新生儿缺氧缺血性脑病促红细胞生成素及血小板生成素变化规律和临床意义

为探讨正常新生儿和HIE新生儿血浆促红细胞生成素(EPO)及血小板生成素(TPO)的变化规律和临床意义，以29例健康足月儿为对照组，62例HIE患儿为HIE组，轻度HIE 30例，中重度HIE组(轻度HIE30例，中重度HIE组32例)，分别检测三组新生儿出生后第1、2、7天血浆EPO和TPO水平、血网织红细胞(Ret)计数和动脉血氧分压(PaO2)值。结果显示：与对照组相比，HIE组在生后第1天EPO、TPO、Ret三值较高，其中以中重度组最高，第2天三组三指标开始迅速下降，轻度HIE组下降较慢，中重组最慢。至第7天，HIE组和对照组三指标无显著性差异。生后第1天EPO、Ret与PaO2值呈负相关，EPO和TPO呈正相关，可以认为，EPP和Ret可作为判断新生儿出生前后体内缺氧的指标之一。新生儿HIE时，TPO与EPO在促进红细胞生成方面有协同作用。     

新生儿促红细胞生成素测定的意义

目的探讨足月新生儿血清促红细胞生成素(EPO)水平及其对临床疾病预测诊断价值。方法选择入院有窒息史或孕母有安胎史的新生儿40例,与足月健康儿15例,采用医学发光酶免疫分析法测定新生儿EPO水平。结果足月新生儿40例中足月小样儿EPO较正常对照组升高,差异有显著性(t=5.69P<0.01)。先天梅毒及先天愚型组EPO值较高(t=29.73P<0.01)。EPO升高者出生后逐步下降。窒息组、先天性心脏病(不含先天愚型)组、高胆红素组与正常对照组比较均无明显差异(t=0.199,0.024,0.347Pa>0.1)。结论新生儿EPO处于一个动态变化,出生后EPO升高能反映胎儿宫内慢性缺氧、宫内营养物质供应不足和宫内严重感染情况,出生后渐下降。出生后窒息或缺氧新生儿EPO测定并不能准确反映缺氧情况,可能受多因素影响。     

促红细胞生成素对新生儿缺氧缺血性脑病患儿血清NSE和S-100B的影响

目的 探讨促红细胞生成素（EPO）对缺氧缺血性脑病（HIE）患儿血清NSE、S-100B 水平的影响及其作用机制。方法 40 例HIE 患儿随机分为常规治疗组（20 例）和EPO 治疗组（20 例）,EPO 治疗组在常规治疗基础上于生后第2 天加用EPO,每日200 IU/kg 静脉注入,疗程7 d。另选择健康足月新生儿20 例作为正常对照组。检测3 组新生儿血清中NSE、S-100B 的水平。结果 治疗前2 组HIE 患儿血清中NSE、S-100B的水平高于正常新生儿（PP>0.05）。3 组新生儿生后第9 天血清NSE、S-100B 水平均低于第1 天水平（PP结论 动态检测血清中NSE、S-100B 的水平,可能有助于HIE 的早期诊断和判断HIE 脑损伤的修复程度;EPO 可能对神经元及神经胶质细胞均有修复作用。     

促红细胞生成素治疗早产儿贫血的疗效评定

为了验证人基因重组促红细胞生成素注射剂(EPO)对早产儿贫血的治疗效果,将53例早产儿贫血患儿随机分为EPO治疗组(31例)和对照组(22例),治疗组予以EPO 200IU/kg皮下注射,每周2次,8周后两组间外周血血红蛋白、红细胞、红细胞压积出现显著性差异(P＜0.001),治疗组上述指标均显著高于对照组,且无明显副作用,说明EPO治疗早产儿贫血安全有效.     

促红细胞生成素联合不同剂量维生素E在防治早产儿贫血中的临床研究

目的 探讨维生素E(VitE)在防治早产儿贫血中的临床疗效.方法 选择我院新生儿病房2010年12月至2011年12月收治的早产儿90例,按入住先后顺序随机分为对照组(A组)、VitE大剂量组(B组)、VitE小剂量组(C组).A组30例,人院后第7天起给予促红细胞生成素(EPO),每周750 IU/kg分3次皮下注射,共4周;同时加服铁剂每日6 mg/kg.另2组在上述对照治疗的基础上,加服不同剂量VitE,共4周.B组30例,VitE每日15 mg/kg;C组30例,VitE每日2.5mg/kg.观察治疗过程中各组血细胞压积(Hct)、血红蛋白(Hb)、红细胞(RBC)、网织红细胞(Ret)及其治疗前后血清VitE浓度的变化.结果 治疗后B、C组患者Hct、Hb、RBC、Ret均有所改善,各项指标改善程度与A组比较,差异有统计学意义(P＜0.05),B与C组各项指标改善程度未见明显差异(P＞0.05).B、C组治疗后血清VitE浓度可见明显升高,且差异有统计学意义(P＜0.05),A组患者上升不明显.结论 在EPO防治早产儿贫血的同时应加服小剂量VitE.     

