等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的比较

目的比较等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的影响。方法选择择期行全身麻醉下整形外科手术的患儿100例,美国麻醉医师协会(ASA)Ⅰ级或Ⅱ级,随机平均分为2组:瑞芬太尼组(R组)和芬太尼组(F组),在丙泊酚麻醉诱导中采用盲法应用瑞芬太尼2μg/kg或芬太尼2μg/kg。采用直接喉镜经口气管插管。监测麻醉诱导前(基础值)、气管插管前即刻、气管插管即刻和气管插管1、2、3、4、5min时的血压(BP)和心率(HR),计算各观察时间点BP和HR相对于基础值的变化率,并计算二重指数(RPP)。结果2组BP和HR的基础值及气管插管时间均无显著性差异。与基础值比较,虽然气管插管导致F组的BP、HR、RPP及其观察期最大值显著增高,但R组气管插管时BP、HR、RPP及其观察期最大值均较基础值显著降低。观察期时间点的BP、HR、RPP及其最大值二组比较均有显著性差异,观察期时间点的收缩压(SBP)和HR变化率及观察期其最大变化率2组比较亦有显著性差异。观察期SBP和HR增加>基础值30%的发生率在F组显著高于R组;但观察期SBP和HR降低>基础值30%的发生率在R组显著高于F组。结论在小儿应用异丙酚静脉麻醉诱导时,联合应用等效小剂量瑞芬太尼较芬太尼更能有效抑制经口气管插管的血流动力学反应。芬太尼2μg/kg不足以完全抑制小儿经口气管插管的血流动力学反应。虽然瑞芬太尼2μg/kg能够完全消除小儿经口气管插管的血流动力学反应,但可导致更多不良的心血管功能抑制。     

小剂量舒芬太尼和枸橼酸芬太尼预防儿童直接喉镜经口气管插管心血管反应的比较

目的比较小剂量舒芬太尼和枸橼酸芬太尼预防儿童直接喉镜经口气管插管心血管反应的效果。方法选择美国麻醉医师协会（ASA）Ⅰ级、拟在经口气管插管全身麻醉下择期整形外科手术的儿童90例。随机平分为对照组、枸橼酸芬太尼组和舒芬太尼组，气管插管前5min采用盲法分别应用9g／L盐水0．2mL／kg、枸橼酸芬太尼2μg／kg和舒芬太尼0．2μg／kg。麻醉诱导后采用直接喉镜实施经口气管插管操作。监测麻醉诱导前（基础值）、后（麻醉诱导后值），气管插管时和气管插管后5min内血压和心率（HR），计算二重指数（RPP）及观察期收缩压（SBP）和HR的变化率，记录观察期SBP和HR达最大值的时间及其气管插管后恢复至麻醉诱导后值的时间。结果经口气管插管导致血压、HR和RPP较基础值显著升高（Pa〈0．05），且以对照组最为明显，枸橼酸芬太尼组次之，舒芬太尼组最轻。气管插管时和气管插管后的血压、RPP及观察期它们的最大值在3组间均有显著性差异（Pa〈0．05）；观察期枸橼酸芬太尼和舒芬太尼组HR无显著性差异（Pa〉0．05）。3组观察期出现SBP和HR最大值的时间无显著性差异（Pa〉0．05），气管插管后舒芬太尼组SBP和HR恢复至麻醉诱导后值的时间显著短于枸橼酸芬太尼组（Pa〈0．05）。舒芬太尼组观察期SBP和HR增加〉基础值30％的发生率和RPP〉22000的发生率显著低于枸橼酸芬太尼组（Pa〈0．05）。结论与小剂量枸橼酸芬太尼相比，小剂量舒芬太尼能更有效地减轻儿童经口气管插管时的心血管反应。     

