Infant influenza

Reports on the symptoms of infant influenza (less than 1 year of age) are very few. From 1989 to 1996, 105 infants with influenza were examined. The symptoms, nutrition and source of infection of the 105 patients were investigated in Sakuma Pediatric Clinic and viral studies were performed at the Kitakyushu City Institute of Environmental Sciences. The symptoms of patients under 6 months old are very mild, with a low maximum body temperature and a short duration of fever. Other complications are few. The symptoms gradually become more severe with each month of age. The ratio of patients displaying a diphasic fever with two peak temperatures increases with each month of age. Over 50% of patients over 9 months old have this diphasic fever with two peak temperatures. It is inconclusive whether an anti-infective factor in human milk exists or not. Of the 105 patients in this study, 28 were under 4 months of age; of these 28, all but 3 were infected by family members.     

Three cases of pyogenic sacro-iliitis,and factors in the relapse of the disease

Pyogenic sacro-iliitis (PS) is a rare disease in childhood. Three cases of PS are reported that were difficult to diagnose. Scintigraphy and magnetic resonance imaging (MRI) were useful for diagnosis. One patient suffered from an episode of relapse. Seventeen other cases of PS were reviewed in the literature to investigate the incidence of abnormal imaging findings and various factors in disease relapse. It was found that the incidence of abnormal findings by scintigraphy was significantly higher than that by computed tomography (P = 0.0057). The duration of intravenous antibiotic administration of the relapse group (14.7 ± 4.7 days) was significantly shorter than that of the non-relapse group (24.3 ± 10.7 days; P = 0.0376). The statistical analysis suggested that intravenous antibiotic administration is necessary at least for 20 days to prevent a relapse of PS.     

滋阴泻火中药为主对改善性早熟儿童骨骼发育作用及机理的探讨

对女性特发性性早熟患儿50例采用滋阴泻火中药与甲地孕酮联合治疗,32例单纯使用甲地孕酮治疗,对照组25例不用药物治疗。对照组于1年后骨龄差/年龄差值从1.39±0.24上升为1.54±0.20(P<0.01),最终身高预测值从154.2±5.3cm下降至149.4±4.8cm(P<0.01)。单纯使用甲地孕酮治疗,对患儿骨龄提前及最终身高预测值下降趋势无明显影响。而联合治疗的患儿生长速率减慢,△BA/△CA值从1.36±0.19下降为0.65±0.16(P<0.001),最终身高的预测值从153.6±3.8cm增加至158.8±4.4cm(P<0.01)。研究结果表明,滋阴泻火中药可明显减慢性早熟儿童的骨骼生长,延缓其骨骼成熟,从而防止骨骺过早融合并改善最终身高。     

Ureaplasma urealyticum, erythromycin and respiratory morbidity in high-risk preterm neonates

We investigated colonization with Ureaplasma urealyticum (Uu) in infants <30 weeks gestation and assessed the relationship to other risk factors influencing respiratory morbidity, plus the effect of treatment with erythromycin. Ventilated preterm infants [ n = 155; median GA 26 (23–29) weeks] were cultured for Uu in endotracheal aspirate and nasopharynx. Colonized infants were randomly assigned to treatment with erythromycin 40mg/kg/d, intravenously or orally. The rate of colonization was 29/155 (19%) and the Uu-colonized infants had lower mean gestational ages than the culture-negative infants (25 vs 26 weeks). For the colonized infants PROM (48% vs12%), chorioamnionitis in the mother (46% vs 17%) and vaginal delivery (71% vs 29%) were more common. More colonized infants needed supplemental oxygen at 36 weeks'postconceptual age ( p < 0:05). Erythromycin treatment was effective in reducing colonization with negative control cultures in 12/14 (86%) of treated infants. No significant differences were found between the colonized treated infants ( n = 14) and those not treated ( n = 14) in time with supplemental oxygen. Oxygen requirement at 36 weeks was related to lower gestational age, late appearance of PDA, late onset sepsis and signs of chorioamnionitis in the mother. We conclude that the Uu colonization is related to increasing immaturity, the presence of prolonged rupture of membranes, signs of chorioamnionitis and vaginal delivery. Treatment with erythromycin reduced colonization but did not significantly alter length of time with supplemental oxygen.     

