Long-term parenteral nutrition

Intestinal failure (IF) is a term applied when intestinal function becomes insufficient to allow adequate absorption of fluid, electrolytes, or nutrients required for normal growth and survival. The development of parenteral nutrition (PN) as a treatment modality has greatly improved the outcome for children with IF and has contributed to improved outcomes in neonates and children from intensive care settings. Home parenteral nutrition (HPN) is central to the care of patients when IF is expected to last for more than 3–6 months. Normal growth and long-term survival is now expected for most children and young people on HPN when only 10 years ago, the prognosis for survival was poor. Adolescents with IF now successfully transfer to adult services, many of which will have been dependent on PN since early infancy. This article reviews the current indications for PN and the recent advances in PN that have contributed to better outcomes. A guideline on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) supported by the European Society of Paediatric Research (ESPR) was published in 2010. This has been recently updated (ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition, 2018) with up-to-date evidence for health professionals working with infants, children and adolescents receiving PN. This update includes details the use of Taurolock? to prevent central venous catheter (CVC) related sepsis, and the role of new multicomponent lipid emulsions. Recommendations have been given with regard to the use of in-line filtration and photoprotection of PN fluids and advice on energy, fluid, electrolyte, macro-and micronutrient intake has been updated.     

身材矮小儿童睡眠饮食和行为问题的病例对照研究

目的 分析身材矮小儿童睡眠、饮食及行为问题,为矮小症的预防与早期干预提供科学依据。方法 选取2017年9月—2018年9月西安交通大学第二附属医院儿科门诊的110例矮小儿童及正常对照组110例,对受试儿童家长进行问卷调查。 结果 生长激素缺乏症62例(56.4%),特发性矮身材48例(43.60%)。矮小男童49人(44.5%),女童61人(55.5%),平均年龄(7.53±2.26)岁。对照组男49人(44.5%),女61人(55.5%),平均年龄(7.33±2.19)岁。两组年龄性别差异无统计学意义(P>0.05),出生体重,目前身高体重及父母身高差异均有统计学意义(P<0.05);饮食行为比较过饱响应、进食缓慢、食物喜好、情绪性饮食减少差异均有统计学意义(P<0.05);睡眠层面比较就寝习惯、入睡潜伏期、睡眠持续时间、睡眠焦虑、夜醒、异态睡眠、白天困倦矮小儿童均高于对照组(P<0.05)。行为分析4～5岁矮小组儿童“抑郁”、“体诉”、“社交退缩”、“分裂样”、“攻击”因子得分显著高于对照组(P<0.05);6～11岁“抑郁”、“体诉”、“社交退缩”“多动”、“分裂样”、“攻击”、“违纪”因子得分显著高于对照组(P<0.05)。 结论 饮食、睡眠及行为问题与儿童生长发育密切相关,是身材矮小症的重要影响因素。     

微生物-肠-脑轴在新生儿缺氧缺血性脑病发病机制中的研究进展

新生儿缺氧缺血性脑病 (HIE) 是新生儿期有较高致残率和致死率的疾病之一。近年来研究显示,新生儿脑部的缺氧缺血性损伤与微生物-肠-脑轴参与的神经系统氧化应激和组织线粒体功能障碍有关,但其分子机制尚不明确;且HIE最关键的环节是二次能量衰竭的发生,两次能量衰竭之间的“潜伏期”就是所谓的治疗“时间窗”,是减轻脑损伤的神经保护措施能被成功应用的最佳时间。本文综述了“微生物-肠-脑轴”参与氧化应激在HIE发病机制中的研究进展,希望通过该轴作用在HIE治疗“时间窗”内,减轻氧化应激对大脑的损伤,从而为肠道菌群与大脑之间的相互作用增加一个新的维度,为HIE的防治打开一扇门。     

认知行为治疗对抑郁症患者疾病认知、心理健康水平及应对方式的影响

目的研究认知行为治疗(cognitive behavior therapy,CBT)对抑郁症患者疾病认知、心理健康水平及应对方式的影响。方法连续选择2016年6月～2017年6月入我院诊断为抑郁症患者共96例,随机将其分为对照组和观察组,各48例。对照组采用常规专科护理,观察组采用CBT;采用生存质量简表(WHOQOL)比较两组患者治疗后疾病认知程度,汉密尔顿抑郁量表(HAMD)比较心理健康水平,简易应对方式问卷(simple coping style questionnaire,SCSQ)比较应对方式。结果观察组治疗后WHOQOL中生理领域、心理领域、社会关系和环境领域4个项目评分和总评分均显著高于对照组,差异有统计学意义(P0.05)。观察组HAMD评分显著低于对照组,可能抑郁和无抑郁人群比例明显升高,差异有统计学意义(P0.05)。观察组SCSQ积极应对评分显著升高,消极应对评分降低,差异有统计学意义(P0.05)。结论 CBT可显著改善抑郁症患者的疾病认知、心理健康水平及应对方式。     

