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我国是世界上人口最多的国家,约有3亿(~14岁)少年儿童,其中对铅毒性作用敏感的人群(~6岁儿童、孕产妇)约1·2亿。目前,铅中毒对我国儿童健康已产生不良影响。近几年来,我国发表的有关儿童铅中毒研究的文章中,一半以上的内容涉及到铅对我国儿童智能、心理行为、生长发育或其他器官发生的不良影响。我国儿童接触铅污染的机会日益增多。我国长期以来一直使用含铅汽油,随着汽车交通业迅速膨胀,铅尘排放已成为持久的污染源。近年来工厂尤其是乡镇企业的大量兴起,通过废气、废水、废渣的排放,使铅污染由城市逐步向外扩展。通过室内装修、吸烟、印…     

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??Visual impairment in children is considered to be an area of priority because of its long term of disability and its influence on development. Early diagnosis of visual impairment in children is very important??visual defects should be discovered as soon as possible and timely treatment should be given in order to obtain maximum vision. It is difficult for children??especially infants??to cooperate in the complicated vision examinations. Therefore??the diagnosis and examination of children’s visual impairment should be based on the age and development phase. The diagnosis and examination of children’s visual impairment can be made by objective methods. The population of visually impaired children includes a substantial proportion of children with additional systemic disorders or damage. Paediatricians and other paediatric professionals play a key role in early detection and multidisciplinary management.     

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??Objective??To investigate the effects of long-term inhalation of corticosteroids at low dose on the height of Chinese children with mild to moderate asthma. Methods??From August 2015 to July 2016??a total of 966 prepubertal children aged 3.0 to 9.5 years from the Cooperative Group of Asthma??the Subspecialty Group of Respiration??the Society of Pediatrics??Chinese Medical Association were enrolled for the analysis of the cross-sectional questionnaire survey??in which 173 were asthmatic children who had received at least 12-month ICS treatment at low dose and stopped the ICS treatment at least 6 months before enrollment??415 were asthmatic children who had received any ICS treatment for no more than 2 months in a year or who didn’t receive ICS treatment??and 378 were healthy controls. The analysis of variance??ANOVA?? test was used to compare height standard deviation score??SDS??and height velocity among these three groups. The t test was used to analyze changes of height indicators across time in the long-term ICS treatment group. Results??No difference was found in the height SDS and weight SDS at enrollment??or in the height SDS and weight SDS one year before enrollment??or in growth velocity and weight velocity among these three groups. In the long-term ICS treatment group??the height SDS slightly decreased at withdrawal of ICS treatment??-0.62±2.75?? compared to that at the start of ICS treatment??-0.23±1.71?? and one year before enrollment??-0.20±2.91????but significantly increased after at least six monthsof withdrawalofICS??enrollment????0.15±1.39??. The height SDS after five years of treatment with ICS was -0.95±1.41??which was significantly reduced compared to the height SDS after one to three years of treatment??0.17±1.40??P??0.020?? or three to five years of treatment??0.32±1.27??P??0.013??. Conclusion??Long-term treatment????five years?? with ICS at low dose is not associated with height reduction in prepubertal children with mild to moderate asthma.     

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推荐意见强度分级指南参考美国肠内肠外营养学会2000年指南,依据证据等级强度,将推荐意见分为了A、B、C三个等级(表1)。表1推荐意见强度分级依据强度分级证据来源A级高质量证据Cochane系统评价,或(和)多个设计完善、与推荐意见直接相关、结论一致的随机对照研究B级较好证据设计良好的非随机对照研究,或随机试验数量少,检出的结论有些差异,但这些差异与推荐意见不直接相关C级专家意见临床经验,但专家已达成共识1肠内营养(Enteral Nutrition,EN)支持通过胃肠道提供营养,无论是经口喂养还是管饲喂养称为肠内营养。1.1推荐摄入量1.1.1能量…     

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目的建立中国癫痫儿童左乙拉西坦(LEV)群体药代动力学(PPK)模型,指导临床合理用药。方法分析2009年6月至2010年12月北京大学第一医院小儿神经门诊及病房收集的220例服用LEV癫痫患儿的250个LEV血药浓度数据,使用非线性混合效应模型(NONMEM)软件,按照一室一级吸收和消除模型,建立我国癫痫患儿LEV的PPK模型。使用正态化预测分布误差(NPDE)方法验证模型。结果 LEVPPK基础模型:清除率(CL/F)=1.56×EXP[ETA(1)]L/h,表观分布容积(V/F)被固定为20L,吸收速率常数(KA)=EXP[ETA(3)]/h;最终模型:CL/F=[1.35×(体重/25.26)0.578]L/h,V/F=20L,KA=2.11×EXP[ETA(3)]/h;CL/F、V/F和KA群体值分别为1.35L/h、20L和2.11/h。经过NPDE方法验证,所建立的最终模型有良好稳定性和预测效能。结论本文建立了中国癫痫患儿LEVPPK模型,模型通过验证及预测效能,可用于指导临床用药。体重是对清除率影响最明显的协变量。     