直接喉镜经口和经鼻气管插管对小儿血流动力学的影响

目的对比观察直接喉镜经口和经鼻气管插管对患儿血流动力学的影响。方法选择60例美国麻醉医师协会分级Ⅰ-Ⅱ级施择期整形外科手术的患儿，随机平均分成经口和经鼻组各30例。在全身麻醉诱导后采用直接喉镜实施气管插管操作。监测麻醉诱导前（基础值）、后，气管插管和气管插管后5min内血压和心率（HR），计算观察时间点的二重指数（RPP）及观察期收缩压（SBP）和HR的变化率，记录观察期SBP和HR达最大值的时间及其气管插管后恢复至麻醉诱导后值的时间。记录气管插管操作时间。结果经鼻组气管插管时间较经口组显著延长。麻醉诱导后二组血压、HR和RPP均显著降低。气管插管导致二组血压、HR和RPP较基础值和麻醉诱导值显著升高。但二组观察期所有时间点的血压、HR和RPP及其最大值均无显著差异。SBP和HR达最大值的时间在经鼻组较经口组显著延长，但是气管插管后SBP和HR恢复至麻醉诱导后时间二组无显著差异。SBP和HR变化率及RPP〉22000的发生率在二组间亦无显著差异。结论经鼻和经口气管插管在全身麻醉小儿可引起类似的血压增高和HR增快反应。     

小剂量芬太尼、瑞芬太尼和舒芬太尼预防儿童经口气管插管心血管反应的比较

目的比较小剂量芬太尼、瑞芬太尼和舒芬太尼对患儿直接喉镜经口气管插管心血管反应的影响。方法选择120例施择期整形外科手术的患儿。随机平均分成对照组、芬太尼组、瑞芬太尼和舒芬太尼组,气管插管前采用盲法分别应用9g/L盐水0.2mL/kg、芬太尼2μg/kg、瑞芬太尼组1μg/kg和舒芬太尼0.2μg/kg。静脉麻醉诱导后采用直接喉镜实施经口气管插管。监测麻醉诱导前、后,气管插管时和气管插管后5min内血压(BP)和心率(HR)及观察期收缩压(SBP)和HR的变化率,并记录观察期SBP和HR达最大值时间及其气管插管后恢复至麻醉诱导后值时间。结果BP和HR基础值及气管插管时间在4组间均无显著性差异。气管插管致BP和HR较基础值显著升高,且是以对照组最为明显,芬太尼组次之,瑞芬太尼和舒芬太尼组最轻。对照组气管插管时BP和HR及其观察期最大值均显著高于芬太尼组、瑞芬太尼和舒芬太尼组;瑞芬太尼组和舒芬太尼组气管插管时的血压和HR及其观察期最大值均显著低于芬太尼组(Pa<0.05)。瑞芬太尼组观察期出现SBP和HR最大值时间显著长于对照组、芬太尼组和舒芬太尼组(Pa<0.05);舒芬太尼和瑞芬太尼组气管插管后SBP和HR恢复至麻醉诱导后值时间显著短于对照和芬太尼组(P<0.05)。瑞芬太尼和舒芬太尼组观察期SBP和HR增加大于基础值30%发生率较芬太尼组显著降低。结论与小剂量芬太尼比较,小剂量舒芬太尼和瑞芬太尼能更有效预防患儿经口气管插管的心血管反应。     

儿童光导纤维支气管镜经口气管插管可导致较成人更严重的血压升高反应

目的比较儿童和成人光导纤维支气管镜（FOB）经口气管插管心血管反应的差异。方法选择美国麻醉医师协会身体状况分级为Ⅰ级、拟在经口气管插管全身麻醉下施择期整形外科手术的儿童和成年患者各30例。在麻醉诱导后实施FOB经口气管插管。记录麻醉诱导前（基础值）、麻醉诱导后（麻醉诱导后值）、气管插管时及气管插管后1、2、3、4和5min时血压和心率（HR）,并计算观察期血压和HR变化率。结果二组气管插管时、气管插管后1～3minHR显著高于基础值和麻醉诱导后值（Pa〈0.05）。成年组气管插管血压较麻醉诱导后值显著升高（Pa〈0.01）,但未超过基础值。儿童组气管插管时和气管插管后1min时血压较基础值和麻醉诱导后值显著升高（Pa〈0.05）。观察期儿童组在各对应时间点收缩压（SBP）变化率及气管插管时、气管插管后1和2min时舒张压（DBP）和平均动脉压（MAP）变化率显著高于成年组（Pa〈0.05）。除麻醉诱导后值外,二组在观察期其他各时间点HR及观察期HR最大变化率均无显著性差异。结论在常用全身麻醉深度下对儿童实施FOB经口气管插管可引起较成人更明显的血压升高反应。     