Neurodevelopmental outcome after prenatal exposure to opiates

To study the developmental effects of prenatal exposure to opiates, a prospective follow up study of 34 drug-exposed (opiates and nicotine) and 42 reference infants (nicotine exposure only) was conducted from January 1992 to September 1995. At the time of delivery, 12 of 34 mothers used opiates without medical control. Twenty-two mothers participated in a methadone maintenance programme. At 1 year, the average Griffiths Developmental Quotient (DQ) was lower in the drug-exposed group (mean: 100.5 vs. references 107.9; P < 0.001). This difference was mainly due to lower subscales “locomotor” (mean 100.8 vs. 111.4; P < 0.05) and “intellectual performance” (mean 100.8 vs. 108.5; P < 0.05) in the drug-exposed group. Severe developmental retardation mean DQ (−2 SD) was diagnosed in 2 drug-exposed infants. Mild developmental retardation (mean DQ: 1 SD– > 2 SD) was found in 7 drug-exposed and in 3 reference infants (P < 0.05). Neurological abnormalities were found more frequently in the drug-exposed group (11 vs. 3 infants; P < 0.01). Among the opiate-exposed infants, the subscales “hearing and speech” and “intellectual performance” were lower in the uncontrolled drug-using than in the methadone group. The 17 fostered infants showed no difference in developmental outcome compared with the 10 infants living with their biological parents (mean DQ: 100.0 versus 101.3). Conclusions At 1 year infants prenatally exposed to opiates are at risk for mild psychomotor developmental impairment. Received: 1 August 1997 / Accepted in revised form: 15 January 1998     

Effect of Dexamethasone Therapy on the Neonatal Ductus Arteriosus

Patent ductus arteriosus (PDA) is believed to be a contributing factor in the etiopathogenesis of bronchopulmonary dysplasia (BPD). We studied the effects of early dexamethasone therapy on persistent ductal patency and the role of PDA in the etiopathogenesis of BPD during the course of a randomized double-blind trial of dexamethasone to prevent BPD. Infants, who weighed between 700 and 999 g, had severe RDS, and had been given surfactant, were randomized to receive a 12-day course of dexamethasone (n= 13) or placebo (n= 17) starting within the first 12 hours of postnatal life. The diagnosis of PDA was made clinically and was confirmed by cardiac ultrasound. The incidence of clinically significant ductus in infants who weighed less than 1000 g was 23% in the dexamethasone-treated group, as compared with 59% in infants who were given placebo. This difference was marginally significant, p= 0.05, odds ratio 0.21, 95% confidence interval 0.04–1.05. None of the infants in the dexamethasone group had recurrence of PDA after indomethacin therapy as compared with three infants in the placebo group. Dexamethasone significantly reduced the number of days infants required ventilator and supplemental oxygen as compared with infants who received placebo. Dexamethasone, as compared with placebo, also reduced the incidence of BPD, p= 0.025, odds ratio 0.08, 95% confidence interval 0.01–0.58. Dexamethasone may reduce the incidence of PDA in premature infants who weigh less than 1000 g at birth and thereby reduce the incidence of BPD.     