中国0~18岁儿童青少年坐高和下肢长生长参照标准值及生长曲线

背景：坐高和下肢长是线性生长评价中的有用指标,但我国儿童青少年这两个指标的生长参照标准值及标准化生长曲线并未完整公布。 目的：研究和制定中国儿童青少年坐高和下肢长的生长参照标准及曲线,供临床医学及其他相关领域参照使用。 设计：横断面调查。 方法：采用2005年“中国九市7岁以下儿童体格发育调查”和“全国学生体质与健康调研”中九省（市）城区92 494名0~18岁健康儿童青少年的身高和坐高测量数据,以身高减去坐高计算获得下肢长,应用LMS方法制定坐高（顶臀长）和下肢长的生长参照标准值及标准化生长曲线。 主要结局指标：坐高和下肢长的生长参照标准值。 结果：①建立了0~18岁男、女童坐高和下肢长的百分位和标准差单位参照标准值,并绘制了两项指标的标准化生长曲线。②坐高生后第1年增长约14 cm,第2和3年分别增长约6 cm和4 cm,之后每年以2~3 cm幅度稳定增长,男童11~13岁、女童9~11岁坐高增速略提高,之后增速减慢,男童17岁、女童15岁基本停止增长。③下肢长生后第1年增长11~12 cm,第2年增长约6.5 cm,2~5岁以每年4~5 cm幅度增长,之后每年以3~4 cm增长,男、女童分别在15岁和13岁基本停止增长。 结论：建立的坐高和下肢长的生长参照标准值与标准化生长曲线,进一步完善了我国儿童青少年生长发育评价标准的指标体系。     

Prediction of final height in short, normal and tall children

Measurements of final height were made on more than 4000 children in the final grade of school in Gothenburg in 1992; at the same time, mid-parental heights were recorded. These data were combined with other information (sex, length of gestation, size at birth, estimated age at peak height velocity (PHV) and height measurements made before 8 years of age) and used in a multiple regression analysis to assess the strength of the linear relationship between attained final height and these other potentially predictive measures of adult height. The R² value increased from 0.16 at birth to 0.64 when the child was 8 years old. The inclusion of mid-parental height in the regression analysis contributed significantly to the explained variation in final height, especially at the earlier ages; the further addition of size at birth and age at PHV provides a small increase in the explained variation. The probability that the final height of a child will be below -2 or above +2 standard deviation scores (SDS) was assessed, based on previous SDS values for height when younger and on mid-parental height SDS. As a result of the large sample size included in the analyses, considerable confidence can be placed on the accurate prediction of final height values in the range -2.5 to +2.5 SDS.     

Growth-chart-based qualitative evaluation of height growth after hematopoietic stem cell transplantation

Growth failure is one of the most common late complications in children undergoing hematopoietic stem cell transplantation (SCT). The present report describes a qualitative method of evaluating height growth after SCT, using a growth chart. The patients were divided into three groups according to the shape of their growth chart: the normal growth chart group, the early-onset growth retardation group (E-group), in which a decreased growth rate was seen during the first year after SCT, and the late-onset growth retardation group (L-group), in which a decreased growth rate was seen more than 1 yr after the SCT. In the E-group, total body irradiation and prolonged steroid therapy were thought to contribute to the growth failure, whereas in the L-group, impaired pubertal development was thought to be responsible. The growth pattern in the L-group may, therefore, be of particular clinical importance, because the final stature of the subjects in this group can be improved by pharmacological adjustment of pubertal onset. Although limited by the small size and heterogeneous nature of the sample, our results suggest that growth-chart-based evaluation may provide important information to stratify subjects showing inadequate growth after SCT into two groups whose follow-up and treatment should be individualized.     

A comparison of target height estimated and final height attained between Swedish and Hong Kong Chinese children

Target height, the genetic potential in stature, is commonly estimated by the corrected midparental height (CMH) method. A new model for estimating target height has recently been introduced based on a large, Swedish, population-based study. The aim of this study was to compare the validity of the two methods for estimating target height in Hong Kong Chinese children. The Hong Kong Chinese were more than 10 cm shorter than the Swedes in stature. The secular increase in height over the two generations, however, was 4.2-4.8 cm for the Hong Kong Chinese, much larger than that of the Swedes (0.7-1.0 cm). The two populations are thus at different stages in the secular trend. The new model derived from Swedish population for estimating target height was shown to be applicable to Hong Kong Chinese children; the mean of residual final height values was close to zero (-0.15 cm, p = 0.74). However, the mean of residual final height was significantly above the expected value of zero (4.5 cm, p<0.0001) when the CMH method was applied to the data, which implies an underestimation bias of 4.5 cm. Consequently, if the CMH method is used to estimate target height and evaluate growth hormone treatment responses in short children, it may inflate the treatment response by 4.5 cm. In conclusion, the recently proposed model for target height estimation offers a better alternative for estimating target height in Hong Kong Chinese children and for assessing growth-promoting treatments.     