光导纤维支气管镜经口和经鼻气管插管患儿心血管反应的比较

目的比较小儿光导纤维支气管镜(FOB)经口和经鼻气管插管的心血管反应。方法选择美国麻醉医师协会(ASA)身体状态分级为Ⅰ级、在全身麻醉下施择期整形外科手术的患儿65例,随机分为经口组(n=36)和经鼻组(n=29)。在常规静脉麻醉诱导后实施FOB气管插管。测定麻醉诱导前(基础值)、后,气管插管时和气管插管后5 min内(测定间隔为1 min)血压(BP)和心率(HR),记录气管插管时间。结果经鼻组气管插管时间显著长于经口组(P<0.05)。FOB气管插管导致两组BP和HR均比麻醉诱导前基础值显著升高(P均<0.05)。与经口组相比,气管插管致BP增高和HR增快反应在经鼻组较轻,持续时间较短。经口组气管插管时BP和HR及观察过程中BP和HR最大值均显著高于经鼻组(P均<0.05)。结论FOB经口和经鼻气管插管均可引起小儿BP和HR显著升高,但FOB经鼻气管插管时心血管反应较FOB经口气管插管时轻。     

舒芬太尼和芬太尼用于小儿腹腔镜手术麻醉的比较

目的 比较舒芬太尼和芬太尼用于小儿腹腔镜手术的临床效果.方法 60例ASA Ⅰ～Ⅱ级择期行腹腔镜下疝囊高位结扎术的患儿,年龄1～3岁,随机分为A、B组两组.患儿入窜后予高浓度七氟烷面罩吸入,浓度8%,氧流呈为7 L/min,患儿入睡后,开放静脉,A组予舒芬太尼0.5μg/kg缓慢静脉注入,B组予芬太尼5μg/kg,两组均复合咪达唑仑0.1～0.15mg,kg,维库溴铵0.1~0.15mg/kg静脉注射,待睫毛反射消失后插管.A、B两组均吸入3%～5%七氟烷维持麻醉.记录诱导前（T0）、气管插管前（T1）、气管插管时（T2）、气管插管后5 min（T3）、气管插管后10 min（T4）、气腹时（T5）、气腹后5 min（T6）、及术后拔管时（T7）、拔管后5 min（T8）、10 min （T9）、30 min（T10）51、1 h（T11）、2 h（T12）的生命体征,包括平均动脉压（MAP）、心率（HR）、经皮脉搏氧饱和度（SpO2）;记录手术结束停药至自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间;记录拔管后5 min、拔管后1 h、2 h的镇痛评分以及苏醒期不良反应.结果 （1）两组诱导插管均顺利,B组插管后出现血压升高,心率增快（P〈0.01）,10min后下降至基础水平,术后拔管时再度出现血压升高,心率增快（P〈0.01）,拔管后逐渐下降,仍高于基础值（P〈0.05）.A组诱导后出现心率下降（P〈0.05）,气管插管、拔管及术中维持时血压、心率水平较T0稍增加,无统计学意义,（P〉0.05）.术后2 h血压升高,心率增快（P〈0.05）.两组SpO2均保持98%～100%（P〉0.05）.（2）术后苏醒时间比较差异无统计学意义（P〉0.05）.（3）术后疼痛评分,A组明显低于B组（P〈0.01）.（4））A组患者术后躁动发生率明显低于B组（P〈0.01）.恶心呕吐发生率两组无显著性差异（P〉0.05）,两组均未发生呼吸抑制.结论 舒芬太尼用于全麻下小儿腹腔镜手术,能有效减轻气管插管的心血管反应,术后苏醒快,呼吸抑制轻,且后续镇痛效果好,能减少躁动等并发症.     