促红细胞生成素治疗新生儿缺氧缺血性脑病疗效观察

目的：通过对促红细胞生成素（EPO）治疗中度、重度新生儿缺氧缺血性脑病（HIE）的疗效观察,了解EPO对神经的保护作用及对新生儿HIE预后的影响。方法：将70例中、重度HIE新生儿随机分为治疗组（35例）和对照组（35例）,其中治疗组中度HIE 22例,重度HIE 13例;对照组中度HIE 24例,重度HIE 11例;同时选取同一时期健康足月儿35例作为正常组。对照组给予常规治疗。除常规治疗外,治疗组给予静脉注射EPO 每日200 IU/kg,每周3次,每6 d查血常规1次,根据血常规结果调整EPO剂量,总疗程为2～4周。所有患儿于28日龄时进行NBNA评分,3月、6月龄时进行智能发育测评（CDCC）。结果：治疗组28日龄NBNA评分正常者比例高于对照组(P<0.05),但仍低于正常组(P<0.01)。3月龄CDCC评分（包括MDI、PDI评分）治疗组正常者比例高于对照组（P<0.05）,但低于正常组（P<0.01）。6月龄CDCC评分治疗组正常者比例高于对照组(P<0.05), 治疗组MDI评分正常者比例与正常组相比较,差异无统计学意义,但PDI评分正常者比例仍低正常组(P<0.05)。结论：EPO可保护因缺氧缺血损害的神经细胞,促进中、重度HIE新生儿大脑发育。     

缺氧缺血性脑病新生儿血清白细胞介素-18及细胞间黏附因子-1水平的变化

目的 观察HIE新生儿血清IL-18及细胞间黏附因子-1(ICAM-1)水平的变化,探讨二者之间的相关性及其与HIE疾病程度的关系.方法 本院新生儿科收住HIE新生儿30例,根据病情分为轻度HIE组16例,中重度HIE组14例.同期健康新生儿20例为健康对照组.分别于出生第3、7天采用酶联免疫吸附法测定HIE组及健康对照组新生儿血清IL-18及ICAM-1水平.结果 1.出生第3天轻度HIE组、中重度HIE组及健康对照组新生儿血清IL-18水平分别为(120.1±12.7)、(175.1±15.4)、(100.3±12.5)ng/L,HIE组均高于健康对照组(P<0.05),中重度HIE组高于轻度HIE组(P<0.05),出生第7天较出生第3天时显著低(P<0.05),但仍高于健康对照组(P<0.05);2.出生第3天轻度HIE组、中重度HIE组及健康对照组新生儿血清ICAM-1分别为(350.45±55.20)、(600.10±94.22)、(250.12±47.09)μg/L,HIE组均显著高于健康对照组(Pa<0.05),中重度HIE组明显高于轻度HIE组(P<0.05),出生第7天较出生第3天时为低(P<0.05),但仍高于健康对照组(P<0.05);3.血清IL-18与ICAM-1水平呈正相关(P<0.05).结论 HIE新生儿血清IL-18及ICAM-1水平与HIE病情相关,可作为新的评价脑部损伤指标之一.     

窒息新生儿脐血促红细胞生成素和内皮素的变化及其相关性研究

目的 探讨新生儿脐血促红细胞生成素(EPO)和内皮素(ET)在窒息缺氧后的变化及其相互之间的关系.方法 选择15例轻度窒息新生儿、17例重度窒息新生儿为研究对象,31例正常新生儿为对照,用放射免疫法测定脐血EPO和ET水平.结果 15例轻度窒息新生儿脐血EPO和ET水平比正常对照组升高(P＜0.05,P＜0.001),17例重度窒息新生儿脐血EPO水平亦较正常对照组升高(P＜0.001).脐血EPO、ET水平和Apgar评分之间存在明显负相关(r=-0.642,P＜0.001;r=-0.887,P＜0.001),EPO、ET间呈正相关(r=0.705,P＜0.001).结论 EPO、ET参与了新生儿窒息的病理过程.     

重组人类促红细胞生成素预防极低出生体重儿贫血的研究

目的　评价重组人类促红细胞生成素 (rhu EPO)在相同剂量下不同应用频度对预防极低出生体重儿(VLBWI)贫血的效果。方法　将东南大学附属徐州医院儿科 2 0 0 1年 9月至 2 0 0 3年 9月收治的 2 2例VLBWI随机分成两组 ,均在出生第 8天开始予rhu EPO ,每周 75 0IU/kg ,共 6周。Ⅰ组 (12例 )每周 3次给药 ;Ⅱ组 (10例 )每周 1次给药。另设未予rhu EPO的 12例VLBWI作为对照组 (Ⅲ组 )。动态观察血红蛋白、红细胞计数、红细胞压积比等。结果　 (1) 3组患儿在出生第 2 8天血红蛋白值的差异均有统计学意义 (P <0 0 1) ,出生第 6 4天的差异有统计学意义 (P <0 0 1) ,但Ⅰ、Ⅱ组间 P =0 0 5 2。 (2 ) 3组患儿在出生第 2 8天红细胞计数的差异均有统计学意义(P <0 0 1) ,出生第 6 4天的差异有统计学意义 (P <0 0 1) ,但Ⅰ、Ⅱ组间P =0 0 74。 (3) 3组患儿在出生第 2 8天红细胞压积比的差异有统计学意义 (P <0 0 1) ,但Ⅰ、Ⅱ组间P =0 14 0 ,出生第 6 4天的差异有统计学意义 (P <0 0 1) ,但Ⅰ、Ⅱ组间P =0 195。结论　在rhu EPO相同的每周总量下 ,每周 3次给药比每周 1次给药能明显提高VLBWI的血红蛋白及红细胞计数     

促红细胞生成素治疗早产儿贫血的疗效评定

为了验证人基因重组促红细胞生成素注射剂（EPO）对早产儿贫血的治疗效果，将53例早产儿贫血患儿随机分为EPO治疗组（31例）和对照组（22例），治疗组予以EPO 200IU／kg皮下注射，每周2次，8周后两组间外周血血红蛋白、红细胞、红细胞压积出现显著性差异（P＜0．001），治疗组上述指标均显著高于对照组，且无明显副作用，说明EPO治疗早产儿贫血安全有效。     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.