Growth charts for use in Australia

Growth charts for use in Australia have recently been modified. Changes have been made to both height for age and weight for age charts as well as body mass index for age. The charts are now based on the published CDC 2000 growth data which are more contemporary than the data used to construct the previous charts. A first centile for height for age has been included as this is used as a screening tool for the provision of growth hormone to children in Australia. The calculation of a precise first centile has been possible as the CDC data includes LMS values which have other significant advantages in the creation of the growth charts. It is noteworthy that the most recently collected anthropometric data for weight (and hence body mass index) have not been included in the calculation of these two charts as it was believed that increasing numbers of children who are overweight or obese in the population would skew these charts in an undesirable way. Height velocity for age and other charts remain unchanged.     

Final height prediction models for pubertal boys

Accurate adult height prediction is of clinical importance in assessing the need for pharmacological intervention and in the evaluation of the outcome of therapy. The methods currently in use are subject to a wide range of error, one source of which is the use of bone age (BA) measurements. We have developed a computer model for predicting adult height in pubertal boys without using BA determinations. The model is based on the existing Infancy–Childhood–Puberty model and calculates the onset of the pubertal growth spurt. Predicted adult height was assessed using this new model and four others in a group of normal boys and in a group of short normal boys receiving growth hormone. Calculated final heights by all the methods were not significantly different. Incorporation of paternal height into the prediction equations increased the accuracy of the prediction. It was concluded that our new model is as accurate as existing methods of predicting final height that involve assessing BA.     

Growth curves for preterm infants

The commonly used growth curves for preterm infants are four decades old and may not be suitable for the current population. Uncertainty exists regarding the most suitable curves for monitoring the growth of preterm infants. While intrauterine growth rate appears to be the ideal growth that needs to be attained by the preterm infants, it may not be feasible given the limitations set by the morbidities of prematurity. Babson and Benda's chart has been updated using recent data from large samples of preterm infants making it useful for monitoring growth of infants in the preterm period. Once a corrected age of 40 weeks is reached, the recently released WHO growth curves can be used to monitor their ongoing growth. While aiming for achieving intrauterine growth velocities in postnatal life, one should not lose sight of the potential short term adverse effects of aggressive nutrition and long term adverse effects of excessive catch up growth.     

New reference growth charts for Japanese girls with Turner syndrome

Background:  Currently used growth charts for Japanese girls with Turner syndrome (TS) were constructed with auxological data obtained before the secular trend in growth reached a plateau. These charts were published in 1992 and may no longer be valid for the evaluation of stature and growth in girls with TS in clinical settings. Thus, we need to establish new clinical growth charts.
Methods:  The samples for analysis were obtained by a retrospective cohort study. A total of 1867 Japanese girls with TS were registered between 1991 and 2004 for growth hormone (GH) treatment and their pretreatment anthropometric measurements were obtained. Reference growth charts were newly constructed using the LMS method from 1447 girls' cross-sectional data after exclusion of measurements derived from those with the presence of puberty, with previous growth-promoting treatment, or without cytogenetic evidence of TS.
Results:  The new clinical reference growth charts differ from the old charts. Secular trends can be detected in both height and weight. Mean adult height on the new chart is 141.2 cm, 3.0 cm taller than the old data. This result seems attributable to the secular trend observed during the same period in Japanese women.
Conclusions:  The newly constructed clinical reference growth charts for Japanese girls with TS seem to be better for the evaluation of growth in girls with TS born after approximately 1970, although selection bias and some other limitations in the present study should be kept in mind.     

Prediction of adult height in healthy Japanese children

Longitudinal records from 13,707 children (6749 boys and 6958 girls), aged 6–17 years, were fitted by a smoothing cubic spline function, and the factors influencing changes in height SD score (SDS) during puberty were analysed. Height SDS at 6 years correlated closely with final height SDS. However, short children at 6 years of age tended to increase their height SDS at final height, whereas tall children at the same age tended to decrease their final height SDS. For children with the same prepubertal height, the later that pubertal maturation occurred, the greater was the final height achieved. As short children entered puberty relatively late and tall children entered puberty relatively early, height SDS tended to approach 0 SD during puberty. A prediction function obtained by multiple regression analysis using height SDS at 6 years, the percentage by which the child is overweight at 6 years, age at onset of the pubertal growth spurt (PGS) and height at onset of the PGS provides a reasonable model for the prediction of final height SDS without the need to estimate bone age.