Anwendung von Fluconazol bei Kindern <1 Jahr: Übersicht

Zusammenfassung. In einem Review wurden 78 Arbeiten zur Anwendung von Fluconazol bei Kindern unter 1 Jahr ausgewertet. Insgesamt werden 726 Patienten beschrieben. Die verwendeten Fluconazoldosierungen lagen zwischen 2 und 50 mg/kg/die. Die Behandlungsdauer betrug maximal 162 Tage. Fluconazol ist nach den vorliegenden umfangreichen Erfahrungen zur Behandlung systemischer Candidosen und Candidämien bei Kindern unter 1 Jahr, einschließlich Neugeborene und Kinder mit sehr niedrigem Geburtsgewicht, wegen seiner guten Wirksamkeit und Verträglichkeit geeignet. Die empfohlen?e Tagesdosis beträgt in der Regel 6 mg/kg*. Bei Kindern mit eingeschränkter Nierenfunktion sollte die Dosis abhängig vom Grad der Nierenfunktionseinschränkung entsprechend den Richtlinien für Erwachsene modifiziert werden. Wegen pharmakokinetischer Besonderheiten sollte das Dosierungsintervall während der ersten beiden Lebenswochen insbesondere bei Kindern mit sehr niedrigem Geburtsgewicht auf 3 Tage und zwischen der 2. und der 4. Woche auf 2 Tage verlängert werden. Danach ist die tägliche Applikation möglich. Diese Richtlinien berücksichtigen die besondere Pharmakokinetik von Fluconazol mit gröfierem Verteilungsvolumen sowie verlängerter Plasmaeliminationshalbwertzeit insbesondere während der ersten 4 Lebenswochen. Um therapeutisch ausreichende Plasmakonzentrationen im Bereich zwischen 4 und 20 μg/ml zu gewährleisten, sollte während der Behandlung gleichzeitig ein Monitoring der Plasmaspiegel erfolgen. Der Stellenwert von Fluconazol bei der Behandlung systemischer Candidosen - auch in höheren Dosierungen - sowie bei der frühen empirischen Therapie bei Kindern mit niedrigem Geburtsgewicht sollte Gegenstand weiterer prospektiver Studien sein. For this review, 78 publications for use of fluconazole in children below 1 year of age were evaluated with a total of 726 patients. The range of fluconazole dosage was 2–50 mg/kg/day with 162 days as maximum duration of treatment. According to the present experience, fluconazole seems to be an efficacious and well tolerated therapy against systemic candidosis and candidemia in children below 1 year of age, including neonates and very low birth-weight infants (VLBWVI). The recommended daily dosage is 6 mg/kg*. In patients with impaired renal function, the daily dose should be reduced in accordance with the guidelines given for adults. In neonates during the first two weeks of life, this dosage should be administered only every 72 hours. In weeks two to four of life, the same dose should be given every 48 hours. After that daily dosing is appropriate. This posology is derived from the age-related pharmacokinetics of fluconazole with a higher volume of distribution and a prolonged plasma elimination half life especially during the first month of life. Drug monitoring during treatment should be performed to en-***     

早泄患者慢性前列腺炎患病情况的临床研究

目的　了解早泄患者慢性前列腺炎的患病情况。方法　 6 8例早泄患者 ,常规检查前列腺液、前列腺按摩前后尿液 ,并做细菌学研究。选 30例健康人为正常对照。结果　早泄患者中慢性细菌性前列腺炎、慢性非细菌性前列腺炎的检出率分别为 4 7.1%和 2 3.5 % ,与对照组相比差异具有显著性 (P <0 .0 5 )。结论　慢性前列腺炎可能在早泄的发病机制中起着重要作用。因此 ,在对早泄患者进行药物及心理治疗之前仔细检查前列腺至关重要。     

全肠外营养对早产儿营养、免疫功能及行为发育的影响

【目的】探讨全肠外营养(TPN)对早产儿营养、免疫功能及行为发育的影响。【方法】监测55例TPN治疗早产儿的营养状况、肝肾功能、血脂水平、免疫功能及矫正胎龄40周时行为发育情况，并与25例未行TPN的早产儿对照分析。【结果】TPN治疗组体重增长快、体重日增长及治疗后体重高于对照组，TPN治疗后血清蛋白、免疫球蛋白及补体水平升高，肝肾功能及血脂检查无明显异常，矫正胎龄40周时NBNA评分高于对照组。【结论】TPN能改善早产儿营养状况、促进免疫水平的提高和行为神经的发育，对早产儿的治疗有重要意义。