儿童生长贴联合重组人生长激素治疗特发性矮小症的疗效

目的探讨儿童生长贴联合重组人生长激素对特发性矮小症的治疗效果。方法回顾性分析2016年2月～2017年2月我科因特发性矮小症就诊的患儿45例;按治疗方法分为对照组、观察组1、观察组2各15例,对照组为拒绝一切药物治疗者,观察组1为采用儿童生长贴治疗的患儿;观察组2为采用生长贴联合重组人生长激素治疗的患儿,疗程均为12个月。比较身高增长值、遗传身高、预测成年身高。结果对照组、观察组1和观察组2比较,身高增长值分别为(3.87±1.25)cm、(7.93±1.53)cm、(10.20±1.97)cm,差异有显著性(F=59.48,P0.01);遗传身高分别为(156.80±4.94)cm、(156.07±3.97)cm、(156.13±4.58)cm,差异无显著性(F=0.12,P0.05);成年预测身高分别为(155.73±3.31)cm、(164.80±5.24)cm、(167.87±5.68)cm,差异有显著性(F=25.35,P0.01)。结论儿童生长贴联合重组人生长激素治疗特发性矮小症可显著增加患儿身高增长值,提高其成年身高预测值。     

97名矮身材儿童自我意识现状及影响因素分析

目的 调查某三级甲等医院矮身材儿童的自我意识水平,并探讨其影响因素。方法 采取便利抽样法,2018年9月—2019年5月抽取河南省某三级甲等医院儿科门诊就诊的矮身材儿童作为研究对象。采用一般资料调查问卷、家庭关怀度指数问卷、儿童自我意识量表对其进行调查。采用多元线性回归分析矮身材儿童自我意识水平的影响因素。结果 97名矮身材儿童的自我意识总分为（53.54±6.11）分,家庭关怀度与儿童自我意识总分呈密切正相关（r=0.533,P<0.05）。多元线性回归分析显示,母亲受教育程度、居住地、家庭关怀指数评分是矮身材儿童自我意识的主要影响因素（P<0.05）,共解释总变异的43.5%。结论 矮身材儿童的自我意识处于偏低水平,受到其母亲受教育程度、居住地、家庭关怀度的影响。建议护理人员关注母亲受教育程度低、居住地在乡镇及农村及家庭关怀度得分低的矮身材儿童,通过健康教育讲座、公共网络平台等方式向其父母提供信息支持,使矮身材儿童父母充分认识到身材矮小对儿童产生的身体、心理影响,提高其对治疗的依从性,同时,对矮身材儿童的心理发展给予充分关注,建立正确的教育和引导方法,帮助父母与矮身材儿童建立良好的亲子关系和家庭氛围,从而提高患儿的自我意识水平。     

Air pollution effects on the gut microbiota: A link between exposure and inflammatory disease

Global incidence rates for inflammatory bowel disease (IBD) have gradually risen over the past 20 years. Genome-wide association studies (GWAS) have identified over 160 genetic loci associated with IBD; however, inherited factors only account for a partial contribution to the disease risk. We have recently shown that urban airborne particulate matter (PM) ingested via contaminated food can alter gut microbiome and immune function under normal and inflammatory conditions. In this addendum, we will discuss how PM can modify the gut microbial form and function, provide evidence on changes seen in intestinal barrier, and suggest a working hypothesis of how pollutants affect the gastrointestinal tract. The significance of the work presented could lead to identifying airborne pollutants as potential risk factors and thus provide better patient care management.     

Bovine Colostrum to Children With Short Bowel Syndrome

Background: Management of short bowel syndrome (SBS) aims to achieve intestinal autonomy to prevent fluid, electrolyte, and nutrient deficiencies and maintain adequate development. Remnant intestinal adaptation is required to obtain autonomy. In the newborn pig, colostrum has been shown to support intestinal development and hence adaptive processes. Aim: The efficacy of bovine colostrum to improve intestinal function in children with SBS was evaluated by metabolic balance studies. Materials and Methods: Nine children with SBS were included in a randomized, double‐blind, crossover study. Twenty percent of enteral fluid intake was replaced with bovine colostrum or a mixed milk diet for 4 weeks, separated by a 4‐week washout period. Intestinal absorption of energy and wet weight was used to assess intestinal function and the efficacy of colostrum. Results: Colostrum did not improve energy or wet weight absorption compared with the mixed milk diet (P = 1.00 and P = .93, respectively). Growth as measured by weight and knemometry did not differ between diets (P = .93 and P = .28). In these patients, <150% enteral energy absorption of basal metabolic rate and 50% enteral fluid absorption of basal fluid requirement suggested intestinal failure and a need for parenteral nutrition (PN). Conclusion: Inclusion of bovine colostrum to the diet did not improve intestinal function. Metabolic nutrient and wet weight balance studies successfully assessed intestinal function, and this method may distinguish between intestinal insufficiency (non–PN‐dependent) and intestinal failure (PN‐dependent) patients.