学会原发性线粒体病患者管理标准专家共识的解读

原发性线粒体病是最常见的先天性代谢缺陷,临床表现及遗传方式具有高度的异质性,致死及致残率高。该病常见多系统受累,非常有必要进行全面评估及多学科管理。线粒体医学会（MMS）2017年发表《原发性线粒体病患者管理标准：线粒体医学会共识声明》,给出基于共识的推荐意见,用于指导该病患者的常规管理及护理。该文主要根据该共识对原发性线粒体病常见受累器官系统的筛查及管理进行解读和总结。