Nasotracheal intubation using fiberoptic bronchoscopy in infants and children

Journal of Anesthesia -     

新生儿G6PD缺陷病和晚发性维生素K缺乏症的特点与预防

目的 探讨新生儿C6PD缺陷病和晚发性维生素K缺乏症的危害与预防措施。方法 回顾分析1995-2000年儿内科住院的1周-2月(不含2月)的婴儿3104例次，其中病死56例。结果 1周-2月的小婴儿占住院患儿的19．34％，其中新生儿G6PD缺陷病239例，占7．70％；晚发性维生素K缺乏症92例，占2．96％。死因的第2、3位分别是晚发性维生素K缺乏症(13例，占23．21％)和新生儿C6PD缺陷病(12例，占21．43％)，两者的病死率分别为14．13％和5．02％，极显著高于(x^2＝17．59，P＜0．01)或相近于(x^2＝0．88，P＞0．05)肺炎的3．57％。新生儿G6PD缺陷病合并感染占38．49％、低氧血症占23．35％、低血糖占19．25％、酸中毒占15．90％，继发胆红素脑病占13．81％。晚发性维生素K缺乏症出现抽搐占90．22％、胃肠、注射部位出血占60．89％；CT证实颅内出血占98．91％。结论 1周-2月的小婴儿约占住院患儿的两成，新生儿G6PD缺陷病和晚发性维生素K缺乏症的病死率均很高，两者是除肺炎外最主要的死因。提议制定并推广预防这2种疾病的常规措施，并参照国内外相应的现状拟出其具体内容。     

婴儿测试行为与智力发展相关性的研究

目的：分析自行编制的一套婴幼儿测试行为评定量表集中反映了哪些行为倾向，并探讨测试行为与智力与运动能力之矧的关系。方法：对象为227名6—12个月的正常婴儿（男130名，女97名），采用贝利婴幼儿发展量表（BSID）和自编的婴儿测试行为评定量表作为研究工具。应用因子分析、方差分析和相关分析的统计学方法进行统计分析。结果：提取出目标定向性，觉醒状态，负性情绪，正性情绪，反应性，活动量共6个因子，方差贡献率为65．43％。目标定向性、觉醒状态、正性情绪、反应性与智力发育指数（MDI）存在明显的相关，目标定向性，正性情绪，反应性与运动发育指数（PDI）存在明显的相关。结论：婴儿测试行为与智力发展相关。     

The development of goal-directed reaching in infants: hand trajectory formation and joint torque control

Nine young infants were followed longitudinally from 4 to 15 months of age. We recorded early spontaneous movements and reaching movements to a stationary target. Time-position data of the hand (endpoint), shoulder, and elbow were collected using an optoelectronic measurement system (ELITE). We analyzed the endpoint kinematics and the intersegmental dynamics of the shoulder and elbow joint to investigate how changes in proximal torque control determined the development of hand trajectory formation. Two developmental phases of hand trajectory formation were identified: a first phase of rapid improvements between 16 and 24 weeks of age, the time of reaching onset for all infants. During that time period the number of movement units per reach and movement time decreased dramatically. In a second phase (28–64 weeks), a period of fine-tuning of the sensorimotor system, we saw slower, more gradual changes in the endpoint kinematics. The analysis of the underlying intersegmental joint torques revealed the following results: first, the range of muscular and motiondependent torques (relative to body weight) did not change significantly with age. That is, early reaching was not confined by limitations in producing task-adequate levels of muscular torque. Second, improvements in the endpoint kinematics were not accomplished by minimizing amplitude of muscle and reactive torques. Third, the relative timing of muscular and motion-dependent torque peaks showed a systematic development toward an adult timing profile with increasing age. In conclusion, the development toward invariant characteristics of the hand trajectory is mirrored by concurrent changes in the control of joint forces. The acquisition of stable patterns of intersegmental coordination is not achieved by simply regulating force amplitude, but more so by modulating the correct timing of joint force production and by the system's use of reactive forces. Our findings support the view that development of reaching is a process of unsupervised learning with no external or innate teacher prescribing the desired kinematics or kinetics of the movement.     

ADRENOCORTICAL CARCINOMA IN INFANCY

A case of adrenocortical carcinoma associated with congenital heart defect in a 6-month-old Japanese girl is reported. A fist-sized tumor was incidentally noted in the right hypochondrium upon admission for cardiac surgery. No clinical endocrinopathy was evident in this case. The resected tumor was encapsulated with smooth surface and no invasion to adjacent tissues or organs was observed. Histologically, the tumor was composed of small cells with granular or clear cytoplasm, and occasional giant cells with single or multiple nuclei. By electron microscopy, the tumor cells showed various nuclear contours with distinct nucleoli and had a moderate amount of cytoplasm containing abundant rough endoplasmic reticulum and mitochondria with variable-sized electron-dense granules. Intercellular desmosome-llke junctions were observed in some tumor cells. Immunohistochemlcally, the tumor cells contained granules positive for estriol, progesterone and Cortisol. These morphological findings including electron microscopic features suggested that the tumor cells had a malignant character.     