小儿尿道下裂矫形术中不同麻醉方式麻醉效果比较

目的比较3种麻醉方式在小儿尿道下裂矫形术中的临床效果。方法选择90例ASA Ⅰ～Ⅱ级行尿道下裂矫形术的患儿,年龄1～4岁？随机分为骶管麻醉组（Ⅰ组）,单纯静脉全麻组（Ⅱ组）,全凭静脉麻醉加气管插管麻醉组（Ⅲ组）,每组30例：术前均静脉注射氯胺酮1mg／kg,随机分组实施麻醉。记录术前基础心率及平均动脉压（MAP）,监测并记录切皮前、切皮时、手术开始后30-min及手术结束后10min的心率和MAP,记录手术结束至苏醒的时间以及苏醒后躁动情况：结果Ⅰ组苏醒时间短,术后躁动发生率低．与Ⅱ,Ⅲ组比较,P〈0．05,差异有统计学意义;Ⅰ组实施麻醉后、术中及术后心率平稳,Ⅱ组术中心率及MAP值与基础值比较,P〈0．05,差异有统计学意义;Ⅲ组术后心率及MAP值与基础值比较,差异有统计学意义,P〈0．05：结论小儿尿道下裂矫形手术采取骶管麻醉,术中、术后呼吸循环功能稳定,术后苏醒迅速,很少出现躁动,较单纯静脉全麻及全凭静脉麻醉加气管插管麻醉有一定优势.     

HC可视喉镜在儿童会厌囊肿手术麻醉中的应用

目的评价HC可视喉镜在儿童会厌囊肿手术气管插管中的临床价值与安全性。方法选取60例行会厌囊肿手术的儿童,ASAⅡ~III级,采用随机数字表分为两组。HC可视喉镜组(S组)和直接喉镜组(D组),每组30例,由同一名麻醉医师完成插管。记录两组气管插管时间、插管成功率和一次成功率,插管前、插管时和插管后2 min的心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP);喉镜下Cormark-Lehane评级。术毕检查口腔内有无损伤、出血或水肿。结果与D组相比,S组Cormark-Lehane分级中Ⅰ和Ⅱ级的例数显著增多(P0.05),插管时间明显缩短(P0.05)。两组插管前和插管后2 mm,患儿HR和MAP差异无统计学意义(P0.05);插管时D组的HR和MAP明显高于S组(P0.05)。结论在儿童会厌囊肿手术中,HC可视喉镜插管成功率高,插管反应轻,插管时间缩短,安全性好。     

麻醉深度指数监测在低温体外循环下先天性心脏病手术中的应用

目的探讨麻醉深度指数(CSI)监测在低温体外循环(CPB)下先天性心脏病(先心病)手术应用的可行性。方法先心病患儿15例。心功能Ⅱ~Ⅲ级。麻醉诱导采用静脉注射枸橼酸芬太尼20μg/kg、乙托咪酯0.3 mg/kg及维库溴铵0.1 mg/kg。麻醉维持采用微量泵持续泵入异丙酚6 mg/(kg.h),切皮前静脉注射枸橼酸芬太尼10μg/kg及维库溴铵0.1 mg/kg。转机后CPB机内加入枸橼酸芬太尼10μg/kg及维库溴铵0.05 mg/kg,异丙酚维持原注射剂量不变。CPB采用高流量100 mL/(kg.min)非搏动性血流灌注。记录各个时间点CSI、鼻咽温度、平均动脉压(MAP)及心率(HR)。结果麻醉诱导后患者各时间点CSI与麻醉诱导前比较均有显著性差异(P<0.05或0.01);CPB期间各时间点CSI指数均低于CPB前即刻(P<0.05),鼻咽温度均低于基础值及CPB前即刻(P<0.05);气管插管、CPB前即刻及CPB期间各时点MAP明显低于基础值(P<0.05或0.01),CPB期间各时点MAP低于CPB前即刻(P<0.05);阻断前即刻HR明显高于基础值及CPB前即刻(P<0.05)。结论CSI监测可有效反映低温CPB下先心病手术中麻醉深度,但小儿CSI变化有其自身特点,低温与CPB对CSI均有影响。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.