Postpartum depression and mother-infant relationship at 3 months old

Background: This paper is part of a prospective, epidemiologic study concerning postpartum depression (PPD). The women were first examined during pregnancy; after delivery they were seen with their infants at 3 and 18 months. The present study focuses on the 3-months-postpartum results. Methods: A sample of 570 women and their infants were examined 3 months after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox et al., 1987. Br. J. Psychiatry 150:782–786), 10.2% of these new mothers presented PPD. The focus of the study concerned the effects of this neurotic disorder on the mother, the infant and on the mother–infant relationship. Results: The deleterious effects concerning the infant were functional disorders such as eating or sleeping difficulties. The ‘depressed’ dyads presented less vocal and visual communications, less corporal interactions and less smiling. Conditions surrounding delivery and tiredness at 3 months are linked to difficulties in mother–infant relationship for the non-depressed mothers. Logistic models showed that primiparous PPD mothers have difficulties bathing their infants, whereas multiparous PPD mothers are more tired. Limitation: This study did not take into account either protective factors or the effects of the infant himself. Clinical relevance: Knowledge of the mothers’ and infants’ difficulties may help caregivers to detect these at-risk dyads and initiate therapeutic measures.     

仰俯卧位对早产儿肺炎患儿肺功能的影响

目的探讨仰俯卧位对早产儿肺炎患儿肺功能的影响.方法应用美国Bicore CP-100新生儿肺功能仪分别对30名不吸氧组(SaO2≥90%)和18名吸氧组(SaO2<90%)早产儿肺炎患儿的肺功能值进行检测.结果不吸氧组患儿俯卧位呼吸频率明显低于仰卧位(43.4±10.2 v 49.8±11.7);俯卧位潮气量明显高于仰卧位(3.11±0.92 v 2.48±0.77 ml/kg);俯卧位气道阻力明显低于仰卧位(98.6±50.1 v 117.4±41.5cm H2O/L/s,);俯卧位动态肺顺应性明显高于仰卧位(1.115±0.401 v 0.914±0.48ml/cm H2O/kg);俯卧位呼吸功明显高于仰卧位(8.0±3.8 v 5.9±2.7gm cm/kg).吸氧组患儿俯卧位呼吸频率明显低于仰卧位(52.7±10.2 v 56.1±12.4);潮气量明显高于仰卧位(2.13±0.42 v 1.79±0.66 ml/kg);俯卧位气道阻力明显低于仰卧位(290.4±107.0 v 319.1±104.1cm H2O/L/s);俯卧位动态肺顺应性明显高于仰卧位(0.562±0.192 v 0.488±0.217ml/cm H2O/kg);俯卧位呼吸功明显高于仰卧位(10.1±4.7 v 7.3±3.4gm cm/kg).结论无论吸氧与否俯卧位均可提高患儿的潮气量、动态肺顺应性和呼吸功,降低呼吸频率和气道阻力,俯卧位为早产儿肺炎患儿的适宜体位.     

幼儿攻击性行为游戏矫正的倒返设计研究

目的：探讨幼儿集体游戏用于矫正幼儿攻击性行为的效果。方法：采用倒返实验，对三名被试进行了游戏矫正。结果：三名被试在实验的基线阶段有明显的攻击性行为，游戏介入后攻击性行为明显减少，游戏取消后攻击性行为再度增加，游戏再次介入后，攻击性行为再次明显减少；方差检验的结果表明，被试在基线阶段的攻击性行为与游戏矫正后的攻击性行为差异极显著。结论：运用自然的幼儿集体游戏可以矫正幼儿的攻击性行为。     

Intrapulmonary cystic lymphangioma in a 2-month-old infant.

Lymphangioma is an abnormal collection of lymphatics that are developmentally isolated from the normal lymphatic system. Lymphangioma rarely presents as a solitary pulmonary lesion. We report a rare case of intrapulmonary cystic lymphangioma involving the upper lobe of the right lung, which presented with dyspnea in a 2-month-old infant. High-resolution computed tomography (HRCT) of the chest demonstrated a well-circumscribed, multiseptate, cystic lesion in the upper lobe of the right lung, mimicking the feature of type I congenital cystic adenomatoid mal-formation. The tumor was removed by bilobectomy of the upper and middle lobes of the right lung, and its pathologic examination confirmed the diagnosis of an intra-pulmonary cystic lymphangioma.     

新生儿TORCH感染的血清学检测与临床分析

目的 对新生儿进行TORCH感染的血清学检查及临床表现分析。方法 用ELASA法检测血清中TORCH(弓形体、风疹病毒、巨细胞病毒、单纯疱疹病毒)IgM。结果 2000年1月至2003年1月本院新生儿重症监护室(NICU)共收治新生儿l554例，其中48例为TORCH感染，巨细胞病毒感染率最高占52．1％；风疹病毒感染占33．3％；单纯疱疹病毒感染占14．6％。未发现弓形体抗体阳性的患儿。结论 新生儿TORCH感染可造成多器官损伤，主要为听力异常、高胆红素血症和肝功能异常、神经系统损伤、心肌损伤、血小板减少、先天性心脏病。计划免疫、母亲孕期筛查、新生儿早期筛查、干预治疗非